Vein Segments Research Articles

Sonographic Diagnosis of Anterior Nutcracker Phenomenon and its Prevalence in Nigerian Males with Varicoceles

Abstract Background: The nutcracker phenomenon (NCP) is a rare and often unrecognised cause of varicocele, haematuria, and chronic pelvic pain due to the left renal vein (LRV) compression between the aorta and the superior mesenteric artery (anterior nutcracker). Its varied clinical manifestations make the diagnosis difficult and usually delayed. A high index of clinical suspicion, with appropriate imaging studies is crucial for the diagnosis. Objectives: We used a colour Doppler ultrasound scan to investigate the anatomic and haemodynamic properties of testicular and renal venous drainage. The emphasis was to determine the presence or absence of NCP, its possible effects on varicocele formation and severity, and its relationship with the body mass index (BMI) of the subjects. Materials and Methods: We carried out Doppler scrotal and upper abdominal ultrasound examinations of 100 subjects with male infertility and clinical varicoceles (group A), and 100 controls with male infertility but without varicoceles (group B). The mean peak velocity (PV) and the anteroposterior (AP) diameters of different segments of the renal veins, as well as the diameters of the testicular veins of the subjects in the two groups were measured and compared. The ratios of the PV and the diameters between the hilar portion and the aorto-mesenteric portion of the LRV were also calculated and compared. A PV ratio or anteroposterior diameter ratio between the two portions greater or equal to 5.0 was considered diagnostic of NCP. The diagnosis of varicocele was confirmed by visualising a dilated pampiniform plexus vein measuring greater than 2 mm in diameter using an ultrasound scan. Results: Six out of 100 subjects in group A had diameter and PV ratios (≥5.0) in the LRV that suggested the presence of NCP, and all participants in group B had neither diameter nor PV ratio suggestive of NCP. The prevalence of NCP seen within the varicocele group in this study was statistically significant (P = 0.038). Five (83.3%) of the six subjects in the NCP-associated varicocele subgroup had microscopic haematuria, orthostatic proteinuria, or both; these qualified them for the diagnosis of nutcracker syndrome (NCS), A significantly lower mean BMI (P = 0.004) was noted among the NCP-associated varicocele subgroup compared to those without NCP. Conclusion: Our findings indicate that the NCP is a significant finding in patients with varicoceles in our environment, and it is more common with lower BMI.

Surgical technique and outcomes associated with the use of femoral vein in venous reconstruction for superior vena cava syndrome.

Superior vena cava syndrome (SVC) is a debilitating disease, and surgical reconstruction has been described with some of the best results using spiral great saphenous vein (SGSV) grafts. SGSV grafts can be difficult to construct, and a long segment of saphenous vein is needed. Femoral vein has been an excellent conduit for infected aortic and peripheral reconstructions in our hands, and we sought to review outcomes using this conduit for SVC reconstruction. This was a single-center, retrospective study that included all patients who underwent SVC reconstruction using femoral vein from January 2000 to December 2023. Follow-up period analysis included reconstruction patency, surgical reinterventions, patient's symptoms, and complications. Ten patients underwent central venous reconstruction or bypass using the femoral vein, with an average age of 51.88years ± 10.20years. SVC syndrome was primarily caused by benign etiologies including pacemakers and indwelling central venous catheters. Common presenting symptoms included head or neck fullness and upper extremity edema. The median follow-up duration was 21months. Primary patency at 1year was 79%. Femoral vein reconstruction presents a promising solution for managing SVC obstruction, offering effective symptom relief and acceptable venous patency rates. Further research including prospective trials and comparative studies is crucial to refining surgical techniques and understanding long-term efficacy in addressing this complex clinical issue.

VSNet: Vessel Structure-aware Network for hepatic and portal vein segmentation

VSNet: Vessel Structure-aware Network for hepatic and portal vein segmentation

Overcoming the technical challenge of venous resection with pancreatectomy: Which factors determine survival?

Pancreatectomy with venous resection (PVR) is nowadays considered standard. However, there is still concern about increased postoperative morbidity and impaired long-term outcome depending on the type of venous resection and reconstruction. The aim was to investigate the predictors of morbidity and long-term survival in patients undergoing PVR in a high-volume center. All consecutive patients undergoing PVR at a single center between January 2008 and January 2019 were retrieved from a prospectively maintained database. Factors associated with postoperative complications and long-term survival were analyzed. Of 290 patients with isolated PVRs, 188 (65%) were performed for pancreatic ductal adenocarcinoma (PDAC). Surgical complications developed in 56% of patients (n=163), and 11% (n=36) had severe complications (Clavien-Dindo>3a). The 90-day mortality was 4.1%. Venous thrombosis occurred in 4.8% (n=14), resulting in one mortality (0.3%). No technical factors were predictive for the development of severe complications. Longer vein segments >3cm could be resected with similar short- and long-term outcome as shorter segments. The survival of patients undergoing PVR for resectable, borderline and locally advanced PDAC was similar (median of 18, 14, and 23 months, p=0.7). On multivariate analysis, elevated CA19-9>200 U/mL and ASA score≥3 were independent predictors of survival (p=0.02), but not resectability at diagnosis nor type of venous reconstruction. The type of venous resection/reconstruction does not influence outcome and should be tailored according to patients' and tumors' characteristics during PVR. The long-term survival after PVR for PDAC is influenced by tumor-and patient-related characteristics, and not technical vascular-resection associated factors.

Early experience managing intravascular coagulum using polidocanol endovenous microfoam: Risk factor analysis.

A single-center retrospective cohort study was conducted to identify potential risk factors that lead to increased incidence of intravascular coagulum (IC) observed in clinical practice using polidocanol endovenous microfoam (PEM 1%, VarithenaTM [polidocanol injectable microfoam], Boston Scientific, Marlborough, Mass). Patients (n = 119) who received polidocanol endovenous microfoam (PEM) treatment for chronic venous insufficiency between December 2021 and January 2024 at a private outpatient vascular surgery clinic were observed to identify potential risk factors in the development of IC. The patients were stratified into two groups: IC (n = 16) versus non-IC (n = 103). Patients who returned with increased pain and irritation at the treatment site in the early post ablation period within 2-6weeks of treatment and had coagulum aspirated at the subsequent follow-up visit met the study criteria and were included in the IC group. In addition, patient demographics, comorbidities, and duplex ultrasound reports were analyzed using deidentified chart records. There were 119 patients treated in the study period with a mean age of 62years. Females were the most common sex 66% (n = 78) and Latinos represented the largest ethnicity 60% (n = 71). Overall, 13% (n = 16) of the patients developed an intravascular coagulum. The mean time to onset of IC was 45days (range: 7-106days) post-ablation. There was no difference between the groups (IC vs non-IC) for age, sex, ethnicity, or index VCSS scores. On univariate analysis, patients who developed IC had lower PEM injection volumes when compared to non-IC patients (4.1 vs 6.3mL, p = .04). High reflux at the GSV (>1800ms) and Latino ethnicity were also found to be significant risk factors. When these factors were evaluated in multivariate analysis, lower PEM injection volumes was the only factor that remained significant for the development of IC (p = .006). Lower polidocanol endovenous microfoam injection volumes is a risk factor for developing intravascular coagulum. Further studies are needed to identify the ideal injection volume per segment of vein treated.

Modified basilic vein transposition surgery for vascular access: Lengthening the basilic vein.

Basilic vein transposition (BVT) surgery is a crucial option for vascular access in hemodialysis patients when other alternatives are unavailable. One of the primary complications affecting the long-term function of arteriovenous fistulas (AVFs) is the development of pseudoaneurysms, often caused by repeated punctures at the same site. This study aims to evaluate whether increasing the length of the basilic vein available for cannulation during the second stage of BVT surgery reduces the risk of puncture-related pseudoaneurysms, thereby improving fistula longevity and functionality. We selected 39 hemodialysis patients unsuitable for cephalic vein AVF creation or who had failed brachiocephalic fistulas. Eligibility criteria included a basilic vein diameter of more than 2.5mm with appropriate venous anatomy confirmed via ultrasound. In the first stage of surgery, the median basilic vein was anastomosed to the superior surface of the brachial artery. One month later, once the vein had matured (diameter ≥4mm), a second stage was performed, which involved liberating an extended segment of the basilic vein down to the forearm. The basilic vein was then anastomosed end-to-end with the median basilic vein to increase the cannulation area. Patients were followed for 1year to evaluate outcomes. All 39 patients successfully underwent the modified BVT technique. Over the 1-year follow-up period, none experienced significant AVF complications, particularly pseudoaneurysm formation. By increasing the usable length of the basilic vein for cannulation, multiple puncture sites were available, reducing the risk of repeated needle insertions at the same site. The modified BVT technique shows promise in reducing the risk of pseudoaneurysm formation and improving AVF patency, potentially enhancing the longevity and functionality of AVFs in hemodialysis patients. Further studies are necessary to confirm the efficacy of this technique in larger patient populations.

Anatomic and clinical implications of venous drainage variations in superior segment resections for clinical T1N0 non-small cell lung cancer.

Superior segmentectomies for clinical T1N0 non-small cell lung cancer (NSCLC) often suffer from inadequate surgical margins. Our study aimed to enhance the precision of superior segmentectomies by focusing on the anatomical features of the superior segmental vein (V6) branches, and assess the relevant outcomes. The clinical data of 646 patients with cT1N0 NSCLC who underwent video-assisted thoracic surgery (VATS) from August 2020 to August 2021 were retrospectively analyzed. A total of 521 patients were enrolled for analyzing the prevalence and drainage patterns of V6b utilizing three-dimensional reconstruction images. Then, 162 patients who underwent segmentectomy were included to analyze the outcomes of superior segmentectomy. Disease-free survival (DFS) was estimated using the Kaplan-Meier method and compared across groups with the log-rank test. The prevalence of V6b2 (a type of intersegmental vein between S6 and S9) and V6b3 (between S6 and S8) were 91.2% (475/521) and 66.2% (345/521), respectively, both primarily converging with other branches of V6. The segmentectomy groups showed no significant differences in surgical margins, tumor size, or other malignancy-related factors, such as TNM stage. Correspondingly, during a median follow-up of 3.23 years [interquartile range (IQR), 2.99-3.61 years], the patients who underwent superior segment (S6) resection achieved an overall survival (OS) rate of 100% (68/68) and a DFS rate of 97.1% (66/68), demonstrating outcomes comparable to other segmentectomies (P>0.05). High prevalence of V6b2 and V6b3 was observed with minimal variation in drainage patterns. Emphasizing these veins to ensure sufficient margins and potentially reducing aggressiveness through early detection, the outcomes of superior segmentectomies in this study are comparable to other segmentectomies and superior to those reported in previous studies.

Automatic segmentation and diameter measurement of deep medullary veins.

As one of the pathogenic factors of cerebral small vessel disease, venous collagenosis may result in the occlusion or stenosis of deep medullary veins (DMVs). Although numerous DMVs can be observed in susceptibility-weighted MRI images, their diameters are usually smaller than the MRI resolution, making it difficult to segment them and quantify their sizes. We aim to automatically segment DMVs and measure their diameters from gradient-echo images. A neural network model was trained for DMV segmentation based on the gradient-echo magnitude and phase images of 20 subjects at 7 T. The diameters of DMVs were obtained by fitting measured complex images with model images that accounted for the DMV-induced magnetic field and point spread function. A phantom study with graphite rods of different diameters was conducted to validate the proposed method. Simulation was carried out to evaluate the voxel-size dependence of measurement accuracy for a typical DMV size. The automatically segmented DMV masks had Dice similarity coefficients of 0.68 ± 0.03 (voxel level) and 0.83 ± 0.04 (cluster level). The fitted graphite-rod diameters closely matched their true values. In simulation, the fitted diameters closely matched the true value when voxel size was ≤ 0.45 mm, and 92.2% of DMVs had diameters between 90 μm and 200 μm with a peak at about 120 μm, which agreed well with an earlier ex vivo report. The proposed methods enabled efficient and quantitative study of DMVs, which may help illuminate the role of DMVs in the etiopathogenesis of cerebral small vessel disease.

Indocyanine green fluorescence identification of the intersegmental plane by the target segmental vein-first single-blocking during thoracoscopic segmentectomy

BackgroundInnovative attempt to explore the feasibility and accuracy of using indocyanine green fluorescence (ICGF) to identify the intersegmental plane by the target segmental veins preferential ligation during thoracoscopic segmentectomy.MethodsA retrospective analysis was conducted on clinical data of 32 consecutive patients who underwent thoracoscopic segmentectomy with intersegmental plane identification using both ICGF and inflation-deflation method after target segmental veins prioritized blocking at Nanjing Chest Hospital from December 2022 to June 2023. Preoperative three-dimensional reconstruction was used to identify the target segment and the anatomical structure of the arteries, veins, and bronchi. After ligating the target segmental veins during surgery, the first intersegmental plane was immediately identified and marked with an electrocoagulation device using an inflation-deflation method. Subsequently, the second intersegmental plane was determined using the ICGF method. Finally, the consistency of the two intersegmental planes was evaluated.ResultsAll the 32 patients successfully completed thoracoscopic segmentectomy without ICG-related complications and perioperative death. The average operation time was (98.59 ± 20.72) min, the average intraoperative blood loss was (45.31 ± 35.65) ml, and the average postoperative chest tube removal time was (3.5 ± 1.16) days. The average postoperative hospital stay was (4.66 ± 1.29) days, and the average tumor margin width was (26.96 ± 5.86) mm. The intersegmental plane determined by ICGF method was basically consistent with inflation-deflation method in all patients.ConclusionThe ICGF can safely and accurately identify the intersegmental plane by target segmental veins preferential ligation during thoracoscopic segmentectomy, which is a beneficial exploration and important supplement to the simplified thoracoscopic anatomical segmentectomy.

THE EFFECTIVENESS OF THE FUNCTIONING OF RECONSTRUCTED HEPATIC VEINS USING VARIOUS TYPES OF MATERIALS IN TRANSPLANTATION OF THE RIGHT LOBE OF THE LIVER FROM A LIVING DONOR

Background. In adult living donor liver transplantation with the right lobe, the venous outflow of the anterior sector is typically restored during the procedure to form a neo-middle hepatic vein. Restoring the middle hepatic vein for the drainage of the anterior sector is critically important for achieving optimal graft function. Various conduits are used for this reconstruction, such as synthetic and biological grafts (e.g., the recipient's portal vein, vessels from a deceased donor, and modified great saphenous vein). However, the selection of the best option remains a topic of discussion. This study evaluates the effectiveness of using biological and synthetic grafts for MHV reconstruction. Materials and methods. A retrospective analysis of outcomes was conducted in patients who underwent transplantation of a modified right liver lobe due to end-stage liver disease from 2011 to 2024. Results. A transplantation of modified right liver lobes was performed on 80 patients. In 69 cases, the reconstruction of the hepatic veins was carried out using a biological graft, while in 11 cases, a synthetic graft was used. Statistically significant differences were noted in mortality and the postoperative period. No significant differences were found in the frequency of intraoperative complications. Conclusion. Our study demonstrates that the use of a biological graft for the reconstruction of the hepatic veins of segments 5 and 8 is more effective than the application of a vascular prosthesis.

Patency and reflux in relation to postthrombotic syndrome: a subanalysis of the Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome trial

BackgroundAdjunctive catheter-directed thrombolysis shows variable efficacy in preventing postthrombotic syndrome (PTS), despite restored patency. ObjectivesThis Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome (CAVA) trial subanalysis investigated the effect of ultrasound-accelerated catheter-directed thrombolysis (UACDT) on patency, reflux, and their relevance in PTS development. MethodsThis multicenter, randomized, single-blind trial enrolled patients (aged 18-85 years) with a first iliofemoral deep vein thrombosis and symptom duration ≤14 days. Patency and reflux were assessed by duplex ultrasound at 12 months (T12) and long-term (LT) follow-up (median, 39.5 months; IQR, 24.0-63.0 months). PTS was diagnosed using the Villalta score. ResultsUACDT significantly improved patency in all vein segments at T12 (60.3% UACDT vs 25.9% standard treatment [ST]; P = .002) and LT (45.2% UACDT vs 11.9% ST; P < .001). Popliteal patency, however, was similar between groups (87.9% UACDT vs 83.3% ST; P = .487). Reflux was similar between groups at T12 and LT; only popliteal reflux was significantly reduced in the UACDT group at LT (22.6% UACDT vs 44.8% ST; P = .010). Absent iliac patency at T12 was associated with increased PTS risk in the ST group only (odds ratio [OR], 10.84; 95% CI, 1.93-60.78; P = .007). In the UACDT group, popliteal reflux at T12 was associated with moderate-to-severe PTS at T12 (OR, 4.88; 95% CI, 1.10-21.57; P = .041) and LT (OR, 5.83; 95% CI, 1.44-23.63; P = .009). Combined popliteal reflux and absent iliac patency significantly amplified PTS risk (OR, 10.79; 95% CI, 2.41-48.42; P < .001). ConclusionUACDT improved patency and reduced popliteal reflux. Iliac patency and popliteal reflux are independently associated with moderate-to-severe PTS and contribute synergistically to its development. However, a proportion of moderate-to-severe PTS cases lacks an evident underlying cause.

Haemodynamic study of left nonthrombotic iliac vein lesions: a preliminary report

Nonthrombotic iliac vein lesions (NIVLs) are significant causes of chronic venous insufficiency (CVI) in the left lower limb and symptom recurrence following left lower limb varicose vein treatment. The goal of this study was to explore the haemodynamic and morphological characteristics of iliac veins in patients with NIVLs. Pressure at the caudal end of the stenotic left common iliac vein (LCIV) segment, local blood flow velocity, and time-averaged wall shear stress in the stenotic segment exhibited positive correlations with the clinical CVI classification (R = 0.92, p < 0.001; R = 0.94, p < 0.001; R = 0.87, p < 0.001), while the relative retention time showed a negative correlation (R = -0.94, p < 0.001). The pressure difference (∆P) between the two ends of the stenotic segment and the velocity difference (∆V) between the stenotic segment and the caudal end were positively correlated with the clinical classification (R = 0.92, p < 0.001; R = 0.9, p < 0.001). The cross-sectional area stenosis rate and length of the stenotic LCIV segment were positively correlated with the clinical classification (R = 0.93, p < 0.001; R = 0.63, p < 0.001). The results suggest that haemodynamic assessment of the iliac vein could effectively portray blood flow disturbances in stenotic segments of the LCIV, potentially reflecting the degree of iliac vein stenosis. Haemodynamic indicators are correlated with the severity of clinical CVI symptoms.

A case of intrahepatic mass-forming portal biliopathy mimicking intrahepatic cholangiocarcinoma.

A 75-year-old man was referred to our department because of an enlarging intrahepatic mass detected on magnetic resonance imaging (MRI) follow-up for another disease. MRI showed hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging in liver segment 4. Abdominal plain computed tomography (CT) indicated a low-density lesion with an unclear boundary, measuring approximately 4cm × 3cm in liver segment 4. Dynamic CT showed early rim enhancement and gradual central enhancement. Contrast-enhanced CT also showed occlusion of the portal vein in segment 4. As the possibility of intrahepatic cholangiocarcinoma could not be excluded on imaging studies, we performed laparoscopic left medial sectionectomy. Histologically, the lesion showed diminished numbers of hepatocytes with increased collagen fibers compared with normal, with no patent portal vein. We considered this lesion a reactive lesion caused by collapse of the liver parenchyma owing to localized obstruction and loss of the portal vein. This lesion was pathologically diagnosed as portal biliopathy. We experienced an extremely rare case of intrahepatic mass-forming portal biliopathy that mimicked a hepatic tumor, which was diagnosed by laparoscopic resection. Portal biliopathy rarely forms intrahepatic mass lesions and must be distinguished from a malignant hepatic tumor.

Expansion of WallStents® after Initial Deployment in Nonthrombotic Iliac Vein Lesions

To determine the structural changes of Wallstents (Boston Scientific, Natick, MA) invivo following deployment in iliac veins. This retrospective single-center study was performed from September 2012 to April 2013 and included 100 office-based patients who underwent initial stent placement for nonthrombotic iliac vein lesions with Wallstent as well as a second procedure for stenting of the contralateral iliac vein. Measurements were obtained with marker balloons and the diameters of the stents were compared at the time of the index procedure to the secondary procedure. The average time between the 2 procedures was 28days (range 3-237, SD±39.89). The overall average stent diameter after the index procedure was 16.38mm (range 10.95-21.45, SD±2.24). The overall average stent diameter of the index stent when remeasured during the second intervention was 17.58mm (range 12.84-24.11, SD±2.38, P=0.0003), which was significantly different from the initial measurements. There was no difference when comparing changes in stent diameter by gender or laterality of procedure. However, there was a significant difference in expansion of stents when placed in the common iliac vein versus the external iliac or common femoral veins. This study shows that self-expanding Wallstents can continue to expand days to weeks invivo following initial deployment. Additionally, we found that the change in diameter from initial placement to follow-up was more significant in stents placed in the proximal and middle segments of the common iliac vein. Wallstents are durable implants designed to last within a patient for the rest of their life, it is important to understand the structural changes occurring after their placement. This study allows for a better understanding of Wallstent dynamics invivo.

Clinical observation of three-dimensional reconstruction in thoracoscopic segmental pneumonectomy.

Accurately identifying the branches of pulmonary segmental vessels and bronchi, as well as adjacent structures, and determining the spatial location of lesions within pulmonary segments, are major challenges for thoracic surgeons. The application of three-dimensional reconstruction technology holds promise in addressing this issue. To evaluate the clinical value of three-dimensional reconstruction in thoracoscopic segmental surgery. Seventy-seven patients who underwent thoracoscopic segmental surgery combined with three-dimensional reconstruction at our hospital from January 1, 2020, to August 31, 2023, were retrospectively analyzed. Preoperative chest enhanced CT scans were conducted, and MIMICS software aided in reconstructing DICOM format original data for patients with pulmonary nodules to facilitate intraoperative nodule localization. Accurate segmental pneumonectomy was performed by comparing preoperative anatomical identification of target segmental arteries, veins, and bronchi, with surgical details and postoperative outcomes recorded, including intraoperative pulmonary resection distribution, operation time, blood loss, chest tube drainage, extubation time, hospital stay, and complications. Following preoperative three-dimensional reconstruction, successful segmental lung surgeries were performed, predominantly with single segmental resection (92.2%), and a minority with combined segmentectomy (7.8%). Median operation time was 130225 minutes, with intraoperative blood loss at 70100 mL and postoperative chest tube drainage at 347 mL (159690mL). Median extubation time and hospital stay were 4 days and 7 days, respectively. Complications within the 3-month follow-up affected 11.7% of cases, including persistent pulmonary leakage (7.1%), pulmonary infection (4.3%), atelectasis (4.3%), and pleural effusion (1.4%), with no fatalities. Preoperative 3D reconstruction can help the operator to perform safe, efficient and accurate thoracoscopic segmental pneumonectomy, which is worth popularizing in clinic.

Vascular imaging for Stereoelectroencephalography: A safety and planning study

BackgroundStereoelectroencephalography (SEEG) is a procedure used to localize the epileptogenic zone in patients with medically refractory epilepsy, involving the stereotactic implantation of electrodes into brain parenchyma. Magnetic Resonance Imaging (MRI), Digital Subtraction Angiography, and Computed Tomography have been used preoperatively to prevent Intracranial Hemorrhage (ICH) by identifying electrode-vessel conflicts (EVC’s) on planned electrode trajectories. There is variation in the use of Digital Subtraction Angiography and non-invasive sequences for vascular planning. Digital Subtraction Angiography provides high spatial resolution, but carries risks of arterial dissection, groin and retroperitoneal hematoma, and a 0.5–1.9% risk of stroke. Our group has incorporated Intravenous Cone Beam Computed Tomography (CBCT A/V) Brain into our SEEG workflow, given its effective implementation in other neurosurgical domains. Primary aims include validating the safety of our CBCT A/V sequence for SEEG planning and determining if CBCT A/V is comparable to other modalities in detecting EVC’s. Secondary aims include elucidating the relationship of conflicting vessel calibre with ICH incidence in SEEG using CBCT A/V imaging. MethodsA single-center retrospective study was conducted of 20 patients who underwent preoperative CBCT A/V Brain and MRI Brain with gadolinium enhancement, encompassing 273 electrode implantations from August 2020 − July 2023. The incidence and grade of post-implant, post-explant symptomatic ICH and asymptomatic ICH was noted. The total number of EVC’s identifiable on MRI and CBCT A/V was recorded, along with average diameter of conflicting vessels. ResultsAcross 20 patients and 273 implanted electrodes, there were four ICH events, where two were symptomatic and two were asymptomatic. The mean diameter of EVC’s across all patients was 1.4 mm (±0.5). A significant difference (P < 0.0001) was observed between the number of EVC’s that CBCT A/V could identify (20) compared to MRI (6). Two EVC’s were identified in the region of two symptomatic ICH’s, with the mean diameter of these conflicted vessels being 1.5 mm (±0.4). The two symptomatic ICH-associated EVC’s were observed on CBCT A/V but not MRI. ConclusionsIn our series, CBCT A/V demonstrates an acceptable safety profile for SEEG planning compared to other imaging modalities. CBCT A/V identified significantly more EVC’s compared to MRI, including those contributing to transient symptomatic intracranial hemorrhage. A conflicting vessel calibre of less than 1.2 mm on CBCT A/V did not contribute to ICH in our SEEG series.

Ultrasound assessment of upper limb arteriovenous fistulas in hemodialysis patients at the Yaounde University Teaching Hospital.

Arteriovenous fistulas are created to serve as a vascular access in hemodialysis patients. Our study assessed the Doppler ultrasound characteristics of upper limb arteriovenous fistulas. We carried out a cross-sectional, consecutive sampling study at the Yaoundé University Teaching Hospital. We interviewed consenting patients on maintenance dialysis performed for at least one month via an upper limb arteriovenous fistula, which was subsequently scanned. We compared the proportions and means using chi-squared and ANOVA tests, respectively, with a threshold for significance set at a p value ≥0.05. Between 1 July and 31 August 2022, we recruited a total of 41 participants, of whom 56.1% were males. The mean age of the participants was 48.39 years. Radiocephalic (76%) and brachiocephalic (24%) arteriovenous fistulas were the only types present. The mean flow volume in the arteriovenous fistulas was 680.47 (365.98) ml/min, with 34.1% of the fistulas having a low flow volume. Also, 56.1% of the arteriovenous fistulas were stenosed, with the main site of stenosis being the juxta-anastomotic segment of the efferent vein. Aneurysms (53.7%), reverse flow (51.2%), venous luminal flaps (22%), and thrombus (17.1%) were the most common complications identified in the study population, with 78.05% of the arteriovenous fistulas having at least one complication. Factors associated with arteriovenous fistula stenosis included the patient body mass index and the radiocephalic fistula type. Diabetes, aneurysms, and luminal venous flaps were found to be associated with low flow volume. The prevalence of vascular modifications and stenosis within functional arteriovenous fistulas was high.

Fully automated assessment of the future liver remnant in a blood-free setting via CT before major hepatectomy via deep learning

ObjectivesTo develop and validate a deep learning (DL) model for automated segmentation of hepatic and portal veins, and apply the model in blood-free future liver remnant (FLR) assessments via CT before major hepatectomy.Methods3-dimensional 3D U-Net models were developed for the automatic segmentation of hepatic veins and portal veins on contrast-enhanced CT images. A total of 170 patients treated from January 2018 to March 2019 were included. 3D U-Net models were trained and tested under various liver conditions. The Dice similarity coefficient (DSC) and volumetric similarity (VS) were used to evaluate the segmentation accuracy. The use of quantitative volumetry for evaluating resection was compared between blood-filled and blood-free settings and between manual and automated segmentation.ResultsThe DSC values in the test dataset for hepatic veins and portal veins were 0.66 ± 0.08 (95% CI: (0.65, 0.68)) and 0.67 ± 0.07 (95% CI: (0.66, 0.69)), the VS values were 0.80 ± 0.10 (95% CI: (0.79, 0.84)) and 0.74 ± 0.08 (95% CI: (0.73, 0.76)), respectively No significant differences in FLR, FLR% assessments, or the percentage of major hepatectomy patients were noted between the blood-filled and blood-free settings (p = 0.67, 0.59 and 0.99 for manual methods, p = 0.66, 0.99 and 0.99 for automated methods, respectively) according to the use of manual and automated segmentation methods.ConclusionFully automated segmentation of hepatic veins and portal veins and FLR assessment via blood-free CT before major hepatectomy are accurate and applicable in clinical cases involving the use of DL.Critical relevance statementOur fully automatic models could segment hepatic veins, portal veins, and future liver remnant in blood-free setting on CT images before major hepatectomy with reliable outcomes.Key PointsFully automatic segmentation of hepatic veins and portal veins was feasible in clinical practice.Fully automatic volumetry of future liver remnant (FLR)% in a blood-free setting was robust.No significant differences in FLR% assessments were noted between the blood-filled and blood-free settings.Graphical

Drug-eluting bead transarterial chemoembolization as neoadjuvant therapy pre-liver transplantation for advanced-stage hepatocellular carcinoma.

The objectives of this study were to assess the safety and efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) as neoadjuvant therapy before liver transplantation (LT) for advanced-stage hepatocellular carcinoma (HCC) and to analyze the prognostic factors. To determine whether DEB-TACE before LT is superior to LT for advanced-stage HCC. A total of 99 individuals diagnosed with advanced HCC were studied retrospectively. The participants were categorized into the following two groups based on whether they had received DEB-TACE before LT: DEB-TACE group (n = 45) and control group (n = 54). The participants were further divided into two subgroups based on the presence or absence of segmental portal vein tumor thrombus (PVTT). The DEB-TACE group consisted of two subgroups: Group A (n = 31) without PVTT and group B (n = 14) with PVTT. The control group also had two subgroups: Group C (n = 37) without PVTT and group D (n = 17) with PVTT. Data on patient demographics, disease characteristics, therapy response, and adverse events (AEs) were collected. The overall survival (OS) and recurrence-free survival (RFS) rates were assessed using Kaplan-Meier curves. Univariate and multivariate Cox regression analyses were conducted to determine the parameters that were independently related to OS and RFS. The DEB-TACE group exhibited an overall response rate of 86.6%. Following therapy, there was a significant decrease in the median alpha-fetoprotein (AFP) level (275.1 ng/mL vs 41.7 ng/mL, P < 0.001). The main AE was post-embolization syndrome. The 2-year rates of RFS and OS were significantly higher in the DEB-TACE group than in the control group (68.9% vs 38.9%, P = 0.003; 86.7% vs 63.0%, P = 0.008). Within the subgroups, group A had higher 2-year rates of RFS and OS compared to group C (71.0% vs 45.9%, P = 0.038; 83.8% vs 62.2%, P = 0.047). The 2-year RFS rate of group B was markedly superior to that of group D (64.3% vs 23.5%, P = 0.002). Results from multivariate analyses showed that pre-LT DEB-TACE [hazard ratio (HR) = 2.73, 95% confidence interval (CI): 1.44-5.14, P = 0.04], overall target tumor diameter ≤ 7 cm (HR = 1.98, 95%CI: 1.05-3.75, P = 0.035), and AFP level ≤ 400 ng/mL (HR = 2.34; 95%CI: 1.30-4.19, P = 0.009) were significant risk factors for RFS. Additionally, pre-LT DEB-TACE (HR = 3.15, 95%CI: 1.43-6.96, P = 0.004) was identified as a significant risk factor for OS. DEB-TACE is a safe and efficient therapy for advanced-stage HCC and also enhances patient survival after LT.

Loci cg06256735 and cg15815843 in the MFAP5 gene regulatory regions are hypomethylated in varicose veins apparently due to active demethylation.

Varicose vein disease (VVD) is a common health problem worldwide. Microfibril-associated protein 5 (MFAP5) is one of the potential key players in its pathogenesis. Our previous microarray analysis revealed the cg06256735 and cg15815843 loci in the regulatory regions of the MFAP5 gene as hypomethylated in varicose veins which correlated with its up-regulation. The aim of this work was to validate preliminary microarray data, estimate the level of 5-hydroxymethylcytosine (5hmC) at these loci, and determine the methylation status of one of them in different layers of the venous wall. For this, methyl- and hydroxymethyl-sensitive restriction techniques were used followed by real-time PCR and droplet digital PCR, correspondingly, as well as bisulfite pyrosequencing of +/- oxidized DNA. Our microarray data on hypomethylation at the cg06256735 and cg15815843 loci in whole varicose vein segments were confirmed and it was also demonstrated that the level of 5hmC at these loci is increased in VVD. Specifically, among other layers of the venous wall, tunica (t.) intima is the main contributor to hypomethylation at the cg06256735 locus in varicose veins. Thus, it was shown that hypomethylation at the cg06256735 and cg15815843 loci takes place in VVD, with evidence to suggest that it happens through their active demethylation leading to up-regulation of the MFAP5 gene, and t. intima is most involved in this biochemical process.