Vein Diameter Research Articles

The Cut-off Value of Great Saphenous Vein Diameter at the Level of Femoral Condyle to Predict the Sapheno-Femoral Junction Incompetence

Background Varicose vein is one of the commonest problems that patients visit to a vascular out patient services (OPD). It causes a great deal of morbidity in today’s population.
 Objective To see the correlation between the size of great saphenous and Saphenofemoral junction incompetence.
 Method From January 2019 till January 2020, 396 patients with symptomatic or clinically diagnosed varicose veins were screened for Saphenofemoral junction reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral measurements. Best saphenous vein diameter cutoff for predicting reflux was determined using receiver operating characteristics curve analysis.
 Result Out of 792 limbs, the Great Saphenous Venous System was involved in 452 limbs, the Short Saphenous Venous System was involved in 151 limbs and significant perforators were present in 240 limbs. Mean great Saphenous Vein diameter of diseased limb (Reflux Positive) was 5.68 mm and 4.0 mm in control group (Reflux Negative). Mean Saphenofemoral junction diameter was 8.23 mm in diseased limbs and 6.16 mm in control limbs. Receiver operating characteristics curve showed great saphenous vein diameter at femoral condyle of 4.5 mm as best cut-off value for diagnosis of sapheno femoral junction reflux.
 Conclusion Great Saphenous Vein diameter at femoral condyle of 4.5 mm is the best cut-off value for diagnosis Saphenofemoral junction reflux. The Sensitivity and specificity of this cut off value is 81.8% and 71% respectively.

Hemato-biochemical and ultrasonographic evaluation of hepatic lipidosis in dairy buffaloes.

Around 60% dairy animals developed moderate to severe hepatic lipidosis at the time of parturition or during early lactation stage. Most of clinician suspect the hepatic lipidosis during above time window only. However, negative energy balance or feeding of high concentrate diet can lead to hepatic lipidosis at any phase of life. The aim of the present study was to evaluate the potential for diagnosis of hepatic lipidosis by means of hemato-biochemical parameters and ultrasonography of the liver at any stage of life. Here, ultrasonographic back fat thickness measurement was correlated with ultrasonographic features of hepatic lipidosis. A total 60 buffaloes were included under the study and sampled for hematological and biochemical parameters. Hematological parameters did not exhibit any significant difference between healthy and hepatic lipidosis-affected buffaloes. Biochemical parameters like beta hydroxy butyric acid, non esterified fatty acid, aspartate amino transferase, gamma glutamyl transferase and alkaline phosphatase revealed a significant increase, while triglyceride, cholesterol, and glucose declined significantly in hepatic lipidosis-affected buffaloes. Total protein, albumin, and total bilirubin levels did not exhibit any significant difference. Based on ultrasonographic findings, the hepatic lipidosis-affected buffaloes were further sub divided into mild, moderate, and severe groups. Portal vein diameter and depth of portal vein were also estimated in current study. Ultrasonographic examination could diagnose 53.33% hepatic lipidosis cases in buffaloes. Among it, 37.50% buffalo had mild hepatic lipidosis, 33.33% had moderate hepatic lipidosis, and 29.16% had severe hepatic lipidosis. Depth of portal vein significantly increased in hepatic lipidosis cases. However, portal vein diameter exhibited a non-significant difference in mild, moderate, and severe groups of hepatic lipidosis. Back fat thickness also revealed a non-significant difference in mild, moderate, and severe hepatic lipidosis. Above study indicate that B mode ultrasonography of the liver can be employed to differentiate various grades of hepatic lipidosis in buffaloes. Biochemical parameters like NEFA, BHBA, AST, GGT, ALP, TG, cholesterol, and glucose can be helpful to screen the hepatic lipidosis at farm level.

Non-invasive assessment of acute heart failure by Stevenson classification: Does echocardiographic examination recognize different phenotypes?

BackgroundAcute heart failure (AHF) presentation is universally classified in relation to the presence or absence of congestion and the peripheral perfusion condition according to the Stevenson diagram. We sought to evaluate a relationship existing between clinical assessment and echocardiographic evaluation in patients with AHF.Materials and methodsThis is a retrospective blinded multicenter analysis assessing both clinical and echocardiographic analyses during the early hospital admission for AHF. Patients were categorized into four groups according to the Stevenson presentation: group A (warm and dry), group B (cold and dry), group C (warm and wet), and group D (cold and wet). Echocardiographic evaluation was executed within 12 h from the first clinical evaluation. The following parameters were measured: left ventricular (LV) volumes, LV ejection fraction (LVEF); pattern Doppler by E/e1 ratio, pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and inferior cave vein diameter (ICV).ResultsWe studied 208 patients, 10 in group A, 16 in group B, 153 in group C, and 29 in group D. Median age of our sample was 81 [69–86] years and the patients enrolled were mainly men (66.8%). Patients in groups C and A showed significant higher levels of systolic arterial pressures with respect to groups B and D (respectively, 130 [115–145] mmHg vs. 122 [119–130] mmHg vs. 92 [90–100] mmHg vs. 95 [90–100] mmHg, p < 0.001). Patients in groups A and C (warm) demonstrated significant higher values of LVEF with respect to patients in groups B and D (43 [34–49] vs. 42 [30–49] vs. 27 [15–31] vs. 30 [22–42]%, p < 0.001). Whereas group B experienced significant lower TAPSE values compared with other group (14 [12–17] mm vs. A: 17 [16–21] mm vs. C: 18 [14–20] mm vs. D: 16 [12–17] mm; p = 0.02). Finally, echocardiographic congestion score including PASP ≥ 40 mmHg, ICV ≥ 21, mm and E/e’ > 14 did not differ among groups. Follow-up analysis showed an increased mortality rate in D group (HR 8.2 p < 0.04).ConclusionThe early Stevenson classification remains a simple and universally recognized approach for the detection of congestion and perfusion status. The combined clinical and echocardiographic assessment may be useful to better define the patients’ profile.

Bundle of Care Promotes Arteriovenous Fistula Maturity in Patients with End-Stage Kidney Disease

Arteriovenous fistula (AVF), as the hemodialysis access, has the advantages of safety, sufficient blood flow, and long use time. To establish an ideal AVF, patients require good vascular condition. However, many teams often neglect preoperative preparation and exercises and have no concept of specialized nursing or bundle of care, directly leading to stenosis of the outflow tract and seriously affected surgical efficacy. This study aimed to evaluate the influence of bundle of care on AVF. A total of 260 patients with end-stage kidney disease were included from January 2019 to December 2020 at Qilu Hospital, Shandong University. Patients were divided into 2 groups, and were treated with ordinary nursing care (the control group) or bundle of care (the observation group). Maturity of AVF fistula and postoperative complications were compared between 2 groups. The observation group was associated with larger internal diameter of the cephalic vein (6.524±0.347 vs. 6.346±0.32 4mm) and faster blood flow at the anastomosis of AVF (568.2±26.8 vs. 565.7±27.5mL/min) than the control group at 2weeks after surgery (both P<0.05). The observation group had a higher maturity rate than the control group (93.1% vs. 81.5%, P<0.05) at 8weeks after surgery. There were lower incidences of fistula stenosis (4.6% vs. 10.8%) and fistula thrombosis (2.3% vs. 7.7%) in the observation group than in the control group (both P<0.05). The secondary patency was higher in the observation group than in the control group (97.7% vs. 92.3%, P<0.05). The use of bundle of care promotes AVF maturity and reduces postoperative complications in patients with end-stage kidney disease.

Intraoperative vascular mapping improves patient eligibility for arteriovenous fistula creation

BackgroundWe assessed the utility of intraoperative vein mapping performed by the operating surgeon for evaluating vessel suitability for arteriovenous fistula (AVF) creation. MethodsIn a retrospective review of 222 AVFs, vein diameter measurements were compared between intraoperative and preoperative mapping in the same anatomical location. AVF creation was based on intraoperative vein diameter ≥2 mm, using a distal to proximal and superficial veins first approach. Potential selection of access type based on preoperative findings alone was analyzed. ResultsThe mean diameter of the veins used for AVF creation measured 3.6 ± 0.8 mm on intraoperative duplex versus 2.5 ± 0.9 mm when the same veins were measured on preoperative duplex. Based on preoperative mapping alone, 23% of patients would have received a more proximal AVF and 5% would have needed a graft. AVFs created more distally based on intraoperative findings had similar maturation rates compared to the rest of the cohort, 79% versus 84% (p = 0.2). ConclusionsIntraoperative vein mapping can be used to evaluate vessel suitability for AVF and compared to pre-operative vein mapping may increase the eligibility of distal veins for fistula creation while reducing the need for AV grafts.

Magnetic resonance analysis of deep cerebral venous vasospasm after subarachnoid hemorrhage in rabbits.

ObjectiveArterial spasm is proved to be an inducer of cerebral ischemia and cerebral infarction, while when a venous spasm occurs, cerebral edema is seen to be caused by a disturbance in cerebral blood flow. However, it is unclear and unproven whether venous spasm occurs after subarachnoid hemorrhage (SAH). To provide the theoretical basis for treating cerebral vasospasm after SAH, magnetic resonance imaging (MRI) was employed to observe the changes in the diameter of deep cerebral veins in rabbits after SAH.MethodsFourteen New Zealand rabbits were randomly divided into the SAH group (n = 10) and the normal saline group (NS group, n = 4). Specifically, the SAH models were established by the ultrasound-guided double injections of blood into cisterna magna. Moreover, the MRI was performed to observe the changes in the diameter of deep cerebral veins (internal cerebral vein, basilar vein, and great cerebral vein) and basilar artery before modeling (0 d) and 1, 3, 5, 7, 9, and 11 d after modeling.ResultsIn the SAH group, the diameter of the basilar artery showed no evident change on the 1st d. However, it became narrower obviously on the 3rd d and 5th d, and the stenosis degree was more than 30%. The diameter gradually relieved from 7th to 9th d, and finally returned to normal on the 11th d. Moreover, the diameter of the internal cerebral vein significantly narrowed on the 1st d, the stenosis degree of which was 19%; the stenosis then relieved slightly on the 3rd d (13%), reached the peak (34%) on the 5th d, and gradually relieved from 7th d to 11th d. Moreover, the stenosis degree of the basilar vein was 18% on the 1st d, 24% on the 3rd d, and reached the peak (34%) on the 5th d.ConclusionAfter SAH in rabbits, the cerebral vasospasm was seen to occur in the basilar artery, and likewise, spasmodic changes took place in the deep cerebral vein. Furthermore, the time regularity of spasmodic changes between the cerebral vein and basilar artery was of significant difference, indicating that the venous vasospasm resulted in active contraction.

Internal jugular vein distensibility: Rapid and reliable bedside assessment tool to predict fluid responsiveness in mechanically ventilated septic patients

Background and Aims: This study aims to evaluate whether respiratory changes in internal jugular vein (IJV) diameter predicts fluid responsiveness in mechanically ventilated patients with sepsis. Methods: In this prospective observational analytic study, mechanically ventilated patients in septic shock received 7ml/kg of Normal Saline (NS) over 15 minutes. Patients were then categorized into two groups retrospectively; fluid responders (R), if there was an increment in Cardiac Index (CI) by more than or equal to 15% following fluid administration, and non-responders (NR) if the increase in CI was less than 15%. The primary outcome was respiratory changes in IJV diameter before and after fluid administration. Ultrasonographic assessment of IJV distensibility was carried out in all mechanically ventilated septic patients before and after fluid administration. Results: In our study, 74 mechanically ventilated septic patients were enrolled. Among them, 29 (39.2%) patients were fluid responders whereas 45 (60.8%) patients were non-responders. Responders demonstrated higher IJV distensibility before volume expansion than non-responders (33.33% vs 16.9%; P &lt;0.001). Significant reduction in this difference was observed following volume challenge in responders (33.33% to 20.18%). An IJV distensibility of &gt;28.2% before fluid administration predicted the change in CI ≥15% with 90% sensitivity and 100% specificity with area under curve of 0.985 (CI 0.963 to 1.006). Conclusion: Ultrasound evaluation of respiratory changes in IJV distensibility effectively predicts fluid responsiveness in mechanically ventilated septic patients.

Varicose disease in pregnant women: clinical patterns and duplex ultrasound investigation of the veins

The objective of the study was to improve the medical care of pregnant women with varicose disease based on the results of duplex ultrasound examination of the veins of the lower extremities, as well as on the clinical and laboratory parameters.We evaluated the data of 128 pregnant women with varicose veins and performed ultrasound to examine the venous system measuring the diameter of the great saphenous vein (GSV) into saphenofemoral junction, midthigh, lower thigh and investigating the venous reflux.The diameter of competent and incompetent GSVsincreased between the first and third trimester in the both groups(p &lt; 0.001). The mean diameter was 4.3 (2.69–5.86) mm in the main group at 22–24 weeks of gestation, 4.6 (2.96‒5.86) mm at 32‒34 weeks, 4.5 (2.91–5.74) mm ‒ after delivery. The diameter of the GSV with reflux was significantly larger than that of GSVs without reflux in the saphenofemoral junction (R = 0.758, p &lt; 0.001).Pregnancy induces the alterations of venous physiology. Examination of clinical and ultrasound data of pregnant women with varicose veins is an important step to prevent the disease progression during pregnancy and childbirth.

Efficiency of endovenous laser and glue ablation methods in comparison with conventional surgery for the treatment of venous ulcers.

In this study, we aimed to investigate the efficiency of endovenous laser and glue ablation techniques and compared the results with conventional surgical stripping. Between January 2005 and January 2020, among 3133 consecutive patients with superficial venous reflux disease receiving treatment at our institution, there were 112 consecutive patients with active venous ulcers. Patients were divided into 3 groups as receiving conventional open surgical treatment (Group 1, n: 70), endovenous glue ablation (Group 2, n: 20), and endovenous laser ablation (Group 3, n: 22). Comorbidity factors, duration and size of the ulcers, deep, perforating, and small saphenous vein disease detected with detailed Doppler ultrasonography, and duration for healing and recurrence were investigated. The age, gender, comorbidities, smoking, history of previous treatment, diameter of the small saphenous vein, number of refluxing perforating veins, size of the ulcer, and ulcer recurrence ratio were not significantly different between groups. There were 7 patients with bilateral disease and in total 119 legs were intervened. Mean durations for complete ulcer healing were significantly lower in Group 1 (53.28 ± 22.1days) than Group 2 (73.7 ± 39.6days); however, it did not differ significantly between Group 1 and Group 3 (62.59 ± 19.65days), and Group 2 and Group 3 (p: 0.26). Ulcers recurred in 23 patients (33%) in stripping group at a mean follow up of 14.42 ± 4.6months, in 7 patients (35%) in glue ablation group at a mean follow up of 11.97 ± 2.94months, and in 5 patients (23%) in laser ablation group at a mean follow up of 12.66 ± 3.48months (p > 0.05 for all). Increased body mass index, co-existence of chronic venous insufficiency, active cigarette smoking, non-compliance with physician advises and exercise and compression stockings, and depth of the ulcers were correlated with recurrence. The rationelle beyond treatment of the venous ulcers and prevention of recurrence relies on relief of the venous hypertension by interventional methods and/or compression therapy. None of the methods is superior over the others. Healing in short term without further recurrence may be achieved with successful intervention as well as good patient compliance.

Risk Predictors of Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease.

The assessment of fibrosis in chronic liver diseases using non-invasive methods is an important topic in hepatology. The aim of this study is to identify patients with non-alcoholic fatty liver disease (NAFLD) and advanced liver fibrosis by establishing correlations between biological/ultrasound markers and non-invasively measured liver stiffness. This study enrolled 116 patients with non-alcoholic fatty liver disease, which were evaluated clinically, biologically, and by ultrasound. Liver fibrosis was quantified by measuring liver stiffness by shear wave elastography (SWE). Multiple correlation analysis of predictors of liver fibrosis identified a number of clinical, biological, and ultrasound parameters (BMI, blood glucose, albumin, platelet count, portal vein diameter, bipolar spleen diameter) that are associated with advanced liver fibrosis in patients with non-alcoholic fatty liver disease. The correlations between the degree of liver fibrosis and the risk values of some serological and ultrasound markers obtained in our study could be useful in clinical practice for the identification of advanced fibrosis in patients with NAFLD.

A novel model based on liver/spleen volumes and portal vein diameter on MRI to predict variceal bleeding in HBV cirrhosis.

To develop a novel logistic regression model based on liver/spleen volumes and portal vein diameter measured on magnetic resonance imaging (MRI) for predicting oesophagogastric variceal bleeding (OVB) secondary to HBV cirrhosis. One hundred eighty-five consecutive cirrhotic patients with hepatitis B undergoing abdominal contrast-enhanced MRI were randomly divided into training cohort (n = 130) and validation cohort (n = 55). Spleen volume, total liver volume, four liver lobe volumes, and diameters of portal venous system were measured on MRI. Ratios of spleen volume to total liver and to individual liver lobe volumes were calculated. In training cohort, univariate analyses and binary logistic regression analyses were to determine independent predictors. Performance of the model for predicting OVB constructed based on independent predictors from training cohort was evaluated by receiver operating characteristic (ROC) analysis, and was validated by Kappa test in validation cohort. OVB occurred in 42 and 18 individuals in training and validation cohorts during the 2 years' follow-up, respectively. An OVB prediction model was constructed based on the independent predictors including right liver lobe volume (RV), left gastric vein diameter (LGVD) and portal vein diameter (PVD) (odds ratio = 0.993, 2.202 and 1.613, respectively; p-values < 0.001 for all). The logistic regression model equation (-0.007 × RV + 0.79 × LGVD + 0.478 × PVD-6.73) for predicting OVB obtained excellent performance with an area under ROC curve of 0.907. The excellent performance was confirmed by Kappa test with K-value of 0.802 in validation cohort. The novel logistic regression model can be reliable for predicting OVB. • Patients with oesophagogastric variceal bleeding are mainly characterized by decreased right lobe volume, and increased spleen volume and diameters of portal vein system. • The right liver lobe volume, left gastric vein diameter and portal vein diameter are the independent predictors of oesophagogastric variceal bleeding. • The novel model developed based on the independent predictors performed well in predicting oesophagogastric variceal bleeding with an area under the receiver operating characteristic curve of 0.907.

312.9: Mathematical Modelling to Determine Segment Perfusion Parameters for Living Donor Liver Transplantation

Introduction: Adult-to-Adult Living Donor Liver Transplantation (A2ALL-1) Cohort Study focused on hepatic blood flow and effect of portal modulation in smaller and left lobe grafts demonstrating a significantly (p = 0.03) higher graft dysfunction in modulated recipients versus unmodulated. The study concluded the need for prespecified portal flow and hepatic venous outflow modulation protocols to better define outcomes of volumetric interventions. We developed a mathematical model of the liver to determine hemodynamic parameters across segments following simulated liver resections and middle hepatic vein interventions in both the remnant donor liver and recipient grafts to predict functional graft outcomes prior to reperfusion. Methods: Arterial/portal/hepatic vein and terminal portal triad diameters from 12 deceased donor livers and biopsies were used in a custom lumped parameter model developed in MATLAB {Fig(a)}. Blood flow is modeled using the Hagen-Poiseuille equation, and the continuity equation is solved to obtain volume flow rate of the whole liver at every point throughout the network {Fig(b)}. Simulated right hepatectomy in the plane of resection shown in Fig(a) is used to derive variations in blood flow and volume through the modeled left liver lobe {Fig(c)}.Results: Schematic illustrations of the modeling components of liver segments demonstrate volume flow rate encoded in pseudocolor mapping in the donor liver before and after right hepatectomy {Fig(b&c)}. Localized increase in blood flow through 2nd and 3rd generations of vessel division is especially apparent in the donor’s simulated remnant left lobe {Fig(c)}. Volume and flow rate alterations in hepatic venous outflow following ligation/reconstruction of middle hepatic veins in the remnant left lobe is evident. Perfusion parameters in the donor graft are also captured to simulate graft perfusion prior to reperfusion in the recipient. Conclusion: Surgical intervention on the middle hepatic vein (MHV) is critical for donor remnant liver outflow and optimal perfusion in the donor graft. Mathematical simulations to predict hemodynamic inflow – outflow parameters in living donor liver transplantation could help guide MHV ligation and reconstruction as well as predict graft perfusion parameters prior to reperfusion.

Radiocephalic Arteriovenous Fistula Patency and Use: A Post Hoc Analysis of Multicenter Randomized Clinical Trials.

Objective:We sought to confirm and extend the understanding of clinical outcomes following creation of a common distal autogenous access, the radiocephalic arteriovenous fistula (RCAVF).Background:Interdisciplinary guidelines recommend distal autogenous arteriovenous fistulae as the preferred hemodialysis (HD) access, yet uncertainty about durability and function present barriers to adoption.Methods:Pooled data from the 2014-2019 multicenter randomized-controlled PATENCY-1 and PATENCY-2 trials were analyzed. New RC-AVFs were created in 914 patients, and outcomes were tracked prospectively for 3-years. Cox proportional hazards and Fine-Gray regression models were constructed to explore patient, anatomic, and procedural associations with access patency and use.Results:Mean (SD) age was 57 (13) years; 45% were on dialysis at baseline. Kaplan-Meier estimates of 3-year primary, primary-assisted, and secondary patency were 27.6%, 56.4%, and 66.6%, respectively. Cause-specific 1-year cumulative incidence estimates of unassisted and overall RC-AVF use were 46.8% and 66.9%, respectively. Patients with larger baseline cephalic vein diameters had improved primary (per mm, hazard ratio [HR] 0.89, 95% confidence intervals 0.81–0.99), primary-assisted (HR 0.75, 0.64–0.87), and secondary (HR 0.67, 0.57–0.80) patency; and higher rates of unassisted (subdistribution hazard ratio 1.21, 95% confidence intervals 1.02–1.44) and overall RCAVF use (subdistribution hazard ratio 1.26, 1.11–1.45). Similarly, patients not requiring HD at the time of RCAVF creation had better primary, primary-assisted, and secondary patency. Successful RCAVF use occurred at increased rates when accesses were created using regional anesthesia and at higher volume centers.Conclusions:These insights can inform patient counseling and guide shared decision-making regarding HD access options when developing an individualized end-stage kidney disease life-plan.

Preoperative estimation of hemi-liver volume using standard liver volume and portal vein diameter ratio in living donor liver transplantation.

Although body surface area (BSA)-based standard liver volume (SLV) formulae have been used for living donor liver transplantation and hepatic resection, hemi-liver volume (HLV) is needed more frequently. HLV can be assessed using right or left portal vein diameter (RPVD or LPVD). The aim of this study was to validate the reliability of using portal vein diameter ratio (PVDR) for assessing HLV in living liver donors. This study included 92 living liver donors (59 males and 33 females) who underwent surgery between January 2020 and December 2020. Computed tomography (CT) images were used for measurements. Mean age of donors was 35.5 ± 7.2 years. CT volumetry-measured total liver volume (TLV), right HLV, left HLV, and percentage of right HLV in TLV were 1,442.9 ± 314.2 mL, 931.5 ± 206.4 mL, 551.4 ± 126.5 mL, and 64.6% ± 3.6%, respectively. RPVD, LPVD, and main portal vein diameter were 12.2 ± 1.5 mm, 10.0 ± 1.3 mm, and 15.3 ± 1.7 mm, respectively (corresponding square values: 149.9 ± 36.9 mm2, 101.5 ± 25.2 mm2, and 237.2 ± 52.2 mm2, respectively). The sum of RPVD2 and LPVD2 was 251.1 ± 56.9 mm2. BSA-based SLV was 1,279.5 ± 188.7 mL (error rate: 9.1% ± 14.4%). SLV formula- and PVDR-based right HLV was 760.0 ± 130.7 mL (error rate: 16.2% ± 13.3%). Combining BSA-based SLV and PVDR appears to be a simple method to predict right or left HLV in living donors or split liver transplantation.

Risk prediction of dysthyroid optic neuropathy based on CT imaging features combined the bony orbit with the soft tissue structures.

PurposeTo analyze computed tomographic (CT) imaging features of patients with dysthyroid optic neuropathy (DON) retrospectively and deduce a more appropriate predictive model.MethodsThe CT scans and medical records of 60 patients with clinically proven Graves' ophthalmopathy (GO) with (26 women and 10 men) and without DON (16 women and 8 men) were retrospectively reviewed, and 20 age- and sex-matched control participants (12 women and 8 men) were enrolled consecutively. The bony orbit [orbital rim angle (ORA), medial and lateral orbital wall angles (MWA and LWA), orbital apex angle (OAA), and length of the lateral orbital wall (LWL)], and the soft tissue structures [maximum extraocular muscle diameters (Max EOMD), muscle diameter index (MDI), medial and lateral rectus bulk from inter-zygomatic line (MRIZL and LRIZL), proptosis, intraorbital optic nerve stretching length (IONSL), superior ophthalmic vein diameter (SOVD), apical crowding, and presence of intracranial fat prolapse] were assessed on a clinical workstation. The CT features among groups were compared, and a multivariate logistic regression analysis was performed to evaluate the predictive features of DON.ResultsAll bony orbital angle indicators, except ORA (p = 0.461), were statistically different among the three groups (all p < 0.05). The values of MWA, LWA, OAA, and LWL were larger in the orbits with the DON group than in the orbits without the DON group (all p < 0.05). The MDI, MRIZL, proptosis, IONSL, and SOVD were statistically significantly different among the three groups (all p < 0.05), in which the orbits with the DON group were significantly higher than the orbits without the DON group and control group. The apical crowding was more severe in the orbits with the DON group than in the orbits without the DON group (p = 0.000). There were no significant differences in the LRIZL and the presence of intracranial fat prolapse (all p > 0.05). The multivariate regression analysis showed that the MWA, MDI, and SOVD were the independent factors predictive of DON. The sensitivity and specificity for the presence of DON by combining these three indicators were 89 and 83%, respectively.ConclusionBone and soft tissue CT features are useful in the risk prediction of DON, especially the MWA, MDI, and SOVD were the independent factors predictive of DON.

Effect of primary balloon angioplasty on draining vein diameter and volume flow in patients with arteriovenous fistula: A cohort study

BackgroundChronic kidney disease (CKD) and end-stage kidney disease (ESKD) cause major morbidity and mortality in 10% of the global population with CKD. The most common renal replacement therapy is hemodialysis with arteriovenous fistula (AVF) access. AVF often undergoes maturation failure due to feeding artery and draining vein inadequacy. Mechanical dilatation, such as primary balloon angioplasty (PBA), can overcome AVF maturation failure. The volume flow (VF) and diameter of the draining veins in AVF patients must be known to evaluate the effect of PBA on AVF maturation. This study aims to analyze the impact of PBA on VF and draining vein diameter in ESKD patients undergoing AVF surgery. MethodsA retrospective cohort clinical trial was conducted at our institution. A total of 75 participants had AVF with an arterial diameter >1.5 mm or vein diameter at the AVF creation site of 2–4 mm. The subjects were divided into 2 groups: the intervention group undergoing PBA (n = 36) and the control group, without PBA (n = 39). PBA was performed using a Mustang ballon (3–6 mm, Medtronic). Follow-ups were conducted at 1 week, 2 weeks, and 6 weeks after AVF creation. ResultsBased on the data, the diameter and VF of the draining veins were significantly larger in the intervention group than in the control group (p < 0.001). Furthermore, we found significant differences in the mean diameter and VF of the draining veins between the control and intervention groups at all stages of examination, from preoperatively to 6 weeks postoperatively (p < 0.001). The strength of the analysis was more than 80%. ConclusionPBA can increase the diameter and VF of the draining veins in patients with AVF.

Development and sensory analysis of fermented dairy beverages with different concentrations of syzygium aromaticum essential oil

Objective: To evaluate the relation between handgrip strength and vascular characteristics of patients with stage IV and V chronic kidney disease (CKD) under conservative or dialysis treatment. Method: A cross-sectional study with 41 CKD patients in stages IV and V under conservative or dialysis treatment were recruited. Radial artery and cephalic vein diameters, mean radial flow velocity, arterial systolic peak and venous distensibility (ultrasonography), handgrip strength (dynamometry) and non-dominant upper limb forearm circumference (perimetry) were evaluated. Results: A relation between handgrip strength and radial artery diameter was observed at 10cm (R2= 23.4%; β= 10.80; CI95%= 1.38-20.21; p= 0.02) and at 20cm (R2= 21.3%; β=7.44; CI95%= 0.16- 14.72; p= 0.04), and with the distensibility at 20cm (R2= 25.9%; β= 6.24; CI95%= 1.39-11.09; p= 0.01). Conclusion: There was a relation between handgrip strength and vascular diameters and venous distensibility in the proximal forearm segments.

Repeated failure of arterio-venous haemodialysis access

Background: The subsequent development of vascular access techniques and devices now permits patients to be maintained on dialysis for decades. Aim of study: To evaluate the most possible causes behind repeated arteriovenous (AV) access failure in ESRD patients and finding the relationship between those causes and the timing of access failure, and putting the possible solutions in the form of interventions and guidelines for those patients. Patients and methods: This retrospective non-randomized study was conducted in department of vascular surgery, Al-Azhar University Hospitals – Cairo (Al-Hussein and Sayed Glal Hospitals). This study was conducted on 100 ESRD patients on regular hemodialysis and with repeated AV access failure; at least two failed accesses for each patient. The total number of failed accesses was 245 where 230 accesses were autogenous AV fistulae and 15 were synthetic bridge grafts in upper limb. Results: Among the cases of access thrombosis 25.5% were associated with access stenosis, 10.5% with hypotension, and 2.5% with external compression. Among the cases of failure of maturation 16% were due to small vein diameter (less than 2.5 mm), 9% associated with hypotension, and 7% with hypotension together with central venous stenosis.

Respiratory variation of central vein diameter in upper body as a surrogate of pulse pressure variation

Background: Cyclical change in central vein diameter during respiratory cycle can be used for fluid-responsiveness assessment. The purpose of this study is to assess variations in the diameter of central veins in upper body region, specifically internal jugular vein (IJV), subclavian vein (SCV), and brachiocephalic vein (BCV), in mechanically ventilated patients. We hypothesized that variations in the diameter of these veins caused by passive ventilation would be strongly concordant with pulse pressure variation (PPV). Methods: The study was conducted in mechanically ventilated, critically ill surgical and medical patients. The PPV values were automatically calculated and were recorded. The diameters of the study veins such as the IJV, SCV, and BCV were measured bedside using the ultrasound. Then respiratory variations of venous diameter were calculated into distensibility index, collapsibility index and variability index. The relationships between PPV and ultrasound-derived parameters were assessed. Patients were separated into two groups according to their PPV values (&gt;13 and &lt;10). The test performance and proper cut-off values of ultrasound-derived parameters to distinguish between these two groups were generated by receiver operating characteristic (ROC) curves. Results: A total of 44 patients were assessed. There were substantial correlations between PPV and ultrasound parameter namely IJV-DI (r=0.652, p&lt;0.001), IJV-VI (r=0.655, p&lt;0.001), SCV-CI (r=0.618, p&lt;0.001), and SCV-VI (r=0.626, p&lt;0.001). While PPV and BCV-CI show moderate correlation (r=0.531, p=0.008). The IJV-DI, IJV-VI, SCV-CI, SCV-VI and BCV-VI values were significantly greater in PPV&gt;13 group than PPV&lt;10 group. All these parameters were effective in distinguishing between PPV&gt;13 from PPV&lt;10 group with AUC 0.983, 0.983, 0.928, 0.928 and 0.826, respectively. The IJV-DI, IJV-VI, SCV-CI, SCV-VI and BCV-VI analysis demonstrated appropriate cut-off values for separating patients with PPV&gt;13 from those with PPV&lt;10 as 16.19% (sensitivity 92%, specificity 96%), 14.98 % (sensitivity 92%, specificity 96%), 9.74% (sensitivity of 93%, specificity of 91%), 12.33% (sensitivity of 87%, specificity of 100%) and 13.71% (sensitivity of 73%, specificity of 100%), respectively. Conclusions: In critically ill patients, all ultrasound-derived measures such as IJV-DI, IJV-VI, SCV-CI, SCV-VI, and BCV-VI revealed significant correlation with PPV value.

TH4.2 To do or not to do, Branch ligation of a non-maturing arterio-venous fistula for haemodialysis

Abstract Aim Up to 20% of arterio-venous fistulas (AVFs) may fail to mature to become usable for renal access in patients on Haemodialysis (HD). There is no consensus on benefit of branch ligation. This study aimed to assess the outcomes of branch ligation on maturation of these AVFs. Methods Electronic patient records and Renalware were accessed to obtain data of branch ligation procedures done at secondary care centre from 2016 till 2021. Results With a prevalent dialysis population of over 771 patients and incident dialysis population of 147 in 2021, we as a centre perform 250–300 access procedures annually. A total of 23 ligation procedure were done in the above-mentioned period. Less than 50% of patients had a large branch documented on Duplex scan report to be draining a significant and measurable flow away from the AVF. The other procedures were done based on clinical judgement. All procedures were done under Duplex guidance and under Local or Regional anaesthesia. About two thirds of the fistulas that required branch ligation were Radio-Cephalic AVFs, the rest Brachio-Cephalic AVFs. No complications were reported though one patient needed a fistuloplasty due to vein pinch. In 16 out of the 23(69.5%) patients there was clinical and sonological improvement in flow, and or vein diameter after the branch ligation making them usable for HD. Conclusion Branch ligation of non- maturing fistula in selected cases can help maturation and make these arteriovenous fistulas usable.