Vein Segments Research Articles

Deep Learning-Based Wrist Vascular Biometric Recognition

The need for contactless vascular biometric systems has significantly increased. In recent years, deep learning has proven to be efficient for vein segmentation and matching. Palm and finger vein biometrics are well researched; however, research on wrist vein biometrics is limited. Wrist vein biometrics is promising due to it not having finger or palm patterns on the skin surface making the image acquisition process easier. This paper presents a deep learning-based novel low-cost end-to-end contactless wrist vein biometric recognition system. FYO wrist vein dataset was used to train a novel U-Net CNN structure to extract and segment wrist vein patterns effectively. The extracted images were evaluated to have a Dice Coefficient of 0.723. A CNN and Siamese Neural Network were implemented to match wrist vein images obtaining the highest F1-score of 84.7%. The average matching time is less than 3 s on a Raspberry Pi. All the subsystems were integrated with the help of a designed GUI to form a functional end-to-end deep learning-based wrist biometric recognition system.

Diagnosis of chronic venous insufficiency

For the treatment of chronic venous insufficiency (CVI), various therapeutic options are available. In addition to conservative compression therapy, classical vein surgery, sclerotherapy and endoluminal therapies are increasingly being used to treat varicose veins. For adifferentiated indication and correct treatment planning, astepwise diagnosis with clinical examination and documentation of typical symptoms, dynamic vein function measurement to assess the global venous status as well as aqualitative assessment of the exact insufficient vein segments by means of color-coded duplex sonography is required. Due to the non-invasiveness of the examination and the good assessability of therapeutically relevant parameters such as anatomic conditions, diameter, and reflux of insufficient veins, color-coded duplex sonography is considered the gold standard for imaging diagnostics.

Laparoscopic Anatomic Segment III Procurement in Pediatric Living Donor Liver Transplantation Using Real-Time ICG Fluorescence In Situ Reduction by the Glissonean Approach

Nowadays, anatomic hepatectomy has been widely accepted and acknowledged as a feasible practice during laparoscopic procedure. We herein report the first case of laparoscopic anatomic segment III (S3) procurement in pediatric living donor liver transplantation using real-time indocyanine green (ICG) fluorescence in situ reduction by Glissonean approach. A 36-year-old father volunteered for living donation to his daughter who was diagnosed with liver cirrhosis and portal hypertension due to biliary atresia. Preoperative liver function was normal with mild fatty liver. Liver dynamic computed tomography showed a left lateral graft volume of 379.43 cm3 with a graft to recipient weight ratio (GRWR) of 4.77%. The ratio of the maximum thickness of the left lateral segment to the anteroposterior diameter of the recipient's abdominal cavity was 1.20. Hepatic veins of segment II (S2) and S3 separately flowed into the middle hepatic vein. The estimated S3 volume was 173.16 cm3 and GRWR was 2.18%. The estimated S2 volume was 118.54 cm3 and GRWR was 1.49%. Laparoscopic anatomic S3 procurement was scheduled. Liver parenchyma transection was divided into 2 steps. Step I: Anatomic in situ reduction of S2 by using real-time ICG fluorescence. Step II: Separating the S3 along the right side of sickle ligament. The left bile duct was identified and divided by ICG fluorescence cholangiography. The total operation time was 318 minutes without transfusion. The final graft weight was 208 g with GRWR of 2.62%. The donor was discharged uneventfully on postoperative day 4, and the graft function recovered to normal in the recipient without any graft related complication. Laparoscopic anatomic S3 procurement with in situ reduction is a feasible and safe procedure in selected donors in pediatric living donor liver transplantation.

Development of a Novel Ex Vivo Porcine Hepatic Segmental Perfusion Proof-of-Concept Model Towards More Ethical Translational Research.

Introduction Ex vivo machine perfusion describes the technique where organs are continuously perfused and oxygenated extracorporeally (at physiological conditions) to maintain the organs' viability. To our knowledge, there are currently no reported studies describing ex vivo perfusion of a single hepatic segment. Here, we describe the development of a porcine ex vivo hepatic segmental perfusion model to demonstrate proof of concept and support further research into the ex vivo perfusion of the human liver using discarded tissue. Methods Whole livers were retrieved from abattoir-derived pigs and connected to a normothermic extracorporeal perfusion circuit. Constant segmental perfusion via the common or segmental hepatic artery and portal vein with heparinised autologous blood was established. The viability of the perfused organ was assessed by monitoring perfusion pressures, flow rates and histology samples. Results Following perfusion and optimisation of the model for three hepatic segments, the third perfusion demonstrated viable hepatocytes centrally after 4 hof segmental perfusion. Conclusion Ex vivo hepatic segmental perfusion is technically challenging but its success in a porcine model and the principles learned should facilitate the development of an analogous human model using discarded tissue following formal liver resections. The model would usea healthy liver segment following a major formal resection such as a hemi-hepatectomy and ex vivo perfusion performed via a segmental hepatic artery and portal vein. If successful this model would represent a significant development and enableethical translation research to assess the response of human livers to a variety of stressors, including toxicity and infection.

Unsubtracted Roadmap Technique for Preventing Cement Leakage During Percutaneous Vertebroplasty: A Retrospective Cohort Study

To determine the effectiveness of the unsubtracted roadmap technique (USRT) for decreasing cement leakage (CL) during percutaneous vertebroplasty (PVP). In this retrospective cohort study, patients who underwent PVP between January and November 2018 were included. Patients were divided into the unsubtracted roadmap (UR) (n=20) and conventional venography (CV) (n=22) groups. USRT was performed before cement injection in the UR group. Computed tomography was performed on the first day after PVP in both groups to assess the CL. The vertebral height restoration rate was confirmed by radiography before and after the procedure. The CL location was classified as basivertebral vein (type B), segmental vein (type S), or cortical defect (type C). Visual analog scale and Oswestry Disability Index scores before and after surgery were calculated to confirm clinical outcomes. Based on the computed tomography images, CL occurred in 7 (34.78%) and 15 (63.64%) cases in the UR and CV groups, respectively. Number of CL type B, S, and C in the UR and CV groups were 2 and 6, 3 and 6, and 2 and 3, respectively. The injected cement volume was not significantly different between the UR (4.86mL) and the CV (4.75mL) groups (P= 0.450). Regarding vertebral body height restoration (P= 0.856) and clinical outcomes, there were no significant differences between both groups. Radiation exposure was significantly less in the UR group (P=0.019). USRT is an effective method for reducing CL and radiation exposure during PVP.

A rare case of neonatal-onset hepatic sinusoidal obstruction syndrome

A male infant, aged 1 month and 14 days, was admitted to the hospital due to abdominal distension lasting for 2 weeks and worsening for 3 days. The infant had a history of omphalitis. Physical examination revealed severe abdominal distension, prominent abdominal wall veins, hepatosplenomegaly, and massive ascites. There was a slight elevation in liver transaminase levels. Liver ultrasound and CT scans demonstrated the absence of visualization of the intrahepatic segment of the portal vein and the left, middle, and right veins of the liver, indicating occlusion of these vessels, along with surrounding fibrous hyperplasia. The clinical diagnosis was hepatic sinusoidal obstruction syndrome resulting from omphalitis. A large amount of bloody ascites developed after 12 days of hospitalization, resulting in hypovolemic shock and respiratory failure. The infant passed away following the family's decision to discontinue treatment. This article focuses on the diagnostic approach and multidisciplinary management of neonatal-onset hepatic sinusoidal obstruction syndrome, as well as provides insights into the differential diagnosis of hepatomegaly and ascites.

Sulodexide Develops Contraction in Human Saphenous Vein via Endothelium-Dependent Nitric Oxide Pathway.

Chronic venous disease (CVD) is a proqgressive and underestimated condition related to a vicious circle established by venous reflux and endothelial inflammation, leading to vein dilation and histology distortion, including loss of media tone. Sulodexide (SDX) is a drug restoring the glycocalyx that demonstrated endothelial protection and permeability regulation, together with anti-thrombotic and anti-inflammatory roles. In the lab it also exhibited vein contractility function. The aim of the present study was to show the possible role of endothelium and nitric oxide pathway on SDX's veno-contractile effect on human saphenous veins. The remnants of great saphenous vein (GSV) segments (n = 14) were harvested during coronary artery bypass graft surgery. They were dissected as endothelium-intact (n = 8) and denuded rings (n = 6). First, a viability test was carried out in bath with Krebs-Henseleit solution to investigate a control and basal tension value. After this, cumulative doses of SDX were applied to rings and contraction values were studied in endothelium-intact phenylephrine (PheE, 6 × 10-7 M) pre-contracted vein rings. Finally, endothelium-intact PheE pre-contacted vein rings were treated by nitric oxide synthase inhibitor Nω-nitro-L-arginine methyl ester (L-NAME, 10-4 M) for 10 min. Contraction protocol was applied, and contraction values were measured in cumulative doses of SDX. The same protocol was applied to endothelium-denuded vein rings to investigate the effect of SDX. Saphenous vein rings showed an increase in contraction to cumulative doses of SDX. In endothel-intact rings, KCL-induced contraction from 92.6% ± 0.3 to 112.9% ± 0.4 with cumulative SDX doses. However, SDX did not show any veno-contractile effect on endothel-denuded rings. In denuded rings contraction responses measured from 94.9% ± 0.3 to 85.2% ± 0.3 with increasing doses of SDX, indicating no significant change. Nitric oxide synthase inhibitor (L-NAME) prohibited the contraction response of the sulodexide in all dosages, indicating that the contractile function of SDX was mediated by endothelial derived nitric oxide. Results of endothel-intact and denuded rings with L-NAME showed a similar incline with denuded rings with SDX only. The results confirmed SDX's veno-contractile effect in human samples, by means of nitric oxide synthase pathways involvement.

Identification and Validation of Hub Genes in the Stenosis of Arteriovenous Fistula.

Arteriovenous fistula (AVF) is the most widely used hemodialysis vascular access in China. However, stenosis of the AVF limits its use. The mechanism of AVF stenosis is currently unknown. Therefore, the purpose of our study was to explore the mechanisms of AVF stenosis. In this study, we identified the differentially expressed genes (DEGs) based on the Gene Expression Omnibus (GEO) dataset (GSE39488) between venous segments of AVF and normal veins. A protein-protein interaction (PPI) network was constructed to identify hub genes of AVF stenosis. Finally, six hub genes (FOS, NR4A2, EGR2, CXCR4, ATF3, and SERPINE1) were found. Combined with the results of the PPI network analysis and literature search, FOS and NR4A2 were selected as the target genes for further investigation. We validated the bioinformatic results via reverse transcription PCR (RT-PCR) and Western blot analyses on human and rat samples. The expression levels of the mRNA and protein of FOS and NR4A2 were upregulated in both human and rat samples. In summary, we found that FOS may play an important role in AVF stenosis, which could be a potential therapeutic target of AVF stenosis.

SDA-UNet: a hepatic vein segmentation network based on the spatial distribution and density awareness of blood vessels

Objective. Hepatic vein segmentation is a fundamental task for liver diagnosis and surgical navigation planning. Unlike other organs, the liver is the only organ with two sets of venous systems. Meanwhile, the segmentation target distribution in the hepatic vein scene is extremely unbalanced. The hepatic veins occupy a small area in abdominal CT slices. The morphology of each person’s hepatic vein is different, which also makes segmentation difficult. The purpose of this study is to develop an automated hepatic vein segmentation model that guides clinical diagnosis. Approach. We introduce the 3D spatial distribution and density awareness (SDA) of hepatic veins and propose an automatic segmentation network based on 3D U-Net which includes a multi-axial squeeze and excitation module (MASE) and a distribution correction module (DCM). The MASE restrict the activation area to the area with hepatic veins. The DCM improves the awareness of the sparse spatial distribution of the hepatic veins. To obtain global axial information and spatial information at the same time, we study the effect of different training strategies on hepatic vein segmentation. Our method was evaluated by a public dataset and a private dataset. The Dice coefficient achieves 71.37% and 69.58%, improving 3.60% and 3.30% compared to the other SOTA models, respectively. Furthermore, metrics based on distance and volume also show the superiority of our method. Significance. The proposed method greatly reduced false positive areas and improved the segmentation performance of the hepatic vein in CT images. It will assist doctors in making accurate diagnoses and surgical navigation planning.

Comparison of endovenous laser ablation and conservative treatment in acute thrombophlebitis of the varicose great saphenous vein: rationale, design and first results of clinical trial

Thrombophlebitis of the superficial lower limb veins is one of the most common complications of chronic vein disease. Nowadays a long-term (at least 45 days) subcutaneous injection of fondaparinux sodium or heparin in combination with elastic compression of the limb is recommended for treatment of superficial vein thrombosis with a moderate risk of thrombus propagation to deep venous system. However, long-term use of anticoagulants is not always possible and sometimes contraindicated. Endovenous laser ablation (EVLA) around thrombus-free junction of great or small saphenous veins without subsequent long-term use of anticoagulants seems to be a promising intervention for treatment of acute thrombophlebitis of varicose superficial veins.The prospective single-center randomized open-label clinical trial was dedicated for comparison the efficacy and safety of three following treatments options for patients with acute thrombosis of the varicose great saphenous vein and location of thrombi in the trunk and/ or its large inflows: EVLA close to saphenous vein junction without anticoagulation, EVLA and 7 days of anticoagulation and noninvasive treatment with anticoagulation for 45 days (subcutaneous injections of the fondaparinux 2,5 mg). Class 2 compression stockings are used in all patients. Adverse outcomes are recorded at 7, 45 and 90 days after randomization. These include the progression of superficial vein thrombosis, recurrent superficial vein thrombosis, thrombosis involvement of the superficial segment of the perforating vein up to the fascia, deep vein thrombosis according to compression ultrasound, and pulmonary embolism with symptoms. Bleedings according to the World Society of Thrombosis and Hemostasis and the Academic Research Consortium classification as well other complications are also recorded. The first 30 patients included in the study have a low incidence of venous thrombosis risk factors and localization of the thrombus relatively far from the saphenofemoral junction. EVLA resulted in persistent cessation of venous blood flow at the intervention site. New episodes of venous thrombosis were noted only in the group of medical treatment — deep vein thrombosis of the contralateral tibia 5 days after stopping of 45-day treatment with fondaparinux and thrombus in the recanalized inflow of the great saphenous vein without involving its trunk at the 21st day after stopping of 45-day injection of fondaparinux. There were no complications in the area of intervention and bleedings.

Internal jugular vein reconstruction using a triple-paneled great saphenous vein graft

BackgroundDonor–recipient diameter discrepancy can be problematic when using an autologous great saphenous vein graft for internal jugular vein reconstruction. A triple-paneled method of saphenous vein grafting is one solution.Case presentationA 54-year-old man with a thyroid papillary carcinoma underwent total thyroidectomy and bilateral neck dissection. An 8-cm segment of the right internal jugular vein was resected. For reconstruction, a 30-cm segment of the great saphenous vein was harvested and divided into three pieces of equal length. After opening each piece longitudinally, they were sutured together in a side-by-side fashion to create a cylinder that was used to reconstruct the internal jugular vein defect. The graft was patent 10 months after the surgery.ConclusionThe triple-paneled method is feasible for autologous great saphenous vein graft reconstruction of the internal jugular vein.

Portal-mesenteric vein resection for pancreatic cancer: Results in par with the defined benchmark outcomes.

Patients with pancreatic cancer (PC), which may involve major peripancreatic vessels, have been generally excluded from surgery, as resection was deemed futile. The purpose of this study was to analyze the results of portomesenteric vein resection in borderline resectable or locally advanced PC. This study comprises the largest series of such patients in Greece. Investigator-initiated, retrospective, noncomparative study of patients with borderline resectable or locally advanced adenocarcinoma undergoing pancreatectomy en-block with portal and/or superior mesenteric vein resection in a tertiary referral center in Greece between January 2014 and October 2021. Follow-up was complete up to December 2021. Operative and outcome measures were determined. Forty patients were included. Neoadjuvant therapy was administered to only 58% and was associated with smaller tumor size (median: 2.9 cm vs. 4.2 cm, p = 0.004), but not with increased survival. Though venous wall infiltration was present in 55%, it was not associated with tumor size, or Eastern Cooperative Oncology Group (ECOG) status. Resection was extensive: a median of 27 LNs were retrieved, R0 resection rate (≥1 mm) was 87%, and median length of resected vein segments was 3 cm, requiring interposition grafts in 40% (polytetrafluoroethylene). Median ICU stay was 0 days and length of hospitalization 9 days. Postoperative mortality was 2.5%. Median follow-up was 46 months and median overall survival (OS) was 24 months. Two-, 3- and 5-year OS rates were 49%, 33%, and 22% respectively. All outcomes exceeded benchmark cutoffs. Lower ECOG status was positively correlated with longer survival (ECOG-0: 32 months, ECOG-1: 24 months, ECOG-2: 12 months, p = 0.02). This series of portomesenteric resection in borderline resectable or locally advanced PC demonstrated a median survival of 2 years, extending to 32 months in patients with good performance status, which meet or exceed current outcome benchmarks.

Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation.

The impact of ablation parameters on acute tissue lesion formation after pulmonary vein isolation (PVI) has not been sufficiently evaluated in patients with atrial fibrillation. Radiofrequency ablation lesion can be visualized by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). We sought to quantitatively analyze the relationship between ablation parameter and tissue lesion following PVI at different segments of pulmonary vein (PV) using LGE-CMR. Twenty-one patients with atrial fibrillation who underwent PVI procedure were retrospectively enrolled. All patients underwent LGE-CMR examination within 3 days after radiofrequency ablation. Ablation parameters during PVI were documented, including lesion size index (LSI), force-time integral (FTI), power, contact force, temperature, and time of duration. The ablation point was projected onto 3-dimensional (3D) left atrial shell constructed base on LGE-CMR and corresponding image intensity ratio (IIR) was calculated on the same shell. A tissue lesion point was defined when the LGE-CMR IIR was > 1.2. In total, 1,759 ablation points were analyzed. The ablation parameters and IIRs for each PV segment were significantly different (P < 0.0001). IIRs corresponding to ablation points at posterior of PV tended to be higher than those at non-posterior of PV when similar ablation parameters were applied during ablation. LSI was a better predictor of tissue lesion existence following PVI than FTI, contact force, power, temperature, and duration time at non-posterior wall of PV. The IIR showed positive correlation with LSI at non-posterior wall of PV (non-posterior of right PV, r = 0.13, P = 0.001, non-posterior of left PV, r = 0.26, P < 0.0001). When similar ablation parameters were applied during PVI, the posterior wall of PV had more severe tissue lesion than non-posterior wall of PV. Therefore, it was reasonable to decrease ablation energy at posterior wall of PV. Moreover, LSI was a better index to reflect tissue lesion quality following PVI at non-posterior of PV.

Displaced bronchus and anomalous pulmonary vein passing dorsal to the pulmonary artery in a patient who underwent right upper lobectomy for lung cancer with lymph node metastases: a case report

BackgroundTracheobronchial anomalies are extremely rare and are often associated with pulmonary arteriovenous anatomical anomalies. An anomalous right upper vein segment that passes between the pulmonary artery (PA) and bronchus is a rare vascular abnormality. We report a case of a displaced superior posterior branch (B2) that was independent of the superior apical/anterior branch (B1 + 3) accompanied by anomalous right superior pulmonary vein (SPV) anatomy in a patient who underwent right upper lobectomy for lung cancer with lymph node metastases.Case presentationA 73-year-old asymptomatic woman was shown to have an abnormal shadow on chest radiography performed during medical checkup and visited our hospital for further evaluation. The patient was diagnosed with primary lung adenocarcinoma (c-T1cN1M0, stage IIB) involving the right superior posterior segment (S2) with an abnormally displaced B2 and an anomalous upper vein segment that was observed to run dorsal to the PA and anterior to the right upper bronchus. We performed right upper lobectomy and systematic hilar and mediastinal nodal dissection via video-assisted thoracoscopic surgery. Intraoperative findings revealed a displaced B2 bronchus independent from the B1 + 3 and an anomalous SPV, which was consistent with preoperative imaging findings.ConclusionPreoperative bronchoscopy and three-dimensional computed tomography angiography (3D-CTA) are essential to confirm bronchial bifurcation and vascular abnormalities to aid with meticulous surgical planning to select the optimal operative technique.

Duration of ergovaline exposure influences serotonin-mediated vasoactivity of bovine mesenteric vasculature.

Ergovaline (ERV), produced in toxic endophyte-infected tall fescue, causes potent vasoconstriction of bovine peripheral and visceral vasculature. Ergovaline acts as both an agonist and an antagonist in bovine gut blood vessels through serotonin (5-HT) receptors and it appears that the type of action could be influenced by the extent of ERV exposure. Because it was unclear how the duration of ERV exposure influences 5-HT-mediated vasoactivity, experiments were designed to evaluate how simultaneous or prior ERV exposure influenced 5-HT-mediated vasoactivity of mesenteric artery (MA) and vein (MV) segments from Holstein steers (N = 10). Vessels were incubated in Krebs-Henseleit buffer containing 0, 0.01, or 0.1 μM ERV for 24 h prior to the 5-HT dose-response or exposed to fixed concentrations of 0, 0.01, or 0.1 μM ERV simultaneously during the 5-HT dose-response. Vessels were suspended in chambers of a multimyograph containing Krebs-Henseleit buffer and equilibrated to 1 g tension for 90 min. Vessels were exposed to increasing concentrations of 5-HT (5 × 10-8 M to 1 × 10-4 M) every 15 min and contractile responses were normalized as a percentage of the maximum contractile response induced by 120 mM KCl reference addition. Two-way analysis of variance was used to separately analyze data for each vessel type and duration of exposure using the MIXED procedure of SAS. When 5-HT concentration increased from 5 × 10-8 to 1 × 10-6 M, simultaneous addition of 0.1 μM ERV increased (P < 0.01) the contractile response of MV compared with additions of 0 and 0.01 μM ERV. At 1 × 10-4 M 5-HT, the simultaneous presence of 0.01 and 0.1 μM ERV decreased (P < 0.01) the contractile response of both MA and MV compared with 0 μM ERV addition. As 5-HT concentrations increased, the contractile response increased (P < 0.01) in both MA and MV with no previous ERV exposure, but decreased in MA and MV with 24 h prior exposure to 0.01 and 0.1 μM ERV. These data demonstrate that the duration of ERV exposure influences 5-HT-mediated vasoconstriction and likely vasorelaxation in bovine mesenteric vasculature. If ERV and 5-HT exposure occur simultaneously, ERV can act as a partial agonist of 5-HT-mediated vasoconstriction. If 5-HT exposure occurs after blood vessels have had prior ERV exposure, it appears that 5-HT may induce vasorelaxation of blood vessels. More research is needed to identify cellular and molecular mechanisms involved with 5-HT-mediated vasoactivity.

Infrainguinal bypass using varicose veins with external scaffolding

Background: Chronic limb-threatening ischemia (CLTI) is associated with high rates of mortality, amputation, and impaired quality of life. The great saphenous vein (GSV) is the first-choice material for surgical revascularization of the infrapopliteal arteries. It may occur that the autologous material is not of good quality, presenting varicosities and ectasias which can affect bypass patency. The long-term patency rate of these operations is still not clear and few evidences are still present in literature. The aim of our study is to report the technical feasibility and efficacy of infrainguinal bypasses performed with autologous ectatic or varicose vein and with the use of external vascular supports. Materials and Methods: From September 2005 to January 2023, infrainguinal venous bypasses with autologous varicose or ectatic vein using an external vascular support were collected in the present study. The indication for surgery was the presence of CLTI with rest pain and/or gangrene. In case of localized dilatations of a segment of the GSV a partial bypass scaffolding (i.e. 10 to 15 cm) was used. Patients with a long segment of varicose vein underwent a completely covered ex situ vein bypass after a bench devalvulation. Follow-up was performed at 1, 3, 6 and 12 months and every 6 months thereafter, by clinical examination and color Doppler ultrasound. The outcome measures were technical success, 30-day and long-term primary and primary assisted bypass patency, as well as the limb salvage rate. External support infection rates upon reoperation for surgical wound infection as well as graft aneurysmal dilatation over time were also analyzed. Results: 63 patients underwent infrainguinal bypass with autologous varicose or ectatic venous material. In 51 patients (80.9%) the GSV was used, in 3 cases (4.8%) the short saphenous vein (SSV) and in 9 cases (14.3%) a composition of both saphenous veins or with one arm vein. Technical success was achieved in all cases and the mean surgical time was 320±80 minutes. No intraoperative mortality was recorded. At 30 days the primary patency and limb salvage rate were 97.8%, due to two early bypass occlusions. No infections of the external vascular support were recorded. During a mean follow-up of 54.6±27.2 months 8 (13.1%) hemodynamic stenoses requiring reoperation and 3 (4.9%) thromboses of the bypass were found. The primary patency rate was 62.8%, assisted primary 76.3%, with a limb salvage rate of 78%. Conclusion: In our experience, the great saphenous vein, even if ectatic or varicose, has proved to be a valuable conduit for the preparation of a infrainguinal bypasses in CLTI patients, with a satisfactory patency and limb salvage rates. In addition, composite vein graft also using arm vein, could be used in infrainguinal bypass with acceptable results. Also in the light of these results, a “saphenous sparing" surgical approach during corrective surgery for venous insufficiency of the lower limbs should be recommended, so as not to preclude future surgical treatments for limb salvage.

PS-BPR01-4: A CASE OF ALDOSTERONE-PRODUCING ADENOMA DIAGNOSED BY ADRENAL ARTERIOGRAPHY AND BRANCH SELECTIVE ADRENAL VENOUS SAMPLING

Case report: A 43-year-old man had been followed up for hypertension and hypokalemia, but self-interrupted his hospital visits for the last four years. Based on the serum potassium level of 2.7 mEq/L, plasma aldosterone concentration of 202 pg/mL, and plasma renin activity of 1.1 ng/mL/hr, he was suspected of primary aldosteronism and was admitted to the previous hospital. A saline suppression test and a rapid ACTH stimulation test were both positive, and 24-hr urinary aldosterone level was 19 μg/day under sodium loading of 170 mEq/day, leading to the diagnosis of primary aldosteronism. Since contrast-enhanced CT showed an 8 mm-sized adenoma in the lower portion of the left adrenal gland, an aldosterone-producing adenoma was suspected and a non-segmental adrenal venous sampling (AVS) was performed. However, it yielded apparent bilateral aldosterone suppression in the main trunk of the bilateral adrenal veins, where the aldosterone-to-cortisol (A/C) ratio was lower than that in the inferior vena cava even after ACTH loading. The patient was referred to our hospital for a segmental AVS. Arteriography was first performed from the left inferior adrenal artery to confirm the outflow vessels from the adenoma. Strikingly, there was an aberrant vein which drained into the proximal segment of the left adrenal vein. CT imaging at the time of arteriography revealed, in addition to the known adenoma, a 6 mm-sized micronodule in the lateral region of the left adrenal gland, and the aberrant vein appeared to be the main outflow vessel from the micronodule. A segmental AVS was performed, and blood samples were taken from the bilateral adrenal veins including the aberrant vein and the main trunk of the left adrenal vein proximal to its confluence. The A/C ratio was highest in the aberrant vein, followed by in the main trunk of the proximal left adrenal vein, while it was markedly suppressed in other branches and the main trunk of the left adrenal vein distal to the confluence of the aberrant vein. Based on these results, the presence of aldosterone-producing adenoma in the left adrenal gland was suggested. Laparoscopic partial left adrenalectomy was performed without postoperative complications. Hypertension and hypokalemia were fully resolved afterwards. Conclusions: Adrenal arteriography and segmental AVS should be considered in such cases that apparent bilateral aldosterone suppression is noted in conventional AVS in patients with clinically suspected aldosterone-producing adenoma.

Abernethy Malformation: Possible Diagnosis for Patients with Congenital Heart Disease and Persistent Cyanosis.

Infant, nine months of age, female, diagnosed with congenital heart disease, with signs of heart failure associated with cyanosis and difficulty in gaining weight. Cardiomegaly with prevalence of pulmonary vascular network. Ectopic atrial rhythm with right ventricular overload and left anterosuperior divisional block. Single atrium with absent interatrial septum, atrioventricular connection with a single valve and two orifices, with increased pulmonary pressure and high Qp/Qs. Absence of portal vein and intrahepatic segment of the inferior vena cava. Infrahepatic portion continuing with the azygos system at the level of the thoracic cavity, presence of mesenteric-caval communication associated with signs suggestive of hepatic peribiliary fibrosis. Abernethy malformation is a rare condition and represents an extrahepatic portosystemic shunt that develops between the mesenteric-portal vasculature and the systemic veins. It may be associated with cardiac malformations and advance with pulmonary hypertension and even the need for liver transplantation. Persistent cyanosis after corrective surgery led to a deeper investigation and correct diagnosis of this malformation. Sternotomy with 68 minutes of cardiopulmonary bypass and nine minutes of total circulatory arrest. In the postoperative period, persistence of cyanosis was evident, even though there were no immediate complications. Patient was discharged on the 10th postoperative day. An abdominal computed tomography angiography confirmed the diagnosis of Abernethy type I malformation, and the patient was transferred for liver transplantation after congenital heart disease treatment.

3D autofluorescence imaging of hydronephrosis and renal anatomical structure using cryo-micro-optical sectioning tomography.

Rationale: Mesoscopic visualization of the main anatomical structures of the whole kidney in vivo plays an important role in the pathological diagnosis and exploration of the etiology of hydronephrosis. However, traditional imaging methods cannot achieve whole-kidney imaging with micron resolution under conditions representing in vivo perfusion. Methods: We used in vivo cryofixation (IVCF) to fix acute obstructive hydronephrosis (unilateral ureteral obstruction, UUO), chronic spontaneous hydronephrosis (db/db mice), and their control mouse kidneys for cryo-micro-optical sectioning tomography (cryo-MOST) autofluorescence imaging. We quantitatively assessed the kidney-wide pathological changes in the main anatomical structures, including hydronephrosis, renal subregions, arteries, veins, glomeruli, renal tubules, and peritubular functional capillaries. Results: By comparison with microcomputed tomography imaging, we confirmed that IVCF can maintain the status of the kidney in vivo. Cryo-MOST autofluorescence imaging can display the main renal anatomical structures with a cellular resolution without contrast agents. The hydronephrosis volume reached 26.11 ± 6.00 mm3 and 13.01 ± 3.74 mm3 in 3 days after UUO and in 15-week-old db/db mouse kidneys, respectively. The volume of the cortex and inner stripe of the outer medulla (ISOM) increased while that of the inner medulla (IM) decreased in UUO mouse kidneys. Db/db mice also showed an increase in the volume of the cortex and ISOM volume but no atrophy in the IM. The diameter of the proximal convoluted tubule and proximal straight tubule increased in both UUO and db/db mouse kidneys, indicating that proximal tubules were damaged. However, some renal tubules showed abnormal central bulge highlighting in the UUO mice, but the morphology of renal tubules was normal in the db/db mice, suggesting differences in the pathology and severity of hydronephrosis between the two models. UUO mouse kidneys also showed vascular damage, including segmental artery and vein atrophy and arcuate vein dilation, and the density of peritubular functional capillaries in the cortex and IM was reduced by 37.2% and 49.5%, respectively, suggesting renal hypoxia. In contrast, db/db mouse kidneys showed a normal vascular morphology and peritubular functional capillary density. Finally, we found that the db/db mice displayed vesicoureteral reflux and bladder overactivity, which may be the cause of hydronephrosis formation. Conclusions: We observed and compared main renal structural changes in hydronephrosis under conditions representing in vivo perfusion in UUO, db/db, and control mice through cryo-MOST autofluorescence imaging. The results indicate that cryo-MOST with IVCF can serve as a simple and powerful tool to quantitatively evaluate the in vivo pathological changes in three dimensions, especially the distribution of body fluids in the whole kidney. This method is potentially applicable to the three-dimensional visualization of other tissues, organs, and even the whole body, which may provide new insights into pathological changes in diseases.

The clinical outcomes of patients with vascular invasion after deceased donor liver transplantation.

Vascular invasion is a major risk factor for poor prognosis of liver transplantation (LT) for hepatocellular carcinoma (HCC), and this study aimed to evaluate the feasibility and efficacy of deceased donor LT (DDLT) for the treatment of microvascular invasion (MVI) and segmental portal vein tumor thrombus (PVTT). We retrospectively analyzed 141 patients who received DDLT for HCC combined with vascular invasion from January 2016 to December 2023 at Shulan (Hangzhou) Hospital. To assess the risk of vascular invasion associated with the LT prognosis, we evaluated various clinicopathologic variables. The recurrence-free survival (RFS) and overall survival (OS) based on different types of vascular invasion were also analyzed. A total of 141 patients were enrolled in this study, including patients with MVI (MVI group, n=60), segmental PVTT with segmental branches of the portal vein or above (segmental PVTT group, n=13), and lobar PVTT involving the left and right branches of the portal vein or the main portal vein (lobar PVTT group, n=68). Between the tumor recurrence group and the no recurrence group, there were significant differences in alpha-fetoprotein (AFP) level, tumor total diameter, pretransplant treatment, histological grade, and types of vascular invasion. Subgroup analyses were performed according to the types of vascular invasion, the lobar PVTT group had a significantly higher recurrence rate (lobar vs. MVI: 88.2% vs. 35.0%, lobar vs. segmental: 88.2% vs. 30.8%, both P<0.001), but there was no difference in recurrence rate between the MVI group and the segmental PVTT group (35.0% vs. 30.8%, P>0.99). The 3-year RFS rate and OS rate were as low as 9.1% and 45.9% in the lobar PVTT group, compared with 65.5% and 76.0% in the MVI group, 58.3% and 75.0% in the segmental PVTT group. Multivariate analysis showed that Child-Pugh classification, tumor total diameter, histological grade, and lobar PVTT were the main risk factors affecting RFS, whereas Child-Pugh classification, tumor total diameter, and lobar PVTT were the main risk factors affecting OS. Finally, analysis of the segmental PVTT group revealed that RFS was significantly higher in well and moderately-differentiated patients than in poor-differentiated patients (P=0.01). Lobar PVTT remains a contraindication to LT, whereas segmental PVTT can still be considered for LT after careful screening.