Vascular Complications In Patients Research Articles

Measurement of left ventricular volume with admittance incorporated onto percutaneous ventricular assist device.

Percutaneous ventricular assist devices (pVADs) incorporated with admittance electrodes have been validated in animal studies for accurate instantaneous volumetric measurements. Since miniaturization of the pVAD profile is a priority to reduce vascular complications in patients, our study aimed to validate admittance measurements using three electrodes instead of the standard four. Complex admittance was measured between an electrode pair and a pVAD metallic blood-intake tip, both with finite element analysis and on the benchtop. The catheter and electrode arrays were first simulated inside prolate ellipsoid models of the left ventricle (LV) demonstrating current flow throughout all parts of the LV as well as minimal influence of off-center catheter placement in the recorded signal. Admittance measurements were validated in 3D-printed models of healthy and dilated hearts (100-400mL end-diastolic volumes). Minimal interference between a pVAD motor and the current signal of our admittance system was demonstrated. A modified Wei's equation focused on three electrodes was developed to be compatible with reduced profile pVADs occurring clinically, incorporated with admittance electrodes and wires. The modified equation was compared against Wei's original equation showing improved accuracy of calculated volumes. Reducing electrode footprint can simplify the incorporation of Admittance technology on any pVAD, allowing for instantaneous recognition of native heart recovery and assistance with pVAD weaning.

#1227 The role of P-selectin (CD62P) expression in renal tissue in the development of diabetic nephropathy

Abstract Background and Aims The prevalence of diabetic nephropathy (DN) is increasing in line with the increase in the incidence of diabetes mellitus (DM) worldwide. The latest data from the International Diabetes Federation (IDF) predicts that by 2045, more than 10.5% of adults worldwide will have diabetes. This will lead to kidney damage in 100-250 million people. DN is characterized by structural and functional changes. As a result of chronic hyperglycemia, pathogenic changes in the vascular wall develop, and the frequency of micro- and macrovascular complications associated with morbidity and mortality among patients with diabetes increases. However, the exact mechanism of vascular complications is not completely clear. Endothelial dysfunction plays a key role in triggering the development of inflammatory mechanisms that are associated with vascular complications in patients with type 2 diabetes mellitus (T2DM). Activation of the endothelium due to increased release of cytokines and expression of adhesion molecules promotes platelet activation and their adhesion to the activated endothelium. Selectins (E-selectin, L-selectin and P-selectin) play a major role in the development of microvascular complications. The aim of the study was to examine the role of P-selectin (CD62p) expression in the glomerular endothelium and peritubular capillaries in patients with different morphological classes of DN and to evaluate its effect on the development and progression of morphological changes in renal tissue. Method Was examined 49 patients with T2DM complicated by the development of DN. The average age of the patients was 66.58 ± 3.27 years. There were 35 women, 14 men. The duration of the disease was 17.70 ± 0.35 years. The duration of DN from the moment of detection of microalbuminuria to the morphological examination of the renal tissue and diagnosis was 1.65 ± 0.34 years. All patients underwent light and immunofluorescence microscopy of kidney tissue biopsies obtained by intravital puncture biopsy. Morphological changes in tissue were assessed in accordance with the latest international classification of diabetic nephropathy developed by the Scientific Committee of the Pathology Society, USA. According to light microscopy data, class IIa (mild mesangial expansion) was detected in 12 patients, class IIb (severe mesangial expansion) in 14 patients, class III (Kimmelstil–Wilson nodular lesions) in 19 patients, and class IV (advanced diabetic glomerulosclerosis) in 5 patients. In addition to light microscopy, the expression of CD62β (P-selectin) in the glomerular endothelium and in peritubular capillaries was determined in all patients. FITc-labeled monoclonal antibodies (FITC anti-human CD62p Antibody, clone AK4 Cat#304904), were used (Biolegend, USA). Results Analysis of biopsy tissue from DN patients showed that CD62p expression is detected both in the glomerular endothelium (1.6383 ± 0.4789 (95% CI: 0.9574-2.7234)) and in peritubular capillaries (1.1702 ± 0.1308 (95% CI: 0.9149–1.4250)). Using the linear regression method with the calculation of the coefficients of determination R2 (R Square), the values of the F criterion, significant regression models were obtained: Expression of CD62p in the glomerular endothelium promotes the development and progression of arteriolar hyalinosis (R2=0.213, F=12.476 p=0.001); expansion of the mesangial matrix (R2=0.362, F=26.09, p=0.0001); thickening of the basement membrane (R2=0.127, F=6.57, p=0.014); development and progression of nodular Kimmelstiel–Wilson lesions (R2=0.106, F=5.360, p=0.025). Expression of CD62p in peritubular capillaries promotes the development of interstitial sclerosis (R2=0.549, F=54.732, p=0.0001). The severity of CD62p expression in the glomerular endothelium depends on the morphological class of DN in patients (R2=0.216, F=12.684, p=0.001). Conclusion

Determining risk factors for vascular and bleeding complications after TAVR using CT angiography

Abstract Funding Acknowledgements None. Introduction The use of pre-procedural computed tomography angiography (CTA) of the iliofemoral sector in the planning of transaortic valve replacement (TAVR) has demonstrated a reduction in the risk of vascular complications in patients undergoing TAVR. In this study, we aimed to characterise the clinical and radiological factors associated with bleeding and vascular complications after TAVR. Methods Patients undergoing transfemoral TAVR in a tertiary centre between 2017 and 2019 were included in this analysis. All patients underwent iliofemoral CTA before the procedure and classical CTA-derived data as well as iliofemoral calcium volume were collected. Clinical data and outcomes regarding bleeding events, as well as vascular complications according to Valve Academic Research Consortium 2 (VARC-2) criteria, were also collected. 207 patients were included in this analysis, of whom 53% were women. The median age was 82 years (IQR 76-86) and the median STS mortality risk score was 3.9% (IQR 2.59-5.99). In this population, vascular complications according to the VARC-2 criteria occurred in 33% of patients (19% with major complications). Patients with lower body mass index (BMI) were more likely to suffer vascular complications. Vascular access with fluoroscopy was associated with a higher prevalence of complications compared to ultrasound-guided vascular access (62% vs. 38%, p=0.037). When considering radiological criteria, smaller minimum luminal diameter and area of the common femoral and external iliac arteries were associated with a greater risk of vascular complications, as were increased sheath to external iliac artery ratios and luminal attenuation values (p<0.05 for all). Bleeding complications occurred in 20 patients, with a greater prevalence of bleeding events in female patients (77% vs. 23%, p=0.001). Patients with a lower BMI, a history of obstructive pulmonary disease or coronary artery disease, aortic insufficiency and fluoroscopic valvular access were more likely to have bleeding complications. Regarding radiological criteria, decreased maximal luminal diameter of the common femoral artery and smaller minimal luminal diameters and areas of the external iliac artery were associated with bleeding complications. Increased sheath-to-femoral artery ratios and luminal attenuation values were associated with an increased risk of vascular complications (p<0.05 for all). Conclusion Our study underscores the importance of pre-procedural CTA in TAVR planning and identifies separate risk factors for vascular and bleeding complications.

Impact of Age on the Occurrence of Vascular Complications in Patients Undergoing Anterior Lumbar Approach Surgery.

Retrospective cohort study. To investigate the impact of age on incidence of vascular complications in patients undergoing anterior lumbar approach surgery. Anterior approach lumbar spinal surgery may facilitate use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of this approach, risks related to vascular injury in older patients have been described in the literature. In total, 751 consecutive patients with degenerative spinal pathology who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation (360), total disc replacement (TDR), or hybrid procedures (ALIF and TDR) were included. Data collected included general patient descriptive data, surgery details, intraoperative vascular injury, and post-operative vascular complications (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)). Rates of vascular complications were compared across age groups. Additionally, the mean age of patients was compared between those with vs. without vascular complications. Overall mean age was 50.4 years (range 20-83 years). Mean estimated blood loss was 91.3ml (range 10 to 2800ml). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins (mean blood loss was 721mL and all were repaired intraoperatively). Postoperatively, 6 patients (0.8%) developed DVT and/or PE (one patient had both). With respect to age, there were no significant differences in rates of intra-operative, post-operative, or combined vascular complication rates across the age group (P>0.38). Additionally, there were no statistically significant differences in the mean ages of patients with vs. those without vascular complications (P>0.17). Overall incidence of vascular complications was 2.0%. No relationship between vascular complications and age was demonstrated. These data suggest that increased age may not necessarily be an absolute contraindication for anterior lumbar approach surgery.

A machine learning approach to predicting vascular calcification risk of type 2 diabetes: A retrospective study.

Recently, patients with type 2 diabetes mellitus (T2DM) have experienced a higher incidence and severer degree of vascular calcification (VC), which leads to an increase in the incidence and mortality of vascular complications in patients with T2DM. To construct and validate prediction models for the risk of VC in patients with T2DM. Twenty-three baseline demographic and clinical characteristics were extracted from the electronic medical record system. Tenclinical features were screened with least absolute shrinkage and selection operator method and were used to develop prediction models based on eight machine learning (ML) algorithms (k-nearest neighbor [k-NN], light gradient boosting machine, logistic regression [LR], multilayer perception [(MLP], Naive Bayes [NB], random forest [RF], support vector machine [SVM], XGBoost[XGB]). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, and precision. A total of 1407 and 352 patients were retrospectively collected in the training and test sets, respectively. Among the eight models, the AUC value in the NB model was higher than the other models (NB: 0.753, LGB: 0.719, LR: 0.749, MLP: 0.715, RF: 0.722, SVM: 0.689, XGB:0.707, p < .05 for all). The k-NN model achieved the highest sensitivity of 0.75 (95% confidence interval [CI]: 0.633-0.857), the MLP model achieved the highest accuracy of 0.81 (95%CI: 0.767-0.852) and specificity of 0.875 (95%CI: 0.836-0.912). This study developed a predictive model of VC based on MLand clinical features in type 2 diabetic patients. The NB model is a tool with potential to facilitate clinicians in identifying VC in high-risk patients.

Hyperhomocysteinemia is a risk factor for vascular complications in patients with chronic kidney disease

Hyperhomocysteinemia is considered a risk factor for many diseases, including thrombosis. Patients with chronic kidney disease often have vascular complications in the form of arterial or venous thrombosis, and it is important to consider the blood homocysteine level as a predictor of thrombophilia. The causes of hyperhomocysteinemia can be both genetic mutations and deficiency of homocysteine metabolism enzymes, as well as deficiency of folic acid, vitamin B12 and, to a lesser extent, deficiency of vitamin B6, which affects methionine metabolism. Given the role of hyperhomocysteinemia as a predictor of cardiovascular events in patients with kidney diseases, in our opinion, the multifactorial nature of increased homocysteine requires further research into some links of its pathogenesis in chronic kidney disease and the development of targeted therapeutic interventions.

Strategies to Minimize Access Site-related Complications in Patients Undergoing Transfemoral Artery Procedures with Large-bore Devices.

Large bore accesses refer to accesses with a diameter of 10 French or greater and are necessary for various medical devices, including those used in transcatheter aortic valve replacement, endovascular aneurysm repair stent-grafts, and percutaneous mechanical support devices. Notably, the utilization of these devices via femoral access is steadily increasing due to advancements in technology and implantation techniques, which are expanding the pool of patients suitable for percutaneous procedures. However, procedures involving large bore devices carry a high risk of bleeding and vascular complications (VCs), impacting both morbidity and long-term mortality. In this review article, we will first discuss the incidence, determinants, and prognostic impact of VCs in patients undergoing large bore access procedures. Subsequently, we will explore the strategies developed in recent years to minimize VCs, including techniques for optimizing vascular puncture through femoral cannulation, such as the use of echo-guided access cannulation and fluoroscopic guidance. Additionally, we will evaluate existing vascular closure devices designed for large bore devices. Finally, we will consider new pharmacological strategies aimed at reducing the risk of periprocedural access-related bleeding.

Management of intervenable factors to reduce vascular complications in patients with internal carotid artery occlusion treated by non-emergency endovascular treatment.

This study aims to identify risk factors for vascular complications during non-emergency endovascular treatment in patients with internal carotid artery occlusion (ICAO) and to propose potential interventions. A retrospective analysis of 92 patients with ICAO who received non-emergency endovascular treatment in our center from 1 January 2018 to 31 June 2023, was conducted. The correlation between intraoperative vascular complications and potential risk factors was studied, and interaction analysis was performed. Our findings revealed that the use of non-neurology guide wires to open vessels (adjusted OR: 4.1, 95%CI: 1.3-12.8; p = 0.014) and glycosylated hemoglobin (HbA1c) ≥ 6.5 mmol/L (adjusted OR: 3.2, 95%CI: 1.2-8.9; p = 0.023) was significantly associated with vascular complications in non-emergency endovascular treatment of ICAO patients. The restricted cubic spline (RCS) showed that the higher the HbA1c level, the higher the risk of vascular complications. The use of non-neurology guide wires for vessel opening during non-emergency endovascular treatment in patients with ICAO increases the risk of vascular complications. Preoperative assessment and management of HbA1c levels can reduce the incidence of intraoperative vascular complications.

Prediction of vascular complications in free flap reconstruction with machine learning.

This study aims to explore the risk factors of vascular complications following free flap reconstruction and to develop a clinical auxiliary assessment tool for predicting vascular complications in patients undergoing free flap reconstruction leveraging machine learning methods. We reviewed the medical data of patients who underwent free flap reconstruction at the Affiliated Hospital of Zunyi Medical University retrospectively from January 1, 2019, to December 31, 2021. Statistical analysis was used to screen risk factors. A training data set was generated and augmented using the synthetic minority oversampling technique. Logistic regression, random forest and neural network, models were trained, using this dataset. The performance of these three predictive models was then evaluated and compared using a test set, with four metrics, area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. A total of 570 patients who underwent free flap reconstruction were included in this study, 46 of whom developed postoperative vascular complications. Among the models tested, the neural network model exhibited superior performance on the test set, achieving an AUC of 0.828. Multivariate logistic regression analysis identified that preoperative hemoglobin levels, preoperative fibrinogen levels, operation duration, smoking history, the number of anastomoses, and peripheral vascular injury as statistically significant independent risk factors for vascular complications post-free flap reconstruction. The top five predictive factors in the neural network were fibrinogen content, operation duration, donor site, body mass index (BMI), and platelet count. Hemoglobin levels, fibrinogen levels, operation duration, smoking history, and anastomotic veins are independent risk factors for vascular complications following free flap reconstruction. These risk factors enhance the ability of machine learning models to predict the occurrence of vascular complications and identify high-risk patients. The neural network model outperformed the logistic regression and random forest models, suggesting its potential to aid clinicians in early identification of high-risk patients thereby mitigating patient suffering and improving prognosis.

Research Progress of Skin Advanced Glycation End Products in Predicting Vascular Complications in Patients with Type 2 Diabetes Mellitus

Research Progress of Skin Advanced Glycation End Products in Predicting Vascular Complications in Patients with Type 2 Diabetes Mellitus

Association between Hemoglobin A1c and Renal Arteriolar Sclerosis in Subjects Presenting without any Apparent Kidney Dysfunction.

Diabetic kidney disease is a major vascular complication in patients with diabetes mellitus (DM). However, the association between the hemoglobin (Hb)A1c levels, notably the prediabetic levels, and renal pathological changes remains unclear. We investigated the association between the HbA1c levels and renal arteriolar lesions in subjects without any apparent kidney dysfunction using a living kidney donor cohort. Between January 2006 and May 2016, 393 living kidney donors underwent a "zero-time" biopsy at Kyushu University Hospital. The patients were divided into four groups (HbA1c levels ＜5.6%, 5.6%-5.7%, 5.8%-6.4%, and ≥ 6.5%, or diagnosed with DM [DM group]). Renal arteriolar hyalinization and wall thickening were assessed using semi-quantitative grading. We then investigated the association between the HbA1c levels and renal pathological changes. 158 (40.2%) patients had arteriolar hyalinization and 148 (37.6%) showed wall thickening. A significant correlation was observed between the HbA1c levels and wall thickening (p for trend ＜0.001). An elevated HbA1c level was significantly associated with wall thickening according to a multivariable logistic analysis in subjects with HbA1c levels of 5.6%-5.7% and 5.8%-6.4%, and the DM group, compared with those with HbA1c levels of ＜5.6% (odds ratio [OR], 1.91; 95% confidence interval [CI]: [1.03-3.54] for 5.6%-5.7%, OR, 1.96; 95% CI: [1.09-3.53] for 5.8%-6.4%, and OR, 2.86; 95% CI: [0.91-9.01] for the DM group), whereas arteriolar hyalinization did not increase within the nondiabetic HbA1c levels. Elevated high-normal HbA1c levels are considered to be independent risk factors for arteriolar wall thickening. Subclinical renal arteriolar sclerosis may develop in patients with prediabetic HbA1c levels.

Treatment of vascular complications following orthotopic liver transplantation. The experience of a regional cente

Objective: vascular complications (VCs) following liver transplantation (LT) can pose a significant threat to the recipient’s life – as the risk of graft loss increases significantly when blood flow in the graft is impaired. Diagnosis and early treatment of VCs seems to be a pressing issue in transplantology. The aim of this study is to evaluate the incidence, treatment and outcome of VCs in patients after orthotopic LT at the Center for Surgery and Donor Coordination, Rostov Regional Clinical Hospital.Materials and methods. Between July 2015 and April 2023, 100 orthotopic LTs were performed. VCs were retrospectively identified and analyzed.Results. The overall incidence of VCs was 24% (n = 24): hepatic artery stenosis, 5% (n = 5); intra-abdominal bleeding, 6% (n = 6); hepatic artery dissection, 2% (n = 2); intrahepatic venous thrombosis Budd–Chiari syndrome), 2% (n = 2); portal vein thrombosis, 1% (n = 1); inferior vena cava thrombosis/iliofemoral deep vein thrombosis, 2% (n = 2); inferior vena cava stenosis, 1% (n = 1); hepatic vein stenosis, 1% (n = 1); recurrent hepatic artery stenosis/thrombosis, 2% (n = 2); mesenteric vein thrombosis, 2% (n = 2).Conclusion. Most VCs following orthotopic LT occur in the early postoperative period and can lead to a high risk of graft dysfunction and patient death. Early recognition, diagnosis, and treatment of post-LT complications are critical to successful short- and long-term graft function and patient survival, even in patients with asymptomatic complications. Treatment options typically include surgical revascularization, percutaneous thrombolysis, percutaneous angioplasty, retransplantation, or, less commonly, a conservative approach.

Computed tomography defined femoral artery plaque composition predicts vascular complications during transcatheter aortic valve implantation.

Vascular and bleeding complications after transcatheter aortic valve implantation (TAVI) are common and lead to increased morbidity and mortality. Analysis of plaque at the arterial access site may improve prediction of complications. We investigated the association between demographic and procedural risk factors for Valve Academic Research Consortium (VARC-3) vascular complications in patients undergoing transfemoral TAVI with use of a vascular closure device (ProGlide® or MANTA®) in this retrospective cohort study. The ability of pre-procedure femoral CT angiography to predict complications was investigated including a novel method of quantifying plaque composition of the common femoral artery using plaque maps created with patient specific X-ray attenuation cut-offs. 23 vascular complications occurred in the 299 patients in the study group (7.7%). There were no demographic risk factors associated with vascular complications and no statistical difference between use of closure device (ProGlide® vs MANTA®) and vascular complications. Vascular complications after TAVI were associated with sheath size (OR 1.36, 95% CI 1.08-1.76, P 0.01) and strongly associated with CT-derived necrotic core volume in the common femoral artery of the procedural side (OR 17.49, 95% CI 1.21-226.60, P 0.03). Plaque map analysis of the common femoral artery by CT angiography reveals patients with greater necrotic core are at increased risk of VARC-3 vascular complications. The novel measurement of necrotic core volume in the common femoral artery on the procedural side by CT analysis was associated with post-TAVI vascular complications, which can be used to highlight increased risk.

Risk assessment of vascular complications following manual therapy and exercise for the cervical region: diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists framework (The Go4Safe project).

What is the diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) framework to assess the risk of vascular complications in patients seeking physiotherapy care for neck pain and/or headache? Cross-sectional diagnostic accuracy study. One hundred and fifty patients seeking physiotherapy for neck pain and/or headache in primary care. Nineteen physiotherapists performed the index test according to the IFOMPT framework. Patients were classified as having a high, intermediate or low risk of vascular complications, following manual therapy and/or exercise, derived from the estimated risk of the presence of vascular pathology. The reference test was a consensus medical decision reached by a vascular neurologist and an interventional neurologist, with input from a neuroradiologist. The neurologists had access to clinical data and magnetic resonance imaging of the cervical spine, including an angiogram of the cervical arteries. Diagnostic accuracy measures were calculated for 'no contraindication' (ie, the low-risk category) and 'contraindication' (ie, the high-risk and intermediate-risk categories) for manual therapy and/or exercise. Sensitivity, specificity, predictive values, likelihood ratios and the area under the curve were calculated. Manual therapy and/or exercise were contraindicated in 54.7% of the patients. The sensitivity of the IFOMPT framework was low (0.50, 95% CI 0.39 to 0.61) and its specificity was moderate (0.63, 95% CI 0.51 to 0.75). The positive and negative likelihood ratios were weak at 1.36 (95% CI 0.93 to 1.99) and 0.79 (95% CI 0.60 to 1.05), respectively. The area under the curve was poor (0.57, 95% CI 0.49 to 0.65). The IFOMPT framework has poor diagnostic accuracy when compared with a reference standard consisting of a consensus medical decision.

Bisphenol A accelerates the vascular complications in patients with Type 2 diabetes mellitus through vascular calcification-a molecular approach.

Environmental pollutant Bisphenol A (BPA) strongly interacts with insulin resistance, which leads to type 2 diabetes mellitus (T2DM). Uncontrolled glucose levels in both blood and urine develops vascular complications in T2DM patients. However, glucose-controlled diabetic patients are also affected by vascular complications due to vascular calcification, and there is a lack of clinically relevant data on BPA levels available in patients with T2DM-associated vascular complications due to vascular calcification. Therefore, we measured BPA levels in T2DM-associated vascular complications and correlated systemic BPA levels with vascular calcification-related gene expression. This study included 120 participants with T2DM and its associated vascular complications. Serum and urinary BPA were estimated using an ELISA kit, and gene expression of the study participants in peripheral blood mononuclear cells (PBMCs) was studied with quantitative real-time PCR. Serum and urinary BPA levels were higher in T2DM and its associated vascular complications with CVD and DN patients compared to control. Both Serum and urinary BPA had higher significance with Sirt1 (p < 0.001, p < 0.001), Runx2 (p < 0.01, p < 0.001) and IL-1beta (p < 0.001, p < 0.02) gene expression in the study groups, but, TNF-alpha significant with Serum BPA (p < 0.04), not urinary BPA (p < 0.31). BPA levels were positively correlated with lower Sirt1 and increased Runx2 in T2DM-associated vascular complications patients. Also, higher expression of IL-1beta and TNF-alpha was observed in T2DM-associated vascular complications patients. Our study is the first to associate BPA levels with vascular calcification in patients with T2DM and its associated vascular complications.

Comparison of Vascular Complications after Arterial Sheath Removal using Manual Compression Method and ClampEase Method in Patients Undergoing Coronary Angiography.

Angiography stands as the paramount and definitive diagnostic method for coronary artery disease. However, akin to various other invasive procedures, it may carry a multitude of complications. This study sought to assess the incidence of vascular complications post-arterial sheath removal, comparing the use of a ClampEase device against manual compression. This quasi-experimental clinical trial involved patients undergoing angiography at the post-angiography ward in Isfahan, Iran. A total of 91 patients were selected through convenience sampling and randomly assigned to either the manual compression or ClampEase device groups. Monitoring common vascular complications like hemorrhage, hematomas, and ecchymosis occurred up to 24 hours post-arterial sheath removal. Data were collected using a digital scale model DM3, a transparent flexible ruler, and a questionnaire named 'vascular complications after angiography.' Analysis was performed using SPSS software version 13. Statistical analysis revealed that, when compared to the manual method, compression with the ClampEase device led to fewer vascular complications in patients and a quicker return to homeostasis. The findings underscore that the ClampEase method is a safer alternative with fewer vascular complications than the manual compression method. This discovery has implications for reducing hospital costs and length of stay. The ClampEase device is associated with a swifter time to hemostasis, contributing to enhanced patient comfort and acceptance.

Multidisciplinary approach to the treatment of patients with periprosthetic joint infection of the hip complicated by injury to the great vessels

Introduction Total counts of total hip arthroplasty (THA) have been increasing for several decades, and the procedures are associated with considerable risk of intra- and postoperative complications. Vascular complications are defined as multiple pathological conditions. They are subdivided into acute adverse events such as intraoperative bleeding, acute ischemia and hematoma and chronic complications such as pseudoaneurysms and arteriovenous fistulas which can cause late ischemic events. A specialized and well-trained multidisciplinary team is required to perform surgical interventions due to the small number of intravascular lesions. The objective was to demonstrate findings of clinical, instrumentation methods and staged treatment of patients with periprosthetic joint infection (PJI) of the hip and complications associated with injury to the great vessels.Material and methods We report two cases of vascular complications in patients with PJI and migration of femoral components into the lesser pelvis.Results An integrated approach to the diagnosis and treatment of patients with PJI and complications associated with injury to the great vessels helped to avoid lethal outcomes of the Girdlestone operation.Discussion Revision THA requires careful planning and an interdisciplinary approach with the help of a clinical pharmacologist, microbiologist, plastic or angiosurgeon. PJI is associated with a high risk of recurrence that would require two-stage, three-stage surgical interventions. With the bone deficiency of the acetabulum and the proximal femur the Girdlestone operation is performed as the final procedure with resultant significant decrease in the functional adaptation of patients.Conclusion Careful preoperative preparation of patients with unstable hip replacement components including migration of the acetabular component into the pelvic cavity and associated PJI would help to avoid such a devastating complication as great vessel injury.

Magnetic resonance imaging manifestations of vascular complications in patients with acute invasive fungal rhinosinusitis

BackgroundOwing to significant morbidity and mortality with the development of vascular complications in patients with acute invasive fungal rhinosinusitis (AIFRS), early identification, and rapid medical or surgical interventions that are essential for improving patients’ outcomes. For the purpose of presurgical mapping and management planning, magnetic resonance imaging (MRI) is essential for the early identification and improved delineation of disease extent.ObjectiveTo evaluate variable MRI manifestations in the detection of the vascular complications in patients with AIFRS and its impact on patients’ survival.MethodsA retrospective study, included 24 patients with histopathological proven AIFRS to review the para nasal sinus MRI findings. MRI were evaluated for the sinus involvement and the extrasinus extension into the orbit and/or the brain. Vascular structures were assessed for the development of vascular complications, like ICA for thrombosis, attenuation or pseudoaneurysm, cavernous sinus and superior ophthalmic veins for thrombosis.ResultsOf the reviewed 24 patients, 16 had cavernous sinus thrombosis, 15 had ICA thrombosis, 10 had ophthalmic vein thrombosis, 4 had ICA attenuation and only two cases had pseudoaneurysm of the ICA. Vascular thrombosis was more common with mucormycosis with cavernous sinus and ophthalmic vein thrombosis which were significantly increased among non survivor patients (90%, 70%), as compared to the survivor patients (50%, 14.29%), with P = 0.04 and 0.005 respectively.ConclusionsVascular complications are common in patients with AIFRS. MRI is helpful in accurate detection of vascular complications in patients with AIFRS.

Effect of Direct Cold Compress for Femoral Arterial Sheath Removal on Reduction of Local Vascular Complications in Patients after Percutaneous Coronary Intervention: A Randomized Controlled Trial

Background: Percutaneous coronary intervention (PCI) is one of the cardiac catheterization procedures used to diagnose and treat coronary artery disease(CAD). It may lead to local vascular complications after the removal of the femoral arterial sheath, which may contribute to morbidity and mortality, and increase the patient's length of stay and hospital costs. Objectives: The present study aimed to determine the effect of direct cold compress for femoral arterial sheath removal on reduction of local vascular complications in patients after PCI. Methods: A randomized controlled trial, post-test only was conducted on patients in the present study. A non-probability (homogenous purposive sample) of (90) patients are involved after PCI (45 patients for the experimental group and 45 patients for the control group). The experimental group exposed to direct cold bag compression for removing the femoral arterial sheath removal. While, the control group exposed for usual nursing care provided for patients in CCU. The study was conducted at Al-Najaf AL Ashraf City/ AL-Najaf Center for Cardiac Surgery and Cardiac Catheterization. The local vascular complications involved in the present study for both groups are hematoma, bleeding and ecchymosis. Outcomes: The study results indicated that there is a reduction in local vascular complications (hematoma, bleeding, and ecchymosis) for patients after femoral arterial sheath removal in the experimental group compared with those patients in the control group. Conclusion: The present study has been concluded that the using of direct cold bag compress for removing the femoral arterial sheath in patients after PCI is an effective approach in reduction of local vascular complications compared with the control group. Recommends: Based on the results of the present study, the researcher suggests the direct cold bag compress for femoral arterial sheath removal as a nursing intervention to reduce local vascular complications (hematoma, bleeding, and ecchymosis) for patients after PCI.

Vascular complications in patients undergoing percutaneous transfemoral aortic valve implantations.

Vascular complications in patients undergoing percutaneous transfemoral aortic valve implantations.