Risk Of PE Research Articles

Case Control Analysis of Fetal Congenital Heart Defects as a Risk Factor for Preeclampsia [10N

INTRODUCTION: Fetal congenital heart defects (fCHD) may indicate an angiogenic imbalance that predisposes mothers to pre-eclampsia (PE.) It is unclear if this is due to other maternal risk factors of PE or from CHD itself. We sought to determine whether fCHD is an independent risk factor for maternal PE. METHODS: This was a case control study of singleton births delivered at the University of Maryland Medical Center from 2007 to 2016. Fetuses with CHD diagnosed by a fetal echocardiography were identified. Known chromosomal anomalies were excluded. The primary exposures of interest were known maternal risk factors for PE. Controls were matched 1 to 3 by history of PE, diabetes mellitus (DM,) and chronic hypertension (CHTN). Risk of PE was analyzed in fCHD vs. non-fCHD pregnancies. Data was analyzed using Chi-squared. RESULTS: 251 fCHD cases met inclusion criteria. These were matched with 753 controls. PE occurred in 15 (6%) deliveries with fCHD and 44 (5.8%) matched controls. Early PE (<34 wks) occurred in 4 (1.6%) fCHD and 10 (1.3%) control pregnancies. Late PE (>34 wks) occurred in 11 (4.4%) fCHD and 34 (4.5%) controls. The presence of fCHD was not associated with PE (OR: 0.98; CI 0.53-1.79; p=0.94). When PE was separated into early and late, CHD was not associated with either early (OR=0.83; CI 0.26-2.67; p=0.75) or late PE (OR: 1.03; CI 0.51-2.07; p=0.93). CONCLUSION: Fetal CHD was not an independent risk factor for PE, early PE, or late PE. Further monitoring does not appear warranted in women with antenatal diagnosis of fCHD.

Assessment of 30-day mortality and complication rates associated with extended deep vein thrombosis prophylaxis following hip fracture surgery

BackgroundDVT is a common complication following lower extremity surgery, occurring in up to 60% of patients undergoing hip fracture surgery without postoperative anticoagulation. The risk of fatal PE continues well-beyond two weeks postoperatively, thus extended DVT prophylaxis beyond 14 days may be warranted. This investigation sought to examine the association between prescription of extended DVT prophylaxis and 30-day postoperative complications following hip fracture surgery. MethodsThis study utilized the ACS NSQIP Hip Fracture Procedure Targeted dataset, a newly available set of patient variables for 2016. The outcome measures were death, occurrence of any postoperative complication, complication subtype, readmission or reoperation within 30-days postoperatively, and length of stay. The primary independent variable was medical DVT prophylaxis continued 28-days postoperatively (“extended DVT prophylaxis”). The control group contains both patients receiving no prophylaxis and those receiving short-duration prophylaxis. Multivariate stepwise logistic regression was employed to control for potential demographic, comorbidity, and procedural/medical confounding factors. ResultsIn total, 7533 surgically treated hip fracture patients treated in 2016 were analyzed. Overall, 57.8% of patients (n = 4354) were prescribed extended DVT prophylaxis. On bivariate analysis, prescription of extended DVT prophylaxis was associated with significantly lower incidence of death (7.7% without vs. 2.7% with, p < 0.0001) and stroke/CVA (1.4% vs. 0.6%, p = 0.0016). In multivariate analysis, prescription of extended DVT prophylaxis was significantly associated with lower odds of death (OR 0.33, p < 0.0001), stroke/CVA (OR 0.44, p = 0.0010), and acute kidney injury (AKI) (OR 0.31, p = 0.0010). ConclusionsThis retrospective cohort study of the 2016 ACS NSQIP found that hip fracture surgery patients prescribed ≥28 days of postoperative DVT prophylaxis exhibited 67% lower odds of death and significantly lower rates of AKI and stroke/CVA as compared to those prescribed short-duration prophylaxis. Given the retrospective and uncontrolled nature of this analysis, these results should be interpreted with caution, and additional prospective randomized controlled trials examining the association between extended DVT prophylaxis and postoperative outcomes are warranted. If these observations accurately reflect real-world experience, these data suggest that ≥28 days of DVT prophylaxis following hip fracture surgery should be strongly considered for patients without explicit contraindications.

Appendectomy for Appendicitis Has Worse Hospital Outcomes in Inflammatory Bowel Disease Patients

Background and Aims: Appendectomy is the choice of surgery for appendicitis but little is known about its outcomes in patients with Inflammatory Bowel Disease (IBD). We sought to compare hospital outcomes of appendectomy for appendicitis between patients with and without IBD. Methods: This is a cross-sectional study utilizing the Nationwide Inpatient Sample between 2009 and 2013. Patients with appendicitis undergoing appendectomy were identified using appropriate International Classification of Diseases codes. Primary outcomes of interest included length of stay (LOS), hospital costs, and post-surgical complications. Univariate and multivariate analyses were used to compare these outcomes between patients with and without IBD. Results: A total of 849,312 patients with appendicitis undergoing appendectomy were included in this study, of which 4261 patients had IBD. IBD patients had longer LOS and increased hospital costs. Crohn’s disease (CD) patients were more likely to develop post-operative pulmonary embolism (adjusted odds ratio (aOR) 7.06, 95% Confidence Interval (CI) (2.19, 22.79)) and anemia (aOR 2.23, 95% CI (1.21, 4.10)), whereas ulcerative colitis patients were more likely to develop post-operative deep vein thrombosis (aOR 9.79, 95% CI (2.41, 39.75)). CD patients were more likely to have perforated ap-pendicitis (aOR 1.37, 95% CI (1.67, 1.11)) and open appendectomy (aOR 1.56, 95% CI (1.96, 1.27)). Conclusions: Appendectomy for appendicitis in IBD patients is associated with adverse hospital outcomes. Focused attempts are needed to decrease the risk of DVT and PE in these patients. Treating patient’s pre-surgical anemia and proactive venous thromboembolism prophylaxis in IBD patients undergoing appendectomy for appendicitis might improve hos-pital outcomes.

Safety of Catheter-Directed Thrombolysis for the Treatment of Acute Lower Extremity Deep Vein Thrombosis: A Systematic Review and Meta-Analysis

Acute lower extremity deep venous thrombosis (DVT) patients receiving catheter directed thrombolysis (CDT) are at a low risk of complications. However, compared with anticoagulation, CDT is associated with a higher risk of complications and PE. Rare mortality related to thrombolytic therapy was reported. More evidence should be accumulated to prove the safety of CDT.

Increased risk of venous thromboembolism associated with polymyositis and dermatomyositis: a meta-analysis.

ObjectivePolymyositis and dermatomyositis (PM/DM) have been implicated in the development of venous thromboembolism (VTE). Previous studies investigating the association between PM/DM and VTE risk had yielded inconsistent findings. The aim of this study was to precisely estimate this association by meta-analysis of all available publications.MethodsTwo investigators independently performed a comprehensive literature search in databases of PubMed, Embase, and the Cochrane Library for eligible studies. The strength for the association was weighed by pooled odds ratios (ORs) with 95% confidence intervals (95% CIs). Stratified analysis and sensitivity analysis were performed for further analysis.ResultsSix studies including 9,045 patients with PM/DM were analyzed. The pooled OR suggested that inflammatory myositis was associated with increased risk of VTE (OR =4.31, 95% CI: 2.55–7.29, P<0.001). Besides, significantly elevated risk of VTE was related with PM and DM, respectively (for PM: OR =6.87, 95% CI: 4.12–11.46, P<0.001; for DM: OR =11.59, 95% CI: 6.54–20.55, P<0.001). In addition, inflammatory myositis could increase the risk of DVT (OR =4.85, 95% CI: 1.38–17.12, P<0.05) and PE (OR =4.74, 95% CI: 2.18–10.30, P<0.05). Sensitivity analysis did not materially alter the pooled results.ConclusionOur study shows strong evidence that patients with inflammatory myositis have an increased risk of VTE.

Association study of FOXP3 gene and the risk of 0020 pre-eclampsia

ABSTRACTPre-eclampsia (PE) is a multifactorial pregnancy disorder, with serious consequences for both the mother and the fetus. Despite intense studies, the pathophysiology of PE remains enigmatic. Previous studies suggested that Treg dysfunction is involved in the pathogenesis of PE. We hypothesized that functional variants of the FOXP3 gene might be associated with PE via dysregulation of Treg cells. Of the 276 subjects, we genotyped three variants of FOXP3 by PCR-RFLP and Tetra ARMS-PCR methods. The genotypic frequencies of rs2232365 were found to be protective from the development of PE under codominant [odds ratio (OR) 0.49, 95 percent confidence interval (CI) 0.28–0.87, p-value = 0.043], dominant [odds ratio (OR) 0.54, 95 percent confidence interval (CI) 0.32–0.94, p-value = 0.027] and over dominant [odds ratio (OR) 0.57, 95 percent confidence interval (CI) 0.35–0.92, p-value = 0.02] models. Moreover, the rs3761548 conferred a risk of PE in recessive model [odds ratio (OR) 2.05, 95 percent confidence interval (CI) 1.08–3.88, p-value = 0.025]. However, no mutation was detected in FOXP3 exon2 in any of the studied samples. Based on our results, thought that FOXP3 variants may be an important contributor for the progression of PE in Iranian women.

Association between the soluble epoxide hydrolase gene and preeclampsia

ABSTRACTObjective: In this study the association between K55R polymorphism, methylation level of the EPHX2 promoter region, and PE was investigated in 520 individuals including 260 PE patients and 260 healthy pregnant women.Methods: K55R polymorphism and methylation level of the EPHX2 promoter were determined by the real-time PCR using double-dye hydrolysis probes and methylation-sensitive high-resolution melting analysis, respectively.Results: The presence of the K55R polymorphism was significantly higher in cases (28.1%) than controls (17.3%), and was associated with increased risk of PE (OR: 1.86; 95% CI: 1.09–2.63). Methylation levels of the EPHX2 promoter region in cases were significantly lower than controls. A 2.83 times increased PE risk was observed in pregnant women with EPHX2 promoter methylation levels of <25% (OR: 2.83; 95% CI: 1.15–6.91).Conclusion: In conclusion, hypomethylation of the promoter region of EPHX2 and K55R polymorphism were associated with significant increased risk of PE. sEH enzyme may play a role in the pathogenesis of PE by contributing to reduction of the vasodilatator, anti-hypertensive, and anti-inflammatory effects of EETs by rapid degradation of these molecules.

Apical Periodontitis, a Predictor Variable for Preeclampsia: A Case-control Study

IntroductionPreeclampsia (PE) is characterized by hypertension and proteinuria after the 20th week of gestation. There is an association between systemic inflammation and adverse pregnancy outcomes such as PE. Therefore, for the first time, the present study aimed to investigate the possible association between maternal apical periodontitis (AP) and PE. MethodsIn this case-control study, 50 mothers who were diagnosed with PE during pregnancy were included in the experimental group. The control group consisted of 50 matched mothers with a normal course of pregnancy. The endodontic and periodontal status of all participants was reviewed using the digital panoramic radiographs that were available before pregnancy. The number of remaining teeth and the presence of AP in all teeth and endodontically treated teeth were recorded using the periapical index. Binary logistic regression was used to determine the possible association between AP and PE (α = 0.05). ResultsAP in at least 1 tooth was found in 27 of the mothers who developed PE (54%) and in 16 of the control patients (32%) (odds ratio [OR] = 2.4, P < .05). Adjusted for the maternal periodontitis, number of teeth, and endodontic treatment, maternal AP was significantly associated with the occurrence of PE (P < .05; OR = 2.23; 95% confidence interval, 95% = 1.92–6.88). ConclusionsAP was significantly more prevalent in the experimental group. For the first time, this study has provided evidence that maternal AP may be a strong independent predictor of PE. Considering the high occurrence of PE, particularly in developing countries, it could be suggested that the risk of PE may be reduced through comprehensive dental examinations for detecting and treating any source of inflammation, including AP, before pregnancy.

The placental vascular endothelial growth factor polymorphisms and preeclampsia/preeclampsia severity

ABSTRACTPreeclampsia (PE) is a serious pregnancy-specific condition, which originates from placenta and finishes after delivery. The present study has investigated the association between placental VEGF I/D (rs35569394), −1154G/A (rs1570360), and −634G/C(rs2010963) polymorphisms and maternal VEGF −2549 I/D (rs35569394) polymorphism with PE and PE severity.In this case-control study, the maternal blood of 217 women with PE and 210 normotensive pregnant women and the placenta of 84 PE women and 103 normotensive women were collected after delivery. Genotyping was done by PCR or PCR-RFLP methods.The maternal VEGF-2549I/D genotypes were not associated with PE or PE severity. The placental VEGF −2549 I/D genotypes were not associated with PE too; however; the placental VEGF-2549 DD genotype was statistically different between women with severe PE and mild PE or the controls. The placental VEGF −634GC and CC genotypes were significantly higher in PE women and associated with 2.6 and 2-fold higher risk of PE, respectively. The VEGF −634GC and CC genotypes were associated with PE severity. No association was found between placental VEGF −1154G/A polymorphism and PE or PE severity. The placental DGC haplotype of VEGF −2549 I/D, −1154G/A, and −634G/C polymorphisms was associated with 2.9-fold higher risk of PE. However, the placental IAG haplotype was associated with 0.3-fold lower risk of PE. In conclusion, the placental VEGF −2549 DD genotype was associated with severe PE and the placental −634GC and CC genotypes were associated with PE and severe PE. No association was found between VEGF −1154G/A polymorphism and PE or PE severity.

Association between Level of Tumor Markers and Development of VTE in Patients with Pancreatic, Colorectal and Ovarian Ca: Retrospective Case- Control Study in Two Community Hospitals.

The risk of venous thromboembolism (VTE) is increased in patients with cancer. However, the role of tumor markers as potential indicators of increased risk of VTE is still undetermined. In this retrospective observational case control study, levels of the tumor markers CEA, CA 19-9 and CA 125 in patients with colorectal, pancreatic, and ovarian cancer respectively, who were admitted to two community hospitals between January 2001 and December 2011, were compared between patients who were VTE positive and those who were VTE negative. The primary goal of this study was to determine whether VTE positive cancer patients had higher tumor marker levels compared to VTE negative cancer patients. In our study, 66.7% (48/72) of patients who were positive for VTE had elevated tumor markers while 65.3% (66/101) of patients who were negative for VTE had low (normal) tumor markers, indicating an association of high tumor marker levels with the diagnosis of VTE. This was statistically significant with an odds ratio of 3.77 and p-value of <0.0001 (95% CI of 1.99-7.14). When the VTE group was further divided into DVT and PE groups, 70.2% (40/57) of patients in the DVT positive group had high tumor markers with a p value of <0.0001 and an odds ratio of 3.99 (95% CI of 2.02 to 7.89) while 57.9% (11/19) of patients in pulmonary embolism positive group had high tumor markers; this was, however, not statistically significant (p-value of 0.35 and a CI of 0.59 to 4.10). In this retrospective study of 173 individuals with a diagnosis of either colorectal, pancreatic, or ovarian Cancer, higher tumor marker levels (CEA, CA 19-9, and CA 125 respectively) were associated with an increased risk of VTE, either DVT or PE. However, when further divided into either DVT or PE groups, the association remained statistically significant only for DVT but not for PE.

Association of maternal angiotensinogen gene M235T polymorphism with preeclampsia in South India: A tertiary care hospital based case-control study

PurposeM235T polymorphism (rs699) in angiotensinogen (AGT) gene is associated with the risk of developing preeclampsia. This case-control study examines the profile of AGT M235T polymorphism in preeclamptic and normotensive pregnancies in a South Indian population. MethodsA total of 300 women comprising of 150 preeclamptic pregnancies and an equal number of normotensive pregnancies were enrolled in the study. AGT M235T polymorphism was determined by PCR-RFLP technique. Differences in the distribution of alleles and genotypes among cases and controls was evaluated for statistical significance by means of contingency table. ResultsThe presence of AGT 235 T allele was found to be associated with the increased risk of developing preeclampsia [P=0.003, odds ratio=1.69 (95% CI: 1.20–2.38)]. At the genotype level, the odds ratio for the risk of PE was 2.52 (95% CI: 1.25–5.07) and 1.67 (95% CI: 1.05–2.63) in the dominant and recessive models respectively. ConclusionsOur results support the conclusion that AGT M235T polymorphism is associated with increased risk of developing preeclampsia in the South Indian population. This is the first study to report a positive association between AGT M235T polymorphism and preeclampsia in the Indian population.

Важность и значение полиморфизма генов при преэклампсии

Was to conduct a systematic review of data on the relationship between polymorphisms genes of detoxification system and development of preeclampsia (РЕ). Рresents the main genes of detoxification system (GSTPI, GSTМI, GSTТI, GРХI, ЕРНХI, SOD-2, SOD-3, CYPIAL, MTHЕR, MTR) and their functions. Of interest is the possibility of calculating the individual risk of PE based on the results about the presence of a combination of different polymorphisms in the genotype of the female. Question about early diagnosis of РЕ remains controversial and not fully understood. It is necessary to conduct further in-depth, extended study of this problem. Key words: preeclampsia, oxidative stress, genes of the detoxification system.

C5. Preeclampsia in twin pregnancies

Aim: To identify the independent risk factors for PE development in twin pregnancies and explore the associated perinatal outcomes.Methods: A retrospective cohort study of twin pregnancies was performed at St George’s University Hospital, London. Maternal and neonatal data were obtained from the hospital’s computerised database. The Chi-square test, Mann–Whitney U test and univariate and multiple-logistic regression analyses were performed.Results: We identified a total of 1250 twin pregnancies who were under the care of SGH from 1999 to 2015. Of these, 120 (9.6%) were complicated by pre-eclampsia according to the ISSHP diagnostic criteria. Pre-eclamptic twin pregnancies were significantly associated with the following perinatal outcomes: induction of labour, emergency caesarean delivery, blood loss at delivery, postpartum haemorrhage ≥500 ml, gestational age at delivery, neonatal unit (NNU) admission and birth weight. Maternal BMI (aOR = 1.060, 95%CI = 1.022–1.099, p = 0.002), chronic hypertension (aOR = 3.131, 95%CI= 1.443–6.792, p = 0.004), and nulliparity (aOR = 1.852, 95% CI = 1.185–2.893, p = 0.007) were independent risk factors for the development of PE in a twin gestation.Conclusions: Nulliparity, maternal BMI and chronic hypertension are factors that increase the risk of PE in a twin gestation, such findings hold clinical significance in relation to the management of twin pregnancies in these women.

Tibial component rotation during the unicompartmental knee arthroplasty: is the anterior superior iliac spine an appropriate landmark?

No "ideal" landmark for tibial component rotation in medial unicompartmental knee arthroplasty (UKA) has been suggested by a biomechanical and clinical study. The aim of this study was to investigate whether the anterior superior iliac spine (ASIS) could provide a consistent rotational landmark of the tibial component during mobile-bearing medial UKA using computed tomography (CT). During sagittal tibial resection, we utilized the ASIS as a rotational landmark. In 47 knees that underwent postoperative CT scans after medial UKA, the tibial component position was assessed by drawing a line tangential to the lateral wall of the tibial component. Rotation of the tibial component was measured using two reference lines: a line perpendicular to the posterior cortical rim of the tibia (angle α) and Akagi's line (angle β). Instant bearing position and posterior cruciate ligament (PCL) fossa involvement were also evaluated. External rotation of the tibial component relative to each reference line was considered positive values. The mean α and β angles were 8.0°±6.1° (range -4.0 to 24.3) and 8.7°±4.8° (range 1.9-25.2), respectively. Fourteen knees (29.8%) showed PCL fossa involvement of the tibial resection margin. One bearing showed complete 180° rotation at 2weeks postoperatively. Due to the wide variation and inherent difficulty of identifying the ASIS during the operation, it is not recommended for guidance of sagittal tibial resection during medial UKA. In cases of inappropriate tibia component rotation, risk of PE bearing spinning and iatrogenic PCL injury should be reminded after medial UKA. IV.

Combination of erythropoietin and tranexamic acid in bilateral simultaneous total hip arthroplasty: a randomised, controlled trial.

This study aimed to evaluate whether the combination of erythropoietin (EPO) and tranexamic acid (TXA) exerted any additional benefits on the number of blood transfusions required and haematological parameters compared with TXA alone following primary bilateral simultaneous total hip arthroplasty. We conducted a single-centre, prospective, randomised, and controlled trial at our hospital. Group EPO + TXA (n = 30) received daily subcutaneous injections EPO (10,000 IU) on preoperative days 1-4 and postoperative days 1-3. Additionally, these patients were administered TXA (15 mg/kg) 10 min prior to the incision. Group TXA (n = 32) received only TXA (15 mg/kg) 10 min prior to the incision. The primary outcomes were the haematological parameters and number of blood transfusions required. The secondary outcomes were total blood loss, drainage volume, and postoperative complications. The total amount of blood transfusion and mean blood transfusion per patient was lower in group EPO + TXA than in group TXA (p = 0.039, p = 0.023; respectively). In the postoperative period, patients in group EPO + TXA had higher haematological parameters (haemoglobin, haematocrit, and reticulocyte count) than patients in group TXA. No significant differences were found in total blood loss, drainage volume, and DVT or PE between the 2 groups. This study showed that administrating EPO + TXA in combination can increase haematological parameters and reduce the need for blood transfusion without increasing the risk of DVT or PE compared with TXA alone.

Some biochemical markers that can predict pre-eclampsia

TNF– α directly damages the vascular endothelial cells, reduces regional blood flow, causes occlusion of vessels and increases endothelial permeability. Endothelial cell injury after TNF– α mediated activation of immune system may result in secretion of vasoactive substances and increase in vascular permeability and intravascular coagulation. TNF-α may be involved in the pathogenesis of preeclampsia and may identify the patients who are at high risk of PE and can be a potential marker of the severity of the preeclamptic syndrome. Preeclamptic women had deranged lipid profile due to abnormal lipid metabolism; this alteration of lipid metabolism may play a key role in the development of symptoms of Pre-eclampsia. Furthermore, changes to lipid metabolism may contribute towards the endothelial lesions observed in pre-eclampsia.

Current practice of consent for trauma surgery: A time for change?

5 Current practice of consent for trauma surgery: A time for change? Steven Churchill*, Cezary Kocialkowski, Ladan Hajipour, Anand Pillai University Hospitals of South Manchester, United Kingdom *Corresponding author. Objectives: The ruling of the Montgomery case this year emphasised the importance of explicit and legally defensible consent in the modern era; the particular nuances relating to informing patients of risks specifically relevant to them. We performed an audit of the current consenting standards in our trauma department to ascertain what can be done to make the consenting process more consistent and justifiable. Methods: We audited 68 consent forms for patients having elective orthopaedic and trauma procedures between February and April 2015. Specifically looking at who consented the patient, the procedure, as well as each risk/complication identified on the form. We also noted any key differences in the way people consented. Results: Consent for 31 trauma procedureswere assessed in the audit: 26 neck of femur (NOF) repairs, three ORIFs and two hip revisions; all of the consent forms were completed by SHO grade doctors. The median day of consent was 1 day pre-procedure. For NOF patients, the proportion consented for specific risks were: pain (53.8%), infection (100%), bleeding (96.2%), leg length discrepancy (11.5%), neurovascular (NV) injury (88.5%), MI (42.3%), DVT/PE (84.6%), fatal PE (3.8%), death (36.4%). Conclusions: Some risks are being well consented consistently such as infection, bleeding and NV injury. However, even though the evidence tells us that the risk of PE following a NOF fracture is around 5% with a 1-year mortality of 20–35%, these are not being consented for universally. This would suggest a more reliable form of consenting maybe appropriate, either through consenting ‘‘stickers’’ or by standardised consent forms. http://dx.doi.org/10.1016/j.injury.2015.12.006

Impact of pelvic lymph node dissection during radical prostatectomy on 30-day post operative complications: Results from a large national database.

238 Background: Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is the most effective method for detecting lymph node metastases in patients with prostate cancer. The association between PLND during RP and morbidity, especially thromboembolic adverse events (AEs), remains unclear. We assessed the effect of PLND on 30−day postoperative AEs in patients undergoing RP using the American College of Surgeons’ National Surgical Quality Improvement Program database (NSQIP). Methods: A total of 21,895 men undergoing RP between 2006 and 2013 were classified into two groups according to surgical approach (MIS−RP vs. ORP) and whether PLND was performed. Multivariate logistic regression adjusting for approach and demographic features was performed to assess the impact of PLND for predicting two primary endpoints (overall complications and major complications defined as Clavien−Dindo ≥ 3) and for 17 types of complications. P−values were adjusted to maintain an experiment−wise p &lt; 0.05. Results: MIS−RP and ORP was performed in 17,354 (79.3%) and 4,541 (20.7%) patients, respectively. PLND was performed in 7,579 (43.7%) and 3,597 (79.2%) patients in the MIS−RP and ORP groups, respectively. The overall postoperative complication rate was 8.7% (5.5% for MIS−RP and 21.0% for ORP). PLND was not associated with a higher risk of DVT (OR 0.99; p= 0.98) or PE (OR 1.02; p= 0.91). However, PLND was associated with a higher risk of superficial surgical site infection (OR 1.68; p = 0.013), organ space surgical site infection (OR 1.77; p = 0.02), and perioperative transfusion (OR 1.32; p = 0.002) regardless of surgical approach. PLND was not associated with overall or major AEs on multivariable analysis. ORP was associated with a significantly higher risk of overall (OR 4.64, p &lt; 0.0001) and major (OR 1.6, p = 0.0004) AEs compared to MIS−RP. Conclusions: PLND during RP is associated with a significantly increased risk of certain types of AEs within the 30−day post−operative period. However, there appears to be no significant association between PLND and thromboembolic AEs.

Endovascular Treatment of Thrombosis and Embolism.

Deep venous thrombosis (DVT) is a common disorder with a significant mortality rate. Successful endovascular treatment of acute DVT is most likely to be achieved in patients with recently formed thrombus, (<10-14 days) with acute iliofemoral DVT. Endovascular treatment options include: Catheter-directed thrombolysis (CDT), pharmacomechanical catheter-directed thrombolysis (PCDT), percutaneous aspiration thrombectomy (PAT), vena cava filter protection, venous balloon dilatation and venous stent implantation. Current practice shows strong clinical tendency for the use of PCDT with or without other endovascular methods and an individualized approach for each DVT patient. PMT has not received general acceptance because of the associated risk of PE and damage to venous valves caused by thrombectomy devices. PAT is most commonly used as an adjunctive endovascular technique like balloon maceration to fragment thrombus, balloon angioplasty, stent implantation and vena cava filter placement. Interventional endovascular therapies for DVT have the potential to provide PE protection and prevention of PTS. Patient centered individualized approach for endovascular DVT treatment is recommended to optimize the ideal clinical result.Acute stroke is the leading cause of death for people above the age of 60 and the fifth leading cause in people aged 15-59. Mortality during the first 30 days of ischemic stroke is 20% and 30% of survivors will remain permanently disabled. Acute stroke patients within the therapeutic window must receive IVrtPA unless there is a contraindication. In case of contraindication to IVrtPA or for patients out of the therapeutic window for thrombolytics, standart of care is the intraarterial treatment. Patients have to be transferred to a comprehensive stroke center with capacity of dedicated neurovascular imaging and interventional neuroradiology. Noncontrast head CT that is used to rule out hemorrhage is followed by imaging studies dedicated to show if there is reasonable penumbra to save. Intraarterial thrombolysis has the main advantage of extended therapy window, earlier and more efficient recanalization and less risk of hemorrhage due to lower doses of thrombolytics. Mechanical thrombectomy has several advantages over IV/IA fibrinolysis including faster recanalization and less risk of hemorrhage especially in large artery occlusions. ASA guidelines recommend choosing stent retrievers over other devices for mechanical thrombectomy. Better recanalization rates and less infarct volume after mechanical thrombectomy result in higher numbers of functionally independent patients compared with other treatments. Two landmark studies that were published recently, SWIFT PRIME and MR CLEAN, showed that IA treatment especially with the new stent retrievers lead to a significant increase in functional recovery and independence in daily life after an acute stroke.Cerebral venous and sinus thrombosis (CVST) comprises nearly 0.5-1% of all stroke cases. CVST causes different neurological deficits depending on the sinus/cortical vein involved. CVST may cause death and dependency in 13.4% of patients. CT/CT venography and MR/MR venography can be effectively used to diagnose and to follow up CVT cases. Anticoagulation with heparin is the most widely accepted therapy to prevent the expansion of the thrombus. Patients deteriorating despite heparinization and patients presenting with very severe neurological deficits must receive endovascular treatment. Endovascular methods include intrasinus infusion of thrombolytics or heparin, balloon angioplasty, mechanical thrombectomy or a combination of different techniques. There is a higher rate or recanalization with endovascular methods compared to other medical therapies.

Central venous catheters and upper extremity deep vein thrombosis in medical inpatients: the Medical Inpatients and Thrombosis (MITH) Study

Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized complication in medical inpatients, with few data available regarding the incidence, risk factors and association with central venous catheter (CVC) use. Between 2002 and 2009 all cases of hospital-acquired venous thromboembolism (VTE) at a university hospital were frequency matched 1 : 2 to non-cases without VTE by admission year and medical service. Records were abstracted to identify, characterize and assess risk factors for UEDVT. Weighted logistic regression was used to calculate odds ratios (ORs) for UEDVT associated with use of a CVC, adjusting for known VTE risk factors. Two hundred and ninety-nine cases of VTE complicated 64 034 admissions to medical services (4.6 per 1000 admissions). UEDVT constituted 51% (91/180) of all deep vein thrombosis (DVT), for an incidence of 1.4 per 1000 admissions (95% confidence interval [CI], 0.8-1.7). There were 247 CVCs placed per 1000 admissions (95% CI, 203-292). The use of a CVC was associated with a 14.0-fold increased risk of UEDVT (95% CI, 5.9-33.2), but was not associated with a significantly increased risk of PE (OR, 1.3; 95% CI, 0.8-2.1). Peripherally inserted central catheters had a higher OR for UEDVT (OR, 13.0; 95% CI, 6.1-27.6) than centrally inserted central venous catheters (CICC) (OR, 3.4; 95% CI, 1.7-6.8). UEDVT is a relevant complication affecting medical inpatients, accounting for half of hospital-acquired DVTs. Use of CVCs was strongly associated with risk of UEDVT.