Vein Flow Research Articles

A case of successful treatment with repeated segmental embolization for downhill esophageal varices caused by giant goiter.

Downhill esophageal varices often develop because of venous hypertension caused by either superior vena cava obstruction or compression. We herein present a case of downhill esophageal varices caused by a giant goiter in a patient with postoperative Graves' disease. A 66-year-old man presented with an enlarged goiter. Gastrointestinal endoscopy revealed upper esophageal varices. This patient was successfully treated with repeated segmental embolization of the thyroid arteries that fed the goiter, followed by embolization of the inflow vein for downhill esophageal varices. Three years later, no re-enlargement of either the goiter or the appearance of downhill varices was observed. Segmental embolization therapy is thus considered to be a safe alternative for the treatment of downhill esophageal varices caused by giant goiter.

Saphenous vein to the right coronary system from the right thoracic artery or the aorta. Long-term propensity-matched results of 2 groups.

Since 2000, we anastomosed the saphenous vein graft to the right coronary artery system using the stump of the right internal thoracic artery as inflow. The long-term results of patients where the right coronary artery was grafted with the right internal thoracic artery or the ascending aorta as saphenous vein inflow has not been reported. From 2000 to 2018, 699 consecutive patients had right internal thoracic artery elongated with saphenous vein (I-graft group, n = 358, 51.2%) or saphenous vein from the aorta (Ao-graft group, n = 341, 48.8%) on right coronary artery system. Inclusion criteria were age ≤75 years, bilateral internal thoracic arteries as a Y graft on the left system (three-vessel disease, n = 603, 86.3%) or as a left internal thoracic artery on left anterior descending and right internal thoracic artery elongated with saphenous vein on the right coronary artery system (two-vessel disease, n = 96, 13.7%), only 1 saphenous vein per patient. Propensity-matching identified 272 patients per group. One-hundred and twenty-two patients underwent coronary computed tomographic angiography to asses grafts patency after a median follow-up of 88 (65-93) months. In the paired samples, there was no difference in the early outcome. Ten-year survival and freedom from death, non-fatal acute myocardial infarction and repeat revascularization were higher in I-graft group: 90.6 [standard error (SE): 2.0] vs 78.2 (SE: 5.3), P = 0.0266, and 85.2 (SE: 2.4) vs 69.9 (SE: 5.3), P = 0.0179. Saphenous vein graft, at a long-time follow-up, showed a higher patency rate (81.6% (SE: 7.0) vs 50.7% (SE: 7.9), P < 0.0001) and a smaller internal lumen diameter (2.7, standard deviation: 0.4 vs 3.4, standard deviation: 0.6 mm, P < 0.0001) when right internal thoracic artery was the inflow. Grafting the right coronary artery with saphenous vein may entail higher patency rate and better outcome when the inflow is the right internal thoracic artery than when is the ascending aorta. Prospective randomized data are needed to test this hypothesis.

Age-Dependent Changes in Regulation of Water Inflow Into the Vitreous Body.

Water inflow into the vitreous body regulated by retinal aquaporin-4 distributed within Müller cells has been observed in mice; however, the changes in this phenomenon with age remain unknown. This study aimed to evaluate whether intravenously injected H2O also flows into the vitreous body of human subjects and to investigate whether water dynamics in the human posterior eye change with age using [15O]H2O positron emission tomography (PET). Forty-six normal adult volunteers underwent [15O]H2O PET, and the standard uptake value (SUV) in the center of the vitreous body after 1000-MBq [15O]H2O administration was assessed. The SUV was fitted to an exponential curve, and y0, the steady state of the SUV, and b, the speed of increase in the SUV, were calculated. The results for patients ranging from in age from 20 to 39, 40 to 59, and 60 to 79 years were compared using analyses of variance followed by Games to Howell tests. For the parameter y0, statistical analysis revealed no statistically significant differences among the three groups. For parameter b, statistical analysis revealed statistically significant differences between the 20 to 39 and 60 to 79 age groups (P = 0.000), the 40 to 59 and 60 to 79 age groups (P = 0.025), and the 20 to 39 and 40 to 59 age groups (P = 0.037). The present study revealed that H2O injected into the vein flows into the human vitreous body and that the speed of increase in water flow into the vitreous body decreases with aging. This study suggests that water dynamics in the posterior eye, or the retinal glymphatic pathway, change significantly with aging.

Pulmonary vein flow split effects in patient-specific simulations of left atrial flow

Disruptions to left atrial (LA) blood flow, such as those caused by atrial fibrillation (AF), can lead to thrombosis in the left atrial appendage (LAA) and an increased risk of systemic embolism. LA hemodynamics are influenced by various factors, including LA anatomy and function, and pulmonary vein (PV) inflow conditions. In particular, the PV flow split can vary significantly among and within patients depending on multiple factors. In this study, we investigated how changes in PV flow split affect LA flow transport, focusing for the first time on blood stasis in the LAA, using a high-fidelity patient-specific computational fluid dynamics (CFD) model. We use an Immersed Boundary Method, simulating the flow in a fixed, uniform Cartesian mesh and imposing the movement of the LA walls with a moving Lagrangian mesh generated from 4D Computerized Tomography images. We analyzed LA anatomies from eight patients with varying atrial function, including three with AF and either a LAA thrombus or a history of Transient Ischemic Attacks (TIAs). Using four different flow splits (60/40% and 55/45% through right and left PVs, even flow rate, and same velocity through each PV), we found that flow patterns are sensitive to PV flow split variations, particularly in planes parallel to the mitral valve. Changes in PV flow split also had a significant impact on blood stasis and could contribute to increased risk for thrombosis inside the LAA, particularly in patients with AF and previous LAA thrombus or a history of TIAs. Our study highlights the importance of considering patient-specific PV flow split variations when assessing LA hemodynamics and identifying patients at increased risk for thrombosis and stroke. This knowledge is relevant to planning clinical procedures such as AF ablation or the implementation of LAA occluders.

Vein fate determined by flow-based but time-delayed integration of network architecture.

Veins in vascular networks, such as in blood vasculature or leaf networks, continuously reorganize, grow or shrink, to minimize energy dissipation. Flow shear stress on vein walls has been set forth as the local driver for a vein's continuous adaptation. Yet, shear feedback alone cannot account for the observed diversity of vein dynamics - a puzzle made harder by scarce spatiotemporal data. Here, we resolve network-wide vein dynamics and shear rate during spontaneous reorganization in the prototypical vascular networks of Physarum polycephalum. Our experiments reveal a plethora of vein dynamics (stable, growing, shrinking) where the role of shear is ambiguous. Quantitative analysis of our data reveals that (a) shear rate indeed feeds back on vein radius, yet, with a time delay of 1-3 min. Further, we reconcile the experimentally observed disparate vein fates by developing a model for vein adaptation within a network and accounting for the observed time delay. The model reveals that (b) vein fate is determined by parameters - local pressure or relative vein resistance - which integrate the entire network's architecture, as they result from global conservation of fluid volume. Finally, we observe avalanches of network reorganization events that cause entire clusters of veins to vanish. Such avalanches are consistent with network architecture integrating parameters governing vein fate as vein connections continuously change. As the network architecture integrating parameters intrinsically arise from laminar fluid flow in veins, we expect our findings to play a role across flow-based vascular networks.

Venographic classification and long-term surgical treatment outcomes for axillary-subclavian vein thrombosis due to venous thoracic outlet syndrome (Paget-Schroetter syndrome)

ObjectiveWe assessed the clinical presentation, operative findings, and surgical treatment outcomes for axillary-subclavian vein (AxSCV) thrombosis due to venous thoracic outlet syndrome (VTOS). MethodsWe performed a retrospective, single-center review of 266 patients who had undergone primary surgical treatment of VTOS between 2016 and 2022. The clinical outcomes were compared between the patients in four treatment groups determined by intraoperative venography. ResultsOf the 266 patients, 132 were male and 134 were female. All patients had a history of spontaneous arm swelling and idiopathic AxSCV thrombosis, including 25 (9%) with proven pulmonary embolism, at a mean age of 32.1 ± 0.8 years (range, 12-66 years). The timing of clinical presentation was acute (<15 days) for 132 patients (50%), subacute (15-90 days) for 71 (27%), and chronic (>90 days) for 63 patients (24%). Venography with catheter-directed thrombolysis or thrombectomy (CDT) and/or balloon angioplasty had been performed in 188 patients (71%). The median interval between symptom onset and surgery was 78 days. After paraclavicular thoracic outlet decompression and external venolysis, intraoperative venography showed a widely patent AxSCV in 150 patients (56%). However, 26 (10%) had a long chronic AxSCV occlusion with axillary vein inflow insufficient for bypass reconstruction. Patch angioplasty was performed for focal AxSCV stenosis in 55 patients (21%) and bypass graft reconstruction for segmental AxSCV occlusion in 35 (13%). The patients who underwent external venolysis alone (patent or occluded AxSCV; n = 176) had a shorter mean operative time, shorter postoperative length of stay and fewer reoperations and late reinterventions compared with those who underwent AxSCV reconstruction (patch or bypass; n = 90), with no differences in the incidence of overall complications or 30-day readmissions. At a median clinical follow-up of 38.7 months, 246 patients (93%) had no arm swelling, and only 17 (6%) were receiving anticoagulation treatment; 95% of those with a patent AxSCV at the end of surgery were free of arm swelling vs 69% of those with a long chronic AxSCV occlusion (P < .001). The patients who had undergone CDT at the initial diagnosis were 32% less likely to need AxSCV reconstruction at surgery (30% vs 44%; P = .034) and 60% less likely to have arm swelling at follow-up (5% vs 13%; P < .05) vs those who had not undergone CDT. ConclusionsParaclavicular decompression, external venolysis, and selective AxSCV reconstruction determined by intraoperative venography findings can provide successful and durable treatment for >90% of all patients with VTOS. Further work is needed to achieve earlier recognition of AxSCV thrombosis, prompt usage of CDT, and even more effective surgical treatment.

Partial Splenic Artery Embolization to Treat Portal Hypertension

AbstractPortal hypertension (PH) commonly occurs in the setting of underlying liver disease and can precipitate variceal bleeding and ascites among other complications. Traditionally, PH is managed with medication or lifestyle changes with refractory cases treated with transjugular intrahepatic portosystemic shunts or splenectomy. Partial splenic artery embolization (PSE) is an alternative treatment which may reduce PH by decreasing splenic vein inflow into the portal vein. In this article, we review the efficacy of PSE and present illustrative cases with a focus on technical and clinical considerations for embolization. We queried the PubMed database from August 1976 to September 2021 for clinical studies of PSE for the treatment of portal hypertension. For each article, the author, year, title, study design, number of patients, age, sex, liver function, technical considerations, adverse effects, and outcomes were recorded. We also review two successful and unsuccessful cases from our institution. A total of 12 studies were identified with 258 patients undergoing 290 PSE treatments. The mean age of patients was 44.1 years (range: 6–77). Most patients had well-compensated liver disease (Child–Pugh (CP) A; 35.1%) or significant functional compromise (CP-B; 44.4%), but a few had decompensated disease (CP-C; 8.9%). The majority (91.7%) of procedures were performed distally within the splenic artery, and on average, 59.5% (20–100) of the spleen underwent infarction. Common complications included symptoms of postembolization syndrome such as abdominal pain (58.5%) and fever (53.2%) as well as atelectasis (9.0%). Five PSE procedures (1.7%) resulted in death secondary to pleuropneumonia, splenic abscess, sepsis, intracranial hemorrhage, and pulmonary embolism, respectively. PSE is an effective but often underutilized treatment for PH. These benefits have risk for minor complications including postembolization syndrome and major complications such as splenic abscess formation. This article will introduce the reader to important technical and clinical considerations regarding PSE.

ADER scheme with a simplified solver for the generalized Riemann problem and an average ENO reconstruction procedure. Application to blood flow

We present numerical schemes for solving hyperbolic balance laws, admitting stiff source terms, to high-order of accuracy in both space and time. The schemes belong to the ADER family of methods and as such rest on two building blocks, namely a non-linear spatial reconstruction procedure and the solution of a generalized Riemann problem (GRP), in which the data is piece-wise smooth and the equations include source terms. This paper presents contributions on both building blocks. Concerning spatial reconstruction we present various versions of a new Essentially Non-Oscillatory (ENO) type reconstruction, called here Averaged ENO (AENO). As to the generalized Riemann problem, we present an improved solver based on two basic ingredients, namely the implicit Taylor series expansion reported in Toro and Montecino (2015) and the simplified Cauchy–Kowalewskaya procedure reported in Montecinos and Balsar (2020).The resulting ADER schemes are implemented and systematically assessed for the linear advection equation and for non-linear hyperbolic system that governs blood flow, with a tube law admitting arteries or veins. For the linear advection equation we implement the new schemes to accuracy ranging from first to seventh order; convergence rate studies confirm that the theoretically expected accuracy is achieved for most versions of the various schemes studied. For the non-linear system we implement the new schemes to accuracy ranging from first to fifth order. Convergence rate studies based on problems with smooth solutions confirm again that the methods attain the theoretically expected accuracy. For the non-linear system the methods are also assessed for Riemann problems for blood flow in arteries with exact solution containing smooth parts and discontinuities, elastic jumps (shocks), and contact discontinuities. Furthermore, for the non-linear system the methods are also assessed for blood flow in veins for a steady problem with smooth analytical solution. As a final assessment of the potential applicability of the methods for realistic simulations in haemodynamics, we apply the methods on a network of 37 blood vessels, for which experimental data is available. The new schemes presented in this paper are simpler than existing versions of ADER methods, involving implicit Taylor series and the Cauchy–Kowalewskaya procedure, published in the literature and, overall, the computational results demonstrate that the new schemes give comparable or superior results, with respect to existing high-order schemes.

Understanding Thrombolysis: Improving Patient Care

<h3>Background Information</h3> Thrombolysis is a process used to break up abnormal blood flow in veins and arteries. Catheter-directed thrombolysis treats vascular blockages and improves blood flow by dissolving abnormal blood clots or by mechanically removing the clots using radiology imaging. Understanding the pathophysiology behind what is causing the thrombus in the patient is as important as managing the patient pre and post thrombolysis procedures. Catheter-directed thrombolysis is a minimally invasive endovascular treatment that is used as an adjunct to anticoagulation. This is a procedure that is performed in Interventional Radiology and the nurses that receive these patients need to understand how to manage them. These patients are often critical and need personalized care and close attention. <h3>Objectives of Project</h3> The purpose of this project is to educate nurses in Interventional Radiology (IR), Intensive Care Units (ICU), and other departments about the pathophysiology of the thrombolysis procedure, along with the preparation, management, and post-procedure care of patients undergoing thrombolysis. <h3>Process of Implementation</h3> The IR shared governance team recognized a gap in knowledge regarding Thrombolysis procedures and the care of patients post-procedure. Current evidence was reviewed and an educational Power Point was created. All members of the IR shared governance team reviewed and offered feedback. The IR Director also reviewed the Power Point for content. Education will be uploaded to the health system's education platform. <h3>Statement of Successful Practice</h3> At the conclusion of the education, learners will be able to describe thrombolysis and how the procedure is performed, define deep vein thrombosis and pulmonary embolism and several methods of treatment for both, and explain the care and management of the patient undergoing Thrombolysis. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Nurses caring for these patients need to understand what to manage and report back to the physician such as changes in mental status, acute headache, nausea/vomiting, and any neurovascular changes. RNs also need to understand appropriate dosages and rates of thrombolytic agents as ordered by the physician in order to properly care for the patient.

State of liver functional activity in children with atopic dermatitis

BACKGROUND: The problem of atopic dermatitis today remains one of the unsolved problems of pediatrics and pediatric allergology. Among the etiopathogenetic mechanisms of atopic dermatitis, the role of endo-allergens formed as a result of impaired digestion and absorption processes in the gastrointestinal tract of a child is separately noted. In such conditions, the load on the detoxification function of the liver increases. In connection with this circumstance, the study of the functional activity of the liver in children with atopic dermatitis is of particular interest. One of its criteria is the nature of intrahepatic hemodynamics.&#x0D; AIM: To find out the features of intrahepatic hemodynamics in the development of atopic dermatitis in children.&#x0D; MATERIALS AND METHODS: 83 children aged 6 months to 5 years with a diagnosis of atopic dermatitis, who made up the main research group, and 33 practically healthy children of the same age, who formed a control group, were examined. The nature of heredity for allergic pathology and morbidity of the gastrointestinal tract was found out in all patients. To obtain information about the functional activity of the liver in all children, hepatic blood flow in the hepatic artery and hepatic vein was studied.&#x0D; RESULTS: Violation of intrahepatic hemodynamics was revealed in children with atopic dermatitis. The blood flow in the hepatic artery in them was characterized by a decrease, and the blood flow in the hepatic vein was characterized by an increase in speed indicators. The detected violations of intrahepatic hemodynamics in children with atopic dermatitis are regarded by the authors of this study as a manifestation of a decrease in the functional activity of hepatocytes in conditions of increased allergenic load.&#x0D; CONCLUSIONS: The study clearly demonstrated a violation of the functional state of hepatocytes in children suffering from atopic dermatitis, expressed in the suppression of hepatic hemodynamics. The question of the primary or secondary nature of this violation is the subject of discussion and further scientific research.

Additional effects of diosmin in the treatment of arterial hypertension in patients with impaired renal venous blood flow

Objective: to estimate of the effect of diosmin in complex antihypertensive therapy on renal function in patients with hypertension and impaired renal venous blood flow.Materials and methods: we observed 147 patients with hypertension aged 40.86±8.27 with signs of bilateral impairment of venous blood flow in the kidneys, which, depending on the amount of therapy, were divided into 2 groups and 2 subgroups. The comparison group consisted of 57 AH patients with unchanged venous blood flow in both kidneys.Results: in the presence of impaired venous blood flow in the renal veins, the use of additional administration of diosmin allows maintaining or improving the filtration capacity of the kidneys. Additional monitoring of patients with impaired venous blood flow in the kidneys is required to assess the effectiveness of antihypertensive therapy with individual drugs with and without venoactive agents.Conclusion: the additional inclusion of diosmin in the complex antihypertensive therapy of patients with arterial hypertension and impaired venous blood flow to the kidneys can preserve and improve kidney function with normalization of GFR.

Computed Tomography Images of Spontaneous Portosystemic Shunt in Liver Cirrhosis.

Spontaneous portosystemic shunt (SPSS) refers to collateral vessels that communicate between the portal vein system and systemic circulation. SPSS mainly includes esophageal varices, gastric varices, left gastric vein, recanalized paraumbilical vein, abdominal wall varices, and spontaneous splenorenal shunt. SPSS contributes to the development of hepatic encephalopathy caused by portal vein inflow bypassing and carries a higher risk of death in liver cirrhosis. Abdominal contrast-enhanced computed tomography is a major imaging approach to establish a diagnosis of SPSS and evaluate its location and feature. This review primarily describes the main contrast-enhanced CT features of SPSS in liver cirrhosis.

Features of hepatobiliary system function in biliary dyskinesia in children with type 1 diabetes mellitus

A study of intrahepatic hemodynamics was conducted in 150 children aged 11 to 14 years, of which 33 were practically healthy children, 117 were patients with biliary dyskinesia (85 with type 1 diabetes, 32 without type 1 diabetes). In patients with biliary dyskinesia, a decrease in the speed of blood flow in the hepatic artery with an increase in indices (resistance, pulsation, systolic-diastolic), as well as an increase in the speed of blood flow in the hepatic vein with a decrease in these indices was revealed. The inhibition of hepatic hemodynamics may be due to the deterioration of bile secretion, as a result of a violation of the normal innervation of the bile system, associated with the development of diabetic neuropathy in children with type 1 diabetes. It is suggested that angiopathy of hepatic arteries and veins plays a certain role in the Genesis of intrahepatic blood flow disorders.

Change of pressure in the circulation of peristaltic blood flow in a vertical Colic vein

Change of pressure in the circulation of peristaltic blood flow in a vertical Colic vein

Blood flow in the umbilical vein of the fetus in first half of pregnancy

The present investigation aims at studying the blood flow in the umbilical vein in the first half of normal pregnancy. It was shown that the establishing of hemocirculation passes through 4 periods: 8- 10th, 11-12th, 13-16th and after the 16th week of pregnancy. Besides that, statistically verified changes in maximum blood flow speed and index of pulsation in this vessel were revealed. Constant bloodstream spectrum reflects stability of oxygenic bloodsupply of the fetus.

Особливості стану венозної гемодинаміки головного мозку в дітей, хворих на бронхіальну астму

Актуальність. Дані щодо кількості хворих із хронічною ішемією головного мозку серед дітей та підлітків поодинокі й нечисленні. Отже, актуальність дослідження стану та змін мозкової гемодинаміки, зокрема венозної циркуляції, у дітей, хворих на бронхіальну астму, не викликає сумніву й є вкрай гострим питанням. Мета. Вивчення особливостeй стану венозної гемодинаміки головного мозку у дітей, хворих на бронхіальнy астмy. Матеріали та методи. Проведено ультразвукове допплерографічне дослідження 101 хворих на бронхіальну астму та 30 здорових дітей віком 10–17 років. Хворих дітей було розподілено за гендерною приналежністю, ступенем контролю та тривалістю захворювання. Ультразвукова допплерографія здійснювалась з визначенням максимальної лінійної швидкості кровоплину в руслі базальної вени Розенталя. Результати. Встановлено явища персистуючої венозної дисгемії та веностазу у хворих дітей, особливо хлопчиків, незалежно від ступеня контролю бронхіальної астми. На показники венозної гемодинаміки також негативно впливала тривалість захворювання понад 5 років. Висновки. Oсобливості венозної циркуляції y дітей, хворих на бронхіальнy астмy, є ранніми доклінічними ознакaми цереброваскулярних порушень. Запропоновано віднести їх до групи ризику щодо виникнення цереброваскулярної патології в майбутньому. Доцільно доповнити диспансернe спостереження дітей, хворих на бронхіальнy астмy, дослідженням стану венозної гемодинаміки з використанням транскраніальної допплерографії та дуплексного сканування магістральних судин головного мозку, що забезпечить ранню діагностику цереброваскулярних порушень.

Effects of different intraabdominal pressures on internal jugular vein, liver and kidney functions in obese patients undergoing laparoscopic sleeve gastrectomy

Objective The aim of this study was to investigate whether there was a difference in laparoscopic sleeve gastrectomy (LSG) performed with either 10 mmHg or 13 mmHg intraabdominal pressures. Effects of these pressures on the internal jugular vein (IJV) diameter and flow along with the liver and kidney function tests were evaluated. Materials and Methods The patients were divided into two groups with respect to the intraabdominal pressure performed during LSG (either 10 or 13 mmHg). The patients’ age, comorbidities, surgical history, height, weight, body mass index, family history, duration of surgery, length of hospital stay, serum liver and kidney function tests (Urea, creatinine, Aspartate transaminase, Alanine transaminase, Gamma-glutamyltransferase, Alkaline phosphatase, bilirubin) and the right IJV diameter and flow measured by Duplex ultrasound before intubation (t1), 10 min after insufflation (t2), and at the end of insufflation (t3) were recorded. Results Preoperative and postoperative kidney and liver function values of the patients in both groups were within the reference range. In both groups, there was a significant decrease in the IJV diameter and flow measurement values at t2 compared to t1, and a significant increase was observed at t3 compared to t2 (p < 0.05). The mean IJV diameter and flow were significantly higher in the 10 mmHg pressure group compared to the 13 mmHg group (p < 0.05). Conclusion Neither of the peak pressures performed intraabdominal during LSG caused an adverse effect on liver or kidney functions. Our study emphasizes that low insufflation pressure does not have an advantage in terms of liver and kidney functions. But laparoscopic sleeve gastrectomy with low intra-abdominal pressure may be beneficial especially in patients who require central vein catheterization during the operation. We consider that LSG performed with CO2 pneumoperitoneum at 10 mmHg is a safe, effective and feasible method that can facilitate the insertion of the intraoperative central venous catheter due to lesser charges in the IJV diameter and flow compared to the standard technique.

Portosystemic shunting procedures for complicated portal hypertension: modern opportunities of mini-invasive technique

Aim. To improve the results of treatment for patients with complicated portal hypertension of cirrhotic genesis using the transjugular intahepatic portosystemic shunt with endovascular obliteration of the inflow pathways to the esophageal-gastric varicose veins.Material and methods. Transjugular intahepatic portosystemic shunt was performed in 172 patients with gastroesophageal variceal bleeding. The patients were divided into 3 clinical groups. The shunting procedure was applied to 62 patients. Another 110 patients underwent transjugular intahepatic portosystemic shunt and selective obliteration of the esophageal-gastric vein inflow pathways. The short-term and long-term results (up to 140 months), the incidence of thrombosis, recurrent bleeding and mortality, as well as their relationship with the established risk factors for complications were traced.Results. All patients achieved an effective reduction in the portosystemic pressure gradient and a reduction in the manifestations of portal hypertension. Recurrence of bleeding caused by shunt thrombosis occurred in 23 (13.3%) patients. In clinical group I (n = 62), this complication was noted in 9 (14.5%) patients, in II (n = 54) – 11 (20.4%) cases, in III (n = 56) – only in 3 (5.4%) cases. Bleeding-free survival decreased from 1.0 to 0.82 in 83.9 months, then plateaued. A sharp decrease in the Kaplan–Meier curve from 1.0 to 0.88 was observed within 24.5 months after the intervention. The largest number of deaths was in group I (30.6%), the smallest in group III (7.1%).Conclusion. Transjugular intahepatic portosystemic shunt supplemented by obliteration the inflows of the esophagealgastric varicose veins provides complete eradication of varicose veins, helps to reduce the frequency of recurrent bleeding and death.

Medium-term outcomes after inferior vena cava reconstruction for acute and chronic deep vein thrombosis and retroperitoneal fibrosis

ObjectiveIn the present study, we evaluated the technical and clinical outcomes after endovascular inferior vena cava (IVC) reconstruction in patients with nonmalignant obstruction. MethodsThe preoperative, procedural, and follow-up medical records and imaging studies were retrospectively reviewed for 59 consecutive patients who had undergone endovascular IVC reconstruction for nonmalignant obstruction from February 2014 to January 2019. The patients were classified into three groups according to the quality of their infrainguinal inflow vessels. The outcomes measured were the primary, primary-assisted, and secondary patency rates, reintervention rates, and symptomatic resolution. ResultsThe indications for treatment were post-thrombotic syndrome (n = 41), acute deep vein thrombosis (n = 12), and retroperitoneal fibrosis (n = 6). The median patient age was 37 years, 11 months, 71.2% were men, and 32.2% had a diagnosis of thrombophilia, with no significant difference in these demographics between the three inflow groups. The median follow-up duration was 2 years, 3 months (range, 6 months to 6 years, 5 months). The whole-cohort primary patency was 91.2%, 71.0%, and 24.1% at 1, 3, and 5 years, respectively. Secondary patency was 76.7% at 1 year and 66.4% at both 3 and 5 years. Inflow group A (no post-thrombotic disease in the femoral or deep femoral veins) demonstrated significantly higher primary patency compared with group B (stenotic disease in one or two infrainguinal inflow veins; P = .009) and significantly higher secondary patency than for both groups B (P = .008) and C (all three infrainguinal inflow veins had stenosed or femoral and/or deep femoral vein occlusion was present; P = .04). In post-thrombotic syndrome patients, the Villalta scores had decreased from a mean of 14.2 to 8.1 at 1 year and 6.8 at 2 years, and the Venous Insufficiency Epidemiological and Economic Study Quality of Life score had improved from a mean of 19.8 to 54.1 and 57.3 at 1 and 2 years, respectively. In the patients with acute deep vein thrombosis, the Villalta score was 2.8 at 1 year and 0 at 2 years. In the patients with retroperitoneal fibrosis, the Venous Insufficiency Epidemiological and Economic Study Quality of Life score had improved from a mean of 25.3 at baseline to 44 at 6 months. ConclusionsEndovascular IVC reconstruction for nonmalignant obstruction can achieve good patency and clinical improvement, although the outcomes were poorer for patients with post-thrombotic disease of the femoral and deep femoral veins.

Retrospective analysis of ultrasound and dopplerographic parameters of liver hemodynamics in prognosis of mortality in patients with severe concomitant injury

Purpose. According to the assessment of liver hemodynamics, to determine the criteria for the probability of death in patients with severe concomitant injury and to establish the decisive time range in which these indicators are prognostic.Material and methods. The analysis of ultrasound (US) indicators in 57 patients with severe concomitant trauma was carried out in order to identify criteria for the probability of death and determine the time range in which these indicators have a prognostic character. All patients were divided into two groups: the first group of 40 surviving patients; the second of 17 dead. For comparison, three values were taken for each ultrasound indicator on the 1st, 3rd, 5th, 7th days from the moment of admission to the hospital. Comparison of the first and second groups of patients by these parameters revealed signs characterizing the violation of liver hemodynamics. The Mann-Whitney test, correlation analysis and stepwise logistic regression were used to study the relationships. Differences were considered statistically significant at a significance level of p &lt; 0.05. Correlation was considered strong when R &gt; 0.5. The best reliable regression model was chosen according to the highest value of the Akaike criterion.Results. In the first three days after trauma in patients of the first and second groups, the most significant were such ultrasound signs as a decrease in the diameter of the own hepatic artery (OHA), a decrease in the linear blood flow velocity (LBFV) along the SPA to 27–38 cm/s, and a decrease in volumetric blood flow in OHA, an increase in the index of resistance (IR) in OHA of more than 0.7, in combination, indicate liver dysfunction in patients in a state of traumatic shock. From the 5th day in the second group of patients, an increase in LBFV in the OHA (100–135 cm/s), an increase of 0.70–0.84, a decrease in volumetric blood flow less than 270 ml/min indicate violations of liver hemodynamics during the formation of organ dysfunction. On the 5–7th day, due to edema of the liver parenchyma against the background of an increase in the size of the liver and spleen and the formation of portal hypertension, arterialization of blood circulation occurs, which is characterized by a significant increase in LBFV in the OHA, a decrease in LBFV and volumetric blood flow in the portal vein. The third-fifth day after the injury can be considered a turning point – the correlation of most of the indicators with the fact of death and significant differences in the criterion in 9 out of 11 indicators indicate significant differences in all indicators in patients of the first and second groups. At the same time, not only dopplerographic indicators of hepatic blood flow, but also linear indicators of the size of the liver, spleen, signs of portal hypertension characterize the severity of the patient’s condition. Findings. 1). Carrying out an ultrasound of the liver with the use of Doppler ultrasound allows in the first 3 days from the moment of injury to conclude that there is liver dysfunction against the background of traumatic shock. 2). Statistical analysis of Doppler parameters of liver hemodynamics makes it possible to identify patients with a poor prognosis, severe liver dysfunction in the first 3–5 days from the moment of injury, as well as with developing multiple organ failure. 3). The obtained ultrasound results, indicating liver dysfunction in the early post-traumatic period, are confirmed by autopsy data.