Vein Diameter Research Articles

Short- and long-term reproducibility of peripheral superficial vein depth and diameter measurements using ultrasound imaging

BackgroundUltrasound imaging is used for diagnosis, treatment, and blood vessel visualization during venous catheter placement. However, various physiological factors (e.g., body temperature and exercise) influence vein diameters, which are expected to exhibit daily or diurnal fluctuations. Therefore, this study aimed to determine the intraday (short-term) and interday (long-term) reproducibility of repeated measurements of the depth and diameter of peripheral superficial veins.MethodsTwenty-three healthy young women (mean age, 21.7 ± 0.8 years) participated in the study to examine the short- and long-term reproducibility of the depth and diameter of the cutaneous vein in the left elbow fossa acquired by ultrasound imaging. Short-term measurement intervals were 10 s, and the probe was released from the skin for each acquisition, which was repeated five consecutive times. Long-term measurements were performed at the same time on the next day following the same procedure. The acquired images were analyzed for vein depth and diameter using ImageJ software. The intraclass correlation coefficient (ICC) was calculated to determine the short- and long-term reproducibility of the measurements. The relationship between the venous depth and venous diameter intra-individual variation was analyzed, as well as the influence of body composition (body fat and muscle mass) on the venous diameter and depth.ResultsFor vein depth measurements, the short- and long-term ICCs were 0.94–0.96 and 0.88, respectively. For the vein diameter, the short- and long-term ICCs were 0.94–0.97 and 0.67, respectively. The short-term ICCs for both vein depth and diameter exceeded 0.9, indicating that the ultrasound vascular measurement was sufficiently reliable. However, long-term reproducibility was slightly lower, especially for the vein diameter. No correlation was found between the intra-individual variation of the vein diameter and vein depth. Although the vein diameter and body fat mass uncorrelated, the vein depth and body fat mass significantly correlated (r = 0.675, 95% confidence interval = 0.281–0.830).ConclusionsThe long-term reproducibility of vein diameters was somewhat lower than that of the short-term reproducibility. This could be attributed to fluctuations in the physiological state of the participant rather than to the instability of the measurement. Therefore, ultrasound measurement of the peripheral superficial vein is sufficiently reliable.

Can ultrasonographic measurement of respiratory variability in the diameter of the internal jugular vein and the subclavian vein predict fluid responsiveness in parturients during cesarean delivery? A prospective cohort study

BackgroundUltrasonic measurements of the respiratory variability in the diameter of internal jugular vein (IJV-CI) and subclavian vein (SCV-CI) have recently been reported to be useful in predicting fluid responses in non-obstetric patients with spontaneous respiration. This study evaluated whether IJV-CI and SCV-CI could reliably predict fluid responsiveness in parturients undergoing elective cesarean delivery. ObjectiveThis study was conducted to determine whether two indicators measured by ultrasound are good predictors of fluid responsiveness of parturients with spontaneous respiration in elective cesarean delivery. DesignA prospective cohort study. SettingA single-center tertiary specialty hospital in China. PatientsA total of 86 patients scheduled for elective cesarean section were included and 6 were excluded for various reasons. InterventionsBased on the results of the fluid challenge, the included parturients were divided into two groups, with those who responded to fluid challenge defined as the positive group and those who did not respond defined as the negative group. Main outcome measuresThe primary endpoint was to determine the predictive value of IJV-CI and SCV-CI for fluid responsiveness (≥15% increases in SVI after fluid challenge) in spontaneous respiration patients. ResultsForty-three (53.8%) parturients were fluid responders. IJV-CI and SCV-CI proved to be the independent predictors for fluid responsiveness by multivariate logistic regression. The area under the ROC curve for IJV-CI and SCV-CI were 0.881 (95% CI, 0.808–0.953, p < 0.0005) and 0.757 (95% CI, 0.648–0.865, p < 0.0008), respectively. Their optimal cut-off values for IJV-CI and SCV-CI were 20.7% (sensitivity of 60%; specificity of 79%) and 32.0% (sensitivity of 34%; specificity of 96%), respectively. The grey zone for IJV-CI and SCV-CI for fluid responsiveness were 20.4–32.4% and 30.4–44.6% and included 25% and 23% of the patients, respectively. ConclusionUltrasonic-derived IJV-CI is better than SCV-CI in predicting fluid responsiveness in spontaneously breathing parturients. Both IJV-CI and SCV-CI are the accurate and readily accessible indices of fluid responsiveness in parturients undergoing elective cesarean delivery. Trial registrationchictr.org.cn (ChiCTR1900028450).

Correction of fetal umbilical vein flow imbalance following laser surgery for twin-twin transfusion syndrome.

Twin-twin transfusion syndrome (TTTS) is characterized by unequal hemodynamics between the twins. We aimed to assess preoperatively the difference in umbilical vein flow (UVF) between the recipient and donor monochorionic diamniotic twins and evaluate the change in UVF following laser surgery in both twins. This was a retrospective cohort study of differences in UVF that occurred following laser surgical treatment of TTTS. Sonographic assessment of the umbilical vein before and 24 h after fetoscopic laser surgery for TTTS was performed. Umbilical vein diameter and time-averaged maximum velocity were measured, and UVF per kg (UVF/kg) was converted into a Z-score by a calculator created using gestational age as an independent variable. Z-score values were converted into centiles, which were evaluated statistically. Median differences in UVF/kg centile values were adjusted for TTTS stage and presence of arterioarterial anastomoses. The study population consisted of 363 TTTS patients. The adjusted preoperative median difference in UVF/kg centile between the recipient vs donor twin was 17.9% (-17.1% to 57.6%), P < 0.0001. The adjusted median difference in UVF/kg centile between the postoperative vs preoperative period among recipients was 2.2% (-10.8% to 13.8%), P < 0.0001, while the adjusted median difference among donors was 27.3% (8.2%-34.6%), P < 0.0001. The preoperative difference in UVF between the recipient and donor twins confirms the pathophysiology of TTTS. Postoperatively, the substantial increase in UVF of the donor twin and the relatively small increase in UVF of the recipient twin confirm that ablation of the vascular communications resulted in rapid improvement in perfusion of the donor twin. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Nomogram for prediction of portal vein system thrombosis after splenectomy for hypersplenism in patients with Wilson disease.

The occurrence of portal vein system thrombosis (PVST) after splenectomy in patients with Wilson disease (WD) can lead to serious complications. The early identification of high-risk patients can help improve patient prognosis. This study aimed to establish and validate a personalized nomogram for assessing the risk of PVST after splenectomy in patients with WD and hypersplenism. We retrospectively collected the data from 81 patients with WD and hypersplenism who underwent splenectomy. Based on whether PVST occurred within a month after the operation, they were divided into the PVST group and the non-PVST group. The clinical data of the 2 groups were compared, and univariate analysis was used to select the statistically significant features and incorporated into the least absolute shrinkage and selection operator (LASSO) regression model for optimization. Multivariate logistic regression analysis was used to determine the independent risk factors for PVST after splenectomy, which were then applied to establish a personalized nomogram. We calculated the concordance (C)-index and drew the receiver operating characteristic (ROC) curve, the model calibration curve, and the clinical decision analysis (DCA) curve to evaluate the accuracy, calibration, and clinical applicability of the model, respectively. We used bootstrapping for internal validation of the model. Univariate analysis showed that the differences in preoperative portal vein diameter and velocity of portal blood flow, postoperative mean platelet volume (MPV), mean platelet distribution width (PDW), D-dimer, prothrombin time (PT), and the increase of platelet count (PLT) were of statistical significance (P<0.05). According to the results of the LASSO and multivariate logistic regression analyses, a model including preoperative portal vein diameter, preoperative portal blood flow velocity, postoperative D-dimer, and the increase of PLT was established to predict the risk of PVST after splenectomy. The model showed good accuracy with a C-index of 0.838 (95% CI: 0.750-0.926) and had a well-fitted calibration curve. Furthermore, internal validation showed it achieved a moderate C-index of 0.805. The DCA curve indicated that the model has clinical applicability when patients are treated at thresholds of 2-100%. Establishing a predictive model for the risk of PVST in patients with WD and hypersplenism after splenectomy can help clinicians identify patients at high risk of PVST who require intervention measures.

The impact of stent-graft sizing on venous stenosis re-intervention and arteriovenous graft patency: Free-floating stent outflow is associated with improved outcomes.

Early cannulation arteriovenous grafts (ecAVG) for dialysis access are limited by reintervention for venous stenosis (VS) despite their good initial patency. Whilst stent-grafts (SG) have shown promise, the optimal sizing is unclear. Therefore, this study aims to determine if outflow vein diameter, SG diameter or these relative to each other (V:Sr) alters outcomes, and if so, which is more important. Retrospective analysis was performed of Gore® Acuseal® ecAVGs with VS treated with Gore® Viabahn® SG over a 7-year period. Primary patency (PP), time to thrombosis and functional patency were analysed by SG length/diameter, vein diameter and V:Sr. We identified 114 ecAVGs with median follow-up 492 days (IQR 189-770). SG length and diameter did not correlate with PP, however, there was a significant relationship between vein diameter and PP (RR = 0.901 (0.832-0.975), p = 0.01) and between V:Sr and PP (RR = 0.462 (0.255-0.838), x2 = 5.866, p = 0.0015). The optimal V:Sr was ⩾1.4 (i.e. vein diameter at least 40% greater than the stent-graft; or 'free-floating' stent outflow) (RR = 2.759 (1.670-4.558), p < 0.001), translating to a difference in median PP of 252 versus 496 days (IQR: 188-316; 322-670). On multivariate analysis, absolute vein diameter lost significance, whilst V:Sr remained an independently significant predictor of PP (RR = 3.247 (1.560-6.759), p = 0.02). Placement of the SG outflow into a relatively larger segment of vein was associated with a significant increase in PP independent of the absolute vein diameter. This suggests that larger calibre SG which are apposed to the vein wall are not required for optimal primary patency, and indeed should be actively avoided. Instead, a 'free-floating' stent outflow which is undersized relative to the recipient vein (whilst maintaining a minimum anchoring calibre) is recommended where possible. This should be considered during intervention and may require selection of longer devices, where practical, to bring the stent outflow into a larger vein segment. Level 3a, Non-randomised controlled cohort/follow-up study.

Identification of reversed portal flow on 4DCT and of factors contributing to reversed portal flow in patients with liver cirrhosis and portosystemic shunt before interventional radiology procedures.

Patients with liver cirrhosis and portosystemic shunt occasionally develop reversed portal flow in the portal venous system. The factors contributing to reversed portal flow in these patients remain unclear. The aim of this study was to identify factors contributing to reversed portal flow in patients with portosystemic shunts based on four-dimensional computed tomography (4DCT), which visualized flow dynamics in the portal venous system. Data from 34 consecutive patients with portosystemic shunts who had undergone 4DCT before interventional radiology procedures were retrospectively investigated in this study. Uni- and multivariate analyses were performed to identify factors contributing to reversed portal flow. Flow dynamics could be visualized on 4DCT in 32 of the 34 patients. Fifteen patients had forward portal flow; 17 had reversed portal flow. The main portal, splenic, and superior mesenteric veins displayed reversed portal flow in five, 12, and five vessels, respectively. Portosystemic shunt originating from splenic and superior mesenteric veins, worse albumin-bilirubin score, and small main portal vein diameter were significant factors contributing to reversed portal flow in both univariate (p=0.049, p=0.027, and p=0.002) and multivariate (odds ratio [OR] 6.345, p=0.012; OR 4.279, p=0.039; and OR 5.516, p=0.019) analyses. The reversed portal flow was visualized on 4DCT. Portosystemic shunt originating distant to the liver, worse albumin-bilirubin score, and small diameter of the main portal vein were factors contributing to reversed flow in the portal venous system.

Shear Wave Dispersion Slope Measured with Shear Wave Dispersion Imaging Is Associated with Variceal Hemorrhage in Cirrhotic Patients.

Portal hypertension (PH), as the main consequence of cirrhosis, leads to the development of gastroesophageal varices (GEVs). Variceal hemorrhage (VH) caused by the rupture of GEVs is a life-threatening emergency. Thus, the prediction of VH risk is considerably important. Our pilot study aimed to identify the risk factors of variceal hemorrhage (VH) in cirrhosis. Cirrhotic patients were prospectively included and divided into two groups according to the presence or absence of VH. Conventional ultrasound and shear wave dispersion (SWD) imaging were conducted to detect the portal vein diameter, spleen diameter, ascites, liver stiffness (LS) and shear wave dispersion slope (SWDS). The laboratory tests were recorded, including platelets (PLT), alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin (ALB). The risk factors of VH were screened using univariate analyses and identified using multivariate logistic regression. The ROC curves were used to assess diagnostic accuracy. Comparisons between AUCs were performed using the Delong method. Sixty-five patients with 22 VHs were finally included. The SWDS, spleen diameter and ascites were identified as independent risk factors for VH. The SWDS showed good performance for diagnosing VH (AUC = 0.768, 95% CI: 0.647-0.864), and sensitively identified 95.5% (95% CI: 77.2%-99.9%) of patients with VH. Including the three risk factors in multivariate logistic regression, we obtained a formula for diagnosing VH: -20.749 + 0.804 × SWDS + 0.449 × spleen diameter + 1.803 × ascites (no ascites = 0, ascites = 1). Comparison of AUCs revealed that the formula (AUC = 0.900, 95% CI: 0.800-0.961) performed better than LS, SWDS, and spleen diameter in diagnosing VH (p &lt; 0.001; p &lt; 0.05; p &lt; 0.05). SWDS is a sensitive parameter for assessing the risk of VH. Combining the SWDS, spleen diameter and ascites resulted in good diagnostic accuracy.

Outcomes of Arterio-venous Fistula Reconstruction in Chronic Kidney Disease Patients Presenting in Tertiary Care Hospital in Eastern Nepal

Introduction: Renal Replacement Therapy is the treatment modality for the chronic kidney disease (CKD) which ranges from hemodialysis, peritoneal dialysis to the renal transplantation, the latter being the best form of treatment. But, renal transplantation is available at limited centers only so hemodialysis is the most commonly used treatment modality of chronic kidney disease which requires a vascular access. But there are limited vascular surgeons in the region so most of the arterio-venous (AV) fistulas are reconstructed by Urologist/Surgeons exposed to vascular surgery during their residency/training period. Objectives: To know the factors influencing the site selection, to assess the success rate and to document the complications of AV fistula reconstruction. Methodology: This is a hospital based prospective observational study conducted in the Birat Medical College – Teaching Hospital, Morang, Nepal from June 2021 to May 2022. We included the CKD patients requiring vascular access for hemodialysis with Color Doppler available for vascular mapping. Patients with brachial sites previously used and without Color Doppler were excluded from the study. AVF was reconstructed under local anesthesia and outcomes were recorded. Results: Thirty one patients of CKD underwent AVF reconstruction over the study period. Male and female ratio was 1.33 (57% and 43%). The mean age was 42.14 ± 11.34 years (Range 26-65 years). The mean diameter of radial artery (RA) and cephalic vein (CV) at wrist were 1.92 ± 0.56mm and 1.91 ± 0.20 mm respectively. Similarly, the mean diameter of brachial artery (BA) and CV at elbow were 3.66 ± 0.87mm and 3.57 ± 0.55 mm respectively. The fistula reconstructed were Lt RC (radio-cephalic) – 50% (14), Lt BC (brachio-cephalic) -35.71% (10) and Lt BB ( brachio-basalic) - 14.29% (4) respectively. Complications occurred in 4 cases (14.28%). Conclusion: Selection of type of AVF creation is influenced by the vessel diameter as well as previous fistula surgery status and AVF access for hemodialysis has adequate patency with acceptable complications.

Utilization of the Rat's Tail as a Novel Model for Arterialized Venous Flap.

Arterialized tissues provide longevity and coverage of critically exposed tissue, and in pliable areas of the body, thin flaps are needed. Arterialized venous flaps provide all the aforementioned qualities, yet unpredictability in flap perfusion requires further investigation in experimental studies. Existing animal models are thicker in nature and rarely mimic commonly used venous flaps in clinical practice. A novel design of the rat's tail provides an ideal model for arterialized venous flaps. Eleven venous flaps were harvested from the rats' tail, all presenting with two parallel veins in configuration. Arterialization of veins using the femoral artery was done in either along-valve or against-valve fashion, with the purpose of testing the flap's response to different clinical configurations. The vessel diameter and flap thickness were measured. Flap viability was monitored for 7 days after surgery to ensure stable flap viability. Thickness of the tail flap ranged from 1.0 to 1.2 mm, while the abdomen skin thickness ranged from 1.4 to 1.5 mm. The mean diameter of the lateral veins was 0.85 ± 0.08 mm, which was in between the average femoral artery diameter (mean 0.76 ± 0.1 mm) and the average femoral vein diameter (1.28 ± 0.2 mm). Four of the nine against-valve flaps achieved more than 50% flap survival, while all along-valve flaps achieved flap viability of more than 75%, as evident by indocyanine green imaging. This flap demonstrates similar properties to thin venous flaps used in clinical situations. Standardization of this model can push forth better understanding of the arterialization phenomenon in venous flaps for future studies.

Efficacy and safety of Fufang Biejia Ruangan Tablets as an adjuvant treatment for chronic hepatitis B liver fibrosis: A systematic review and meta-analysis.

Meta-analysis was used to evaluate the efficacy of Fufang Biejia Ruangan Tablets in the treatment of chronic hepatitis B (CHB) liver fibrosis. Databases, including PubMed, China Knowledge Network (CNKI), China Biomedical Database (CBM), Wan Fang, VIP database, Embase, and Cochrane Library were searched. The time was searched up to May 2022. The participant intervention comparator outcomes of this study were as follows: P, patients with CHB liver fibrosis; I, Fufang Biejia Ruangan Tablets; C, pharmacological placebo; O, the efficacy rate, alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB), procollagen III protein (PIIIP), hyaluronic acid (HA), laminin (LN), collagen C type IV (IV-C), portal vein diameter, spleen thickness and HBV-DNA negative conversion rate. The Cochrane Risk of Bias tool, Begg's test and Egger's test were used to evaluate the methodological quality of eligible studies. A randomized controlled trial of Fufang Biejia Ruangan Tablets was used to treat CHB liver fibrosis. Three reviewers independently selected trials, extracted data, cross-checked, and performed methodological quality assessments. Data analysis was completed by Review Manager 5.3. Twenty-six studies with 2717 patients were included in the meta-analysis. The meta-analysis showed that Fufang Biejia Ruangan Tablets was effective by increasing the efficacy. Fufang Biejia Ruangan Tablets was more efficient in improving ALT, AST, TBIL, ALB, PIIIP, HA, LN, IV-C, portal vein diameter, spleen thickness, and HBV-DNA negative conversion rate with no serious adverse reactions. It was shown that Fufang Biejia Ruangan Tablets can effectively improve liver function and relieve liver fibrosis, but future research should focus on rigorously designed, multicenter, and large randomized controlled trials.

The Effects of Vasodilation Induced by Brachial Plexus Block on the Development of Postoperative Thrombosis of the Arteriovenous Access in Patients with End-Stage Renal Disease: A Retrospective Study

Although brachial plexus block (BPB)-induced vasodilation reduces the incidence of arteriovenous access (AC) thrombosis, BPB cannot completely prevent its development. Therefore, we retrospectively investigated the factors affecting BPB-induced vasodilation and their effects on AC thrombosis development. Ninety-five patients undergoing AC surgery under BPB were analyzed. Vessel diameters were measured before and 20 min after BPB. The surgery abandoned before the BPB placement was performed when the BPB-induced increases in vessel diameters met its indications. Complete occlusive access thrombosis (COAT) was defined as loss of pulse, thrill, or bruit. Fourteen patients (14.7%) developed COAT. The outflow vein was more dilated by BPB than the inflow artery (0.6 versus 0.1 mm in median, p < 0.001). The original surgery plan was changed for seven patients (7.4%). Diabetes mellitus (DM) and ischemic heart disease (IHD) decreased the extent of increases in the inflow artery by -0.183 mm (95% confidence interval [CI] [-0.301, -0.065], p = 0.003) and outflow vein diameters by -0.402 mm (95% CI [-0.781, -0.024], p = 0.038), respectively. However, DM, IHD, and changes in the vessel diameters had insignificant effects on the development of COAT. In conclusion, although DM and IHD attenuate the vasodilating effects of BPB, they do not contribute to the development of COAT.

Lymphaticovenular anastomoses training model for multiple stages of lymphedema by using efferent lymphatic plexus of the mesenteric lymph node of rats.

Lymphaticovenular anastomosis (LVA) has transformed lymphedema treatment and has become an important part of the surgical therapy. LVA requires supermicrosurgical skills and unique nontraumatic techniques as the lymphatic vessel diameter of varies with the progression of lymphedema from 0.3 to 0.8 mm. However, even though several supermicrosurgical vessel anastomosis training models have been reported, only few focus on LVA including both various sizes of lymphatic vessels and lymphatic dissection. We report the establishment of a novel in-vivo LVA training model using the rat efferent lymphatic plexus of the mesenteric lymph node. Lymphatic vessels in the efferent lymphatic plexus of the mesenteric lymph node and mesenteric veins of 10 male Wistar rats, 572-850 g, were used for LVA in an intima-to-intima coaptation manner using 12-0 nylon suture with 4-6 stitches in an end-to-end fashion. Postoperative patency was evaluated with indigo carmine blue after completion of anastomosis. Diameters of lymphatic vessels in the plexus and recipient veins were measured. The diameters of lymphatic vessels in efferent lymphatic plexus of the mesenteric lymph nodes and mesenteric veins used as recipients were measured in all 10 male rats. The mean number of lymphatic vessels included in efferent lymphatic plexus of the mesenteric lymph nodes was 7.5 (range, 5-11) and the mean diameter of the lymphatic vessels was 0.34 mm (range, 0.1-1.2 mm). The mean diameter of lymphatic vessels used for LVA was 0.46 mm (range, 0.25-0.7 mm). The mean diameter of the recipient veins was 0.49 mm (range, 0.35-0.7 mm). The postoperative patency rate after LVA was 100% (10/10). We reported the establishment of LVA model involving the use of the efferent lymphatic plexus of the mesenteric lymph node and mesenteric veins in rats.

Non-invasive model for predicting esophageal varices based on liver and spleen volume.

Upper endoscopy is the gold standard for predicting esophageal varices in China. Guidelines and consensus suggest that patients with liver cirrhosis should undergo periodic upper endoscopy, most patients undergo their first upper endoscopy when esophageal variceal bleeds. Therefore, it is important to develop a non-invasive model to early diagnose esophageal varices. To develop a non-invasive predictive model for esophageal varices based on liver and spleen volume in viral cirrhosis patients. We conducted a cross-sectional study based on viral cirrhosis crowd in the Second Affiliated Hospital of Xi'an Jiaotong University. By collecting the basic information and clinical data of the participants, we derived the independent risk factors and established the prediction model of esophageal varices. The established model was compared with other models. Area under the receiver operating characteristic curve, calibration plot and decision curve analysis were used to test the discriminating ability, calibration ability and clinical practicability in both the internal and external validation. The portal vein diameter, the liver and spleen volume, and volume change rate were the independent risk factors of esophageal varices. We successfully used the factors to establish the predictive model [area under the curve (AUC) 0.87, 95%CI: 0.80-0.95], which showed better predictive value than other models. The model showed good discriminating ability, calibration ability and the clinical practicability in both modelling group and external validation group. The developed non-invasive predictive model can be used as an effective tool for predicting esophageal varices in viral cirrhosis patients.

The impact of acute COVID-19 on the retinal microvasculature assessed with multimodal imaging.

To quantify retinal microvascular findings in the acute phase of COVID-19 using multimodal imaging and compare them with healthy, age-matched controls. Hospitalized patients in the acute phase of COVID-19 without known systemic comorbidities (n = 75) and healthy controls (n = 101) aged 18-65 were enrolled in this prospective cross-sectional study. The retinal microcirculation and microvasculature impairments were assessed using fundus photography, swept-source optical coherence tomography, and swept-source optical coherence tomography angiography in the COVID-19 unit and compared with healthy, age-matched controls. Retinal findings were predominately observed in patients with severe disease (P = 0.006). Patients with severe disease were shown to have increased both mean vein diameter (Coef. = 19.28, 95% CI: 7.34-31.23, P = 0.002) and mean artery diameter (Coef. = 11.07, 95% CI: 0.84-21.67, P = 0.044). Neither blood vessel diameters were correlated with any confounding variables (age, sex, treatment with oxygen, LDH, or ferritin). Patients with severe COVID-19 were shown to have significantly increased retinal nerve fiber layer thickness in the superior and inferior quadrants both in the inner (S: P = 0.046; I: P = 0.016) and outer (S: P = 0.026; I: P = 0.014) ring and significantly increased GCL thickness in the outer temporal quadrant (P = 0.038). There were no statistically significant differences in vessel density or the foveal avascular zone area between the groups. The severity of COVID-19 was significantly correlated with the presence of retinal microangiopathy, which could become a biomarker of angiopathy in patients with COVID-19.

Nomogram for Predicting Postoperative Portal Venous Systemic Thrombosis in Patients with Cirrhosis Undergoing Splenectomy and Esophagogastric Devascularization.

The aim of the study is to develop a nomogram for predicting postoperative portal venous systemic thrombosis (PVST) in patients with cirrhosis undergoing splenectomy and esophagogastric devascularization. In total, 195 eligible patients were included. Demographic characteristics were collected, and the results of perioperative routine laboratory investigations and ultrasound examinations were also recorded. Blood cell morphological traits, including the red cell volume distribution width (RDW), mean platelet volume, and platelet distribution width, were identified. Univariate and multivariate logistic regressions were implemented for risk factor filtration, and an integrated nomogram was generated and then validated using the bootstrap method. A color Doppler abdominal ultrasound examination on a postoperative day (POD) 7 (38.97%) revealed that 76 patients had PVST. The results of the multivariate logistic regression suggested that a higher RDW on POD3 (RDW3) (odds ratio (OR): 1.188, 95% confidence interval (CI): 1.073-1.326), wider portal vein diameter (OR: 1.387, 95% CI: 1.203-1.642), history of variceal hemorrhage (OR: 3.407, 95% CI: 1.670-7.220), and longer spleen length (OR: 1.015, 95% CI: 1.001-1.029) were independent risk parameters for postoperative PVST. Moreover, the nomogram integrating these four parameters exhibited considerable capability in PVST forecasting. The nomogram's receiver operating characteristic curve reached 0.83 and achieved a sensitivity and specificity of 0.711 and 0.848, respectively, at its cutoff. The nomogram's calibration curve demonstrated that it was well calibrated. The nomogram exhibited excellent performance in PVST prediction and might assist surgeons in identifying vulnerable patients and administering timely prophylaxis.

Risk Factors of Arteriovenous Fistula Stenosis of Patients with Maintenance Hemodialysis.

To investigate the risk factors of arteriovenous fistula stenosis in maintenance hemodialysis patients. A total of 80 patients with maintenance hemodialysis in our hospital from January 2017 to January 2022 were included. According to the stenosis degree of the arteriovenous fistula, patients were divided into a stenosis group (n = 35) and an unobstructed group (n = 45). Laboratory examination data, such as the demographic characteristics of patients, past medical history, the use of traditional Chinese medicine (TCM), the TCM for improving blood circulation to promote blood circulation and remove blood stasis, and cellular immune function, were collected. Multivariate Logistic regression analysis was used to analyze the influencing factors. There was no significant difference in the age, sexuality, body mass index, proportion of patients with coronary heart disease, cephalic vein diameter, radial artery diameter, albumin, fibrinogen, and blood calcium levels between the two groups (P > 0.05). Compared with the unobstructed group, the stenosis group had higher rates of diabetes and hypertension as well as significantly higher levels of platelets, parathyroid hormone, and D-dimer (P < 0.05). The proportion of TCM application in the stenosis group was 28.6% (10/35), which was significantly lower than that in the unobstructed group 57.8% (26/45). The difference was statistically significant (χ 2 = 6.785, P=0.009). The levels of CD3+ (37.5 ± 5.1% vs. 42.0 ± 4.8%), CD4+ (35.7 ± 3.2% vs. 39.6 ± 3.1%) and CD4+/CD8+ (1.4 ± 0.3 vs. 2.4 ± 1.0) in the stenosis group were significantly lower, while CD8+ level was significantly higher (26.8 ± 5.1% vs. 18.5 ± 6.2%) than that in the unobstructed group (P < 0.001). Logistic regression analysis indicated that the usage of TCM was an independent risk factor for arteriovenous fistula stenosis after adjustment for other factors (odds ratio [OR] 0.302; 95% confidence interval [95% CI] 0.100-0.896; P=0.039). Less use of traditional Chinese medicine for activating blood circulation and removing blood stasis and poor cellular immune function are important factors affecting the function of the arteriovenous fistula in patients with maintenance hemodialysis, which is worthy of clinical attention.

Differential hemodynamics between arteriovenous fistulas with or without intervention before successful use.

A significant number of arteriovenous fistulas (AVFs) fail to maturate for dialysis. Although interventions promote maturation, functional primary patency loss is higher for AVFs with interventions (assisted maturation) than AVFs without interventions (un-assisted maturation). Although blood flow-associated hemodynamics have long been proposed to affect AVF remodeling, the optimal hemodynamic parameters for un-assisted maturation are unclear. Additionally, AVF maturation progress is generally not investigated until 6 weeks after AVF creation, and the examination is focused on the AVF's venous limb. In this exploratory study, patients (n = 6) underwent magnetic resonance imaging (MRI) at 1 day, 6 weeks, and 6 months after AVF creation surgery. Before successful use for hemodialysis, three AVFs required intervention and three did not. MRI of the AVFs were used to calculate lumen cross-sectional area (CSA) and perform computational fluid dynamics (CFD) to analyze hemodynamics, including velocity, wall shear stress (WSS), and vorticity. For the venous limb, the no-intervention group and intervention group had similar pre-surgery vein diameter and 1-day post-surgery venous CSA. However, the no-intervention group had statistically larger 1-day venous velocity (0.97 ± 0.67 m/s; mean ± SD), WSS (333 ± 336 dyne/cm2) and vorticity (1709 ± 1290 1/s) than the intervention group (velocity = 0.23 ± 0.10 m/s; WSS = 49 ± 40 dyne/cm2; vorticity = 493.1 ± 227 1/s) (P < 0.05). At 6 months, the no-intervention group had statistically larger venous CSA (43.5 ± 27.4 mm2) than the intervention group (15.1 ± 6.2 mm2) (P < 0.05). Regarding the arterial limb, no-intervention AVF arteries also had statistically larger 1-day velocity (1.17 ± 1.0 m/s), WSS (340 ± 423 dyne/cm2), vorticity (1787 ± 1694 1/s), and 6-month CSA (22.6 ± 22.7 mm2) than the intervention group (velocity = 0.64 ± 0.36 m/s; WSS = 104 ± 116 dyne/cm2, P < 0.05; vorticity = 867 ± 4551/s; CSA = 10.7 ± 6.0 mm2, P < 0.05). Larger venous velocity, WSS, and vorticity immediately after AVF creation surgery may be important for later lumen enlargement and AVF maturation, with the potential to be used as a tool to help diagnose poor AVF maturation earlier. However, future studies using a larger cohort are needed to validate this finding and determine cut off values, if any.

Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant.

IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed. Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications. Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.

Portal hypertension in familial Mediterranean fever patients

IntroductionFamilial Mediterranean fever (FMF) is an autoinflammatory disease characterized by polyserositis and arthritis attacks, which are mediated by increased plasma levels of cytokines. Our hypothesis was that the increase in specific cytokines can also lead to portal hypertension, even in the absence of overt hepatic steatosis. MethodsWe designed a comparative cross-sectional study with 41 patients and 30 healthy individuals to show if there is a relationship between portal hypertension and FMF. B mode ultrasound and Doppler ultrasound were utilized to evaluate liver echogenicity, portal vein diameter, peak portal blood flow velocity, and portal vein flow direction, which are important diagnostic criteria for portal hypertension. ResultsSpleen and liver sizes and portal vein diameters of the FMF patients and the healthy controls were not significantly different. Imaging of 4 patients revealed periportal cuffing and one patient with periportal cuffing also had a fine granular appearance of the liver. The peak portal blood flow velocity of the FMF patients was lower than that of the control group (p<0.007). ConclusionThe FMF group had significantly lower peak portal blood flow velocity than the control group, indicating the existence of portal hypertension. However, the differences between the other findings that correlate with portal hypertension were not significant.

Varicocele treatment - outcomes of ligation and embolisation in the treatment of 281 men with a clinically palpable varicocele

<h3>Objectives</h3> Treatment options for varicoceles include surgical ligation (SL) and radiological embolisation (RE). RE has the advantages of being performed under LA. The EAU guidelines quote the recurrence rate with RE of 3.8-10%, hence SL is often performed despite the potential for increased morbidity. Our objective was to compare the outcomes of SL and RE with respect to improvement in semen analyses and sonographic findings. <h3>Methods</h3> This was a retrospective study investigating men who had varicocele treatment from 2017-2020. We assessed their pre-and post-treatment SA and ultrasound. The results were analysed using Wilcoxon, Mann-Whitney and t-test. <h3>Results</h3> 281 patients were treated; 168 with RE, 113 with SL. 124 had pre-and post-treatment SA (RE n=78, SL n=46). Both groups showed statistically significant improvement in count; RE 63% (p=<0.001), SL 52% (p=0.009) and Morphology; RE 45% (p=0.003), SL 46% (p=0.005). Neither group showed a statistically significant improvement in Motility; RE 47% (p=0.156), SL 46% (p=0.032). There was no statistically significant difference between the two groups. 83 patients had a pre-and post-treatment US performed (RE n=56; SL n=27). Vein diameter decreased in 68% following RE (3.7±0.86 mm to 3.1±0.80 mm, p<0.0001), 84% following SL (3.91±1.0 mm to 3.1±0.72 mm, p=0.001). Doppler US demonstrated cessation of reflux in 56% treated by RE (n=32) and 52% following SL (n=23). Technical failure for embolization included 11 single sided failures and 1 bilateral. <h3>Conclusions</h3> Neither RE and SL are superior for improving semen analysis parameters. Vein diameter decreases significantly after both. RE is a LA, day case procedure versus a GA and groin incision. We would favour the less invasive technique in the light of these findings. <h3>Conflicts of Interest</h3> n/a