Vein Flow Research Articles

Blood flow in the brain venous blood vessels of children with cerebral palsy while using Bobath therapy

In the diagnosis of the causes of neurological disorders in children’s with cerebral palsy has attached the results of Transcranial Doppler. Bobath therapy is the most innovative and effective methods of physical rehabilitation. For the determination of brain blood flow of children of preschool age with various CNS lesions for the influence of the physical therapy using the Bobath’s method, 35 children aged 4.1 ± 1.1 years were examined. That was the main group (MG). All of 72 procedures were conducted. There was also a control group (CG), the results of the brain blood flow had been studied and analyzed in 34 children aged 3.8 ± 0.9 years who were undergoing rehabilitation using standard methods. Traditional methods of physical therapy and the methods of the Bobath therapy have a significant effect on the brain venous blood flow. At the same time, the significance of individual methods of physical therapy is not convincing. The comparison of changes in blood flow using the Bobath therapy and traditional methods allowed identifying certain differences. The influence of the Bobath methods, on the first place, concerns the more optimal effect on the blood flow in the veins of the spine and the direct venous sinus. At the same time, changes in blood flow with traditional approaches are more convincing to the effect on blood flow in the internal jugular veins and veins of Rosenthal.

Celiac Disease Presenting As Budd Chari Syndrome

An 11 year old female child presented with generalized body swelling, ascites and hepatomegaly. She had history of recurrent loose stools since last 5 years. Initial work up revealed ascites, and hepatomegaly. Serum proteins were within normal limits. Initial USG revealed isoechoeic space occupying lesion in segment VII of liver with ascites. USG Doppler revealed attenuation of blood flow in right hepatic vein. Ascites suddenly improved after 5 days, repeat USG revealed that all three hepatic veins and inferior vena cava were patent. CECT abdomen showed hemangioma measuring 2.1 X 2.6 X 1.36 cm in segment VII of liver with fatty liver with ascites with mesenteric lymphadenopathy. Serum tTGlevel carried out because of short stature and history of diarrhea was 372U/ml (normal 0-20 U/ml). Celiac disease was confirmed on biopsy. Hence the diagnosis of celiac disease with transient obstruction of hepatic veins due to hemangioma or thrombus. Keywords: Budd Chiari; Ascites; Celiac disease

Stent Extension below the Common Femoral Vein in Extensive Chronic Iliofemoral Venous Obstructions

PurposeTo analyze whether primary venous stent placement into 1 dominant inflow vein peripheral to the common femoral vein (CFV) confluence is feasible. Materials and MethodsRetrospective review was performed of 14 consecutive patients who underwent primary venous stent placement into veins peripheral to the CFV between 2013 and 2016. Mean patient age was 49 years; 6 (43%) patients were women. All patients had successful deep venous stent placement with brisk contrast flow through the stent. Patients had primary percutaneous stent placement when postthrombotic changes extended peripherally to the femoral confluence but a trabeculation-free area in the deep femoral vein (DFV) could be identified. Based on imaging findings, the DFV had to be considered the prominent inflow vein with normal anatomy. Femoral vein, DFV, and collateral inflow were minimally impaired owing to postthrombotic scarring or trabeculations. ResultsPrimary, assisted primary, and secondary patency rates were 92% at a median follow-up of 481 d (range, 411–792 d). Venous Clinical Severity Score decreased from a mean of 8.9 to 6.4 (P = .03). The Villalta scale decreased from a mean of 11.7 to 4.3 (P = .003). Before intervention, venous claudication was present in 92% and remained in 38% after intervention (P = .016). ConclusionsStent placement through the femoral confluence into a dominant inflow vein is a promising option in a carefully selected group of patients.

Outcomes of endovascular reconstruction of the inferior vena cava with self-expanding nitinol stents.

Occlusion of the inferior vena cava (IVC) often causes venous claudication, leg swelling, or skin changes. We hypothesized that the outcome of nitinol stents for endovascular reconstruction of the IVC is similar to the outcome reported for steel alloy stents. From the prospective Bern Venous Stent Registry, we investigated technical success, patency rates, and clinical outcome in consecutive patients with endovascular IVC reconstruction. During routine follow-up visits, stent patency was assessed by duplex ultrasound. Clinical outcomes were evaluated using the Bozkaya score, Villalta score, and revised Venous Clinical Severity Score. Of the 62 patients (mean age, 46± 18years), 33 (53%) patients were treated for the post-thrombotic syndrome, 17(27%) for acute thrombosis, and 12 (19%) for nonthrombotic IVC occlusion. Technical success was achieved in 61 (98%) patients, with a mean of 4.5± 1.9 stents (iliac kissing stents in 84%). During follow-up (mean, 21months), 22 (36%) underwent endovascular reintervention for symptomatic stent stenosis (13 [21%] with complete stent occlusion). Primary, primary assisted, and secondary patency rates at 24months were 57% (95% confidence interval [CI], 50%-73%), 76% (95% CI, 65%-86%), and 87% (95% CI, 80%-95%), respectively. None developed new ulcers, and all eight patients with venous ulcers at baseline had complete healing. Twenty-nine (48%) patients showed significant clinical improvement, and another 26 (43%) were free from any symptoms or signs of venous hypertension. Patients with post-thrombotic venographic changes of the femoral veins at baseline or a history of thrombosis were more likely to lose primary patency compared with patients with normal leg inflow veins and no history of thrombosis (19 [48%] vs 3 [16%]; P= .02). The clinical outcome of endovascular reconstruction of the IVC with nitinol stents was favorable. However, approximately one-third of the patients required reintervention to maintain stent patency, most likely because of the impaired venous inflow.

Umbilical cannulation optimizes circuit flows in premature lambs supported by the EXTra-uterine Environment for Neonatal Development (EXTEND).

Bronchopulmonary dysplasia is a disease of extreme prematurity that occurs when the immature lung is exposed to gas ventilation. We designed a novel 'artificial womb' system for supporting extreme premature lambs (called EXTEND) that obviates gas ventilation by providing oxygen via a pumpless arteriovenous circuit with the lamb submerged in sterile artificial amniotic fluid. In the present study, we compare different arteriovenous cannulation strategies on EXTEND, including carotid artery/jugular vein (CA/JV), carotid artery/umbilical vein (CA/UV) and umbilical artery/umbilical vein (UA/UV). Compared to CA/JV and CA/UV cannulation, UA/UV cannulation provided significantly higher, physiological blood flows to the oxygenator, minimized flow interruptions and supported significantly longer circuit runs (up to 4weeks). Physiological circuit blood flow in UA/UV lambs made possible normal levels of oxygen delivery, which is a critical step toward the clinical application of artificial womb technology. EXTEND (EXTra-uterine Environment for Neonatal Development) is a novel system that promotes physiological development by maintaining the premature lamb in a sterile fluid environment and providing gas exchange via a pumpless arteriovenous oxygenator circuit. During the development of EXTEND, different cannulation strategies evolved with the aim of improving circuit flow. The present study examines how different cannulation strategies affect EXTEND circuit haemodynamics in extreme premature lambs. Seventeen premature lambs were cannulated at gestational ages 105-117days (term 145-150days) and supported on EXTEND for up to 4weeks. Experimental groups were distinguished by cannulation strategy: carotid artery outflow and jugular vein inflow (CA/JV; n=4), carotid artery outflow and umbilical vein inflow (CA/UV; n=5) and double umbilical artery outflow and umbilical vein inflow (UA/UV; n=8). Circuit flows and pressures were measured continuously. As we transitioned from CA/JV to CA/UV to UA/UV cannulation, mean duration of circuit run and weight-adjusted circuit flows increased (P<0.001) and the frequency of flow interruptions declined (P<0.05). Umbilical vessels generally accommodated larger-bore cannulas, and cannula calibre was directly correlated with circuit pressures and indirectly correlated with flow:pressure ratio (a measure of post-membrane resistance). We conclude that UA/UV cannulation in fetal lambs on EXTEND optimizes circuit flow dynamics and flow stability and also supports circuit flows that closely approximate normal placental flow.

Abstract TP119: Feasibility of Automated Analysis of Dual- Venc 4d Flow Mri to Assess Hemodynamics in Patients With Intracranial Atherosclerotic Disease

Purpose: Advanced imaging and automated image processing techniques were used to demonstrate the feasibility of 4D flow MRI as a clinical tool for assessment of intracranial hemodynamics in patients with intracranial atherosclerotic disease (ICAD). Introduction: ICAD patients have a high risk of stroke recurrence, which could be partly due to intracranial hemodynamic failure. Thus, it is critical to assess the impact of ICAD on cerebrovascular flow dynamics. Dual- venc 4D flow MRI allows the assessment of flow in major intracranial arteries and veins by providing a large dynamic range. A new automated post-processing tool was developed to ease the cumbersome processing task that hinders clinical application of 4D flow MRI. Method: Intracranial dual- venc 4D flow MRI (Fig 1a) was acquired in 20 healthy volunteers (12M, 43±18Y) and three ICAD patients: two men, 65Y with near occlusion and 43Y with 65% stenotic right MCAs and a 70Y woman with stenoses in PCAs and ACAs (&gt; 50%). Post-processing included automated segmentation of vessels, extraction of centerlines, positioning multiple analysis cut-planes (1 mm inter-plane distance) along the vessels, and computing peak velocity (PK) and flow rate (FR) for each vessel (Fig. 1b and 1c). Results: Fig. 1d and 1e present cumulative results for the control subjects, which show the PV and FR left/right ratios are close to one. this suggests hemodynamic symmetry between left and right hemispheres for controls. For the 65M patient with RMCA stenosis, the PV ratio/FR ratio in ICA and MCA were 1.37/2.26 and 1.44/7.09. The 43M patient with stenotic RMCA showed asymmetry only in the MCA-FR (1.6). The 70F case had multiple stenoses with the most pronounced asymmetry in PCA-PV and -FR (0.42 and 0.6). Discussion: We demonstrated the feasibility of using dual- venc 4D flow MRI and automated flow analysis tool to quantify hemodynamic markers such as PV, FR and flow asymmetry in ICAD patients with the potential application for ICAD risk stratification.

Real-time observation of pathophysiological processes during murine experimental Schistosoma japonicum infection using high-resolution ultrasound imaging

BackgroundHepatosplenic lesion formation is one of the typical clinical symptoms of schistosomiasis japonica. Although it is established that circum-oval granuloma formation mediated by T lymphocytes is the key event triggering the formation of hepatic lesions, the time-course kinetics of disease progression remains to be fully elucidated.MethodsThe real-time process of the pathophysiology of schistosomiasis japonica from the early to late clinical phase was non-invasively observed in a murine experimental infection model using high-resolution ultrasonography. Together with clinical parameters, including body weight and the levels of serum markers of hepatic damage or fibrosis, ultrasonography was used to assess changes in the liver parenchyma and diameter of the portal vein and portal blood flow velocity. In parallel, parasitological parameters were observed, including egg number in the feces and maturation of parasites.ResultsAbnormal high-echo spot patterns in the liver parenchyma, reflecting hepatic fibrosis in ultrasonography, appeared in the liver at 4 weeks post-infection and the pattern became more enlarged and severe over time. This finding was concordant with parasite maturation and initial egg excretion. The serum M2BPGi level markedly increased from 8 weeks post-infection, suggesting sharp deterioration of hepatic fibrosis. At the same time, the diameter of the portal vein, reflecting portal hypertension, became enlarged and reached the peak level at 8 weeks post-infection. Ascites were apparent around the spleen at 9 weeks post-infection, and dilatation of the splenic vein was noted at 10 weeks post-infection. Live adult worms seemed to be detected in the portal vein at 4 weeks post-infection by ultrasonography.ConclusionsWe obtained real-time imaging of the development of hepatosplenic lesions of schistosomiasis japonica in mice. The time-course kinetics of the onset, development, and modulation of each symptom was uncovered. These results are expected to provide new clues for understanding the pathophysiology of human schistosomiasis japonica.

Mathematical Modelling to Simulate Biological Fluid Flow in a Collapsible Tube

The purpose of this paper is to advance a mathematical model for reviewing to simulate biological flows such as blood flow in arteries or veins, flow of urine in urethras and air flow in the bronchial airways. They can also be used to study and prediction of many diseases, as the lung disease (asthma and emphysema), or the cardiovascular diseases (heart stroke), Makinde (2005). In this work, laminar flow of an incompressible viscous fluid through a collapsible tube of circular cross section is considered. Collapsible tubes are easily deformed by negative transmural pressure owing to marked reduction of rigidity. Thus, they show a considerable nonlinearity and reveal various complicated phenomena Our objectives are to study the effect of temperature along the tube as the fluid Prandtl number and Reynolds number increases. We launch the mathematical formulation of the problem. The problem is solved by using power series and perturbation techniques with help of boundary conditions and results are displayed graphically for different flow characteristics, velocity profile.

The use of nonselective beta blockers is a risk factor for portal vein thrombosis in cirrhotic patients.

Background/Aim:A reduction in portal vein inflow velocity seems to predispose to the emergence of portal vein thrombosis (PVT). Nonselective β-blockers (NSBBs), used to prevent variceal bleeding, may increase the development of PVT by reducing portal vein inflow velocity. In this retrospective case-control study, we evaluated the risk factors and clinical features of a first event of PVT in 130 cirrhotics, 19 (15%) with (PVT group) and 111 (85%) without PVT (non-PVT group).Patients and Methods:Patient evaluation and NNBB treatment were carried out according to the AASLD guidelines.Results:PVT was prevalently partial (84%) and asymptomatic (84%). Patients with PVT were treated with different regimens, and resolution of thrombosis was observed in about 50% of the cases. In both groups, HCV was the most frequent cause of cirrhosis and Child-Pugh score A was prevalent. Ascites and esophageal varices were more frequent in the PVT group (P = 0.05 and <0.000, respectively). Treatment with NSBBs was significantly more frequent in the PVT group than in the non-PVT group (P < 0.000). PVT was associated with higher prevalence of chronic renal disease (P = 0.002), higher PT impairment (P = 0.003) and lower AST and ALT (P = 0.000). At multivariate logistic regression analysis, history of esophageal varices (P = 0.007) and NSBB treatment (P = 0.0003) were independent risk factors significantly associated with PVT.Conclusions:Esophageal varices and NSBB treatment were independent risk factors of PVT. Larger studies should evaluate the risk between variceal bleeding and portal vein thrombosis of using NSBBs, particularly in the prevention of first bleeding in nonadvanced liver cirrhosis.

Nontumorous Portal Vein Thrombosis in Liver Cirrhosis: Possible Role of β-Blockers

Objective: Nonselective β-blockers (NSBB) are used in liver cirrhosis (LC) to prevent variceal bleeding because they decrease portal pressure. A main risk factor for the development of portal vein thrombosis (PVT) in LC is decreased portal vein inflow velocity. The aim of our study was to examine retrospectively the incidence of PVT and its correlation with the use of β-blockers in a cohort of LC patients. Subjects and Methods: Data from 230 LC patients (90% Child-Pugh class A), who had been followed up for at least 5 years, were reviewed. The diagnosis of PVT was made by ultrasound. The presence of PVT was evaluated with multiple logistic regression analysis where the independent variables were those significant in the univariate analysis. Results: The prevalence of PVT at baseline was 4.5%, and the incidence was 4.3% at 5 years; among the subjects taking β blockers, 46.4% were taking NSBB. A total of 19 PVT cases were found. Grade of esophageal varices (p < 0.01), PLT (p < 0.003), INR (p < 0.03), spleen diameter (p < 0.001) and PLT/spleen ratio (p < 0.0005) were significantly associated with PVT. The use of NSBB indicated a higher risk of PVT compared to selective β-blockers (SBB) (p < 0.05). In logistic regression analysis only the grade of esophageal varices was significant (p < 0.02). Univariate analysis of patients taking β-blockers showed an association of PVT with grade of esophageal varices (p < 0.01), CP class (p < 0.02), AST (p < 0.03), ALT and albumin (p < 0.02), PLT count and PLT/LD (p < 0.03), longitudinal diameter of the spleen (p < 0.005), ascites (p < 0.05), portal vein (p < 0.0001) and NSBB (OR 8.1; 95% CI 1.7–38.8). Conclusion: NSBB seem to play a role in PV thrombogenesis. Further studies are needed, especially in decompensated LC patients.

Varicose veins of the small pelvis and pelvic congestion syndrome. A differentiated approach: the choice of method of contraception, treatment, prevention

The article considers the main points that affect the quality of life of women with varicose veins of small pelvis with congestion and without it, in particular the use of hormonal methods of contraception, and also discussed the issues of diagnostics, prevention and treatment of these diseases. Algorithms of clinical tactics for conducting such patients are presented. Particular attention is focused on the features of the appointment of hormonal drugs in this category of women. You can determine the methods of treatment and avoid long-term unreasonable prescription of various medicine (especially hormones that will mask or worsen the course of the disease) if you select groups of women with varicose veins of the small pelvis without congestion and with it (reflux).Varicose veins of the small pelvis and pelvic congestion syndrome are conditions that require an interdisciplinary and differentiated approach. Symptoms of these conditions can be put on a mask of various gynecological, urological, traumatological diseases. Anatomical and physiological features of the structure of the veins and the regulation of their venous tone explain the possibility of forming a venous congestive syndrome in women. This can be due to two reasons: due to the violation of the outflow of venous blood or due to the obstruction of any vein of the ovary, any increase in intravascular pressure not controlled by the venous tone at the level of the pelvis.Varicose veins of the small pelvis and pelvic congestion syndrome remain unexplored until the end. There are no uniform standards for their diagnostics. Varicose veins of the small pelvis and pelvic congestion syndrome are different diseases which requiring an understanding of the mechanisms of their development and consequences. If a pelvic varicose veins are suspected, the first diagnostic test is usually ultrasound. Modern ultrasound technique can evaluate blood flow in various veins. To study the blood flow in the veins, laparoscopy, venography in combination with CT or MRI can also be performed.

LEFT ATRIAL FLOW IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION USING 4D PHASE CONTRAST MAGNETIC RESONANCE IMAGING

Atrial fibrillation (AF) is a common arrhythmia associated with elevated morbidity and mortality from systemic thrombo-embolism. Patterns of left atrial (LA) flow may provide valuable insights for thrombogenic risk. However, such fluid dynamics are challenging to explore given 3-dimensional complexity and possible dependence on pulmonary vein inflow symmetry. This study aimed to explore patterns of LA flow in patients with paroxysmal AF and provide preliminary insights surrounding need to consider pulmonary vein inflow symmetry to understand such patterns. 30 subjects (20 with paroxysmal AF, and 10 controls) in sinus rhythm were scanned using a 3T MRI scanner with a standardized protocol inclusive of full heart 4D flow MRI (Fig. 1A-B). Analysis planes were prescribed at the posterior, middle, and distal third (close to mitral valve) of the left atrium (Fig. 1C) as well as in the ostium of each dominant pulmonary vein (Fig. 1D). Blood flow analyses for each plane included: peak velocity (PVel), net flow, forward flow, retrograde flow, and regurgitant fraction (%). Left atrial flow patterns were visually scored for vortex formation, rotation and fractionation in all subjects. Age was 53±17 years in AF subjects and 48±11 years in controls. At the basal, mid and distal planes LA PVel were significantly lower in subjects with AF versus controls (0.38±0.10 m/s vs. 0.57±0.18 m/s, p=0.003; 0.40±0.12 m/s vs. 0.53±0.22 m/s, p=0.043; 0.44±0.15 m/s vs. 0.66±0.32 m/s, p=0.017, respectively). Pulmonary vein PVel were similarly between AF and control subjects, both for individual veins and for mean patient values. Patients with AF showed significant asymmetry in PVel between the left superior (LS) and right superior (RS) pulmonary veins (0.51±0.16 m/s vs. 0.41±0.11 m/s, p=0.003, respectively). Vortical LA flow patterns were observed in all subjects and reliably followed a clockwise rotation pattern. Patients with AF demonstrated broader, more complex, and fractionated vortical flow patterns than control subjects (Fig. 1E). This study demonstrated that 4D flow imaging of LA inflow and vortex formation is clinically feasible and identifies observable differences in LA vortices between patients with paroxysmal AF and healthy controls. Loss of pulmonary vein inflow symmetry was observed in those with AF. Whether this is a cause or a result of altered LA flow vortex characteristics remains unknown. Future work in larger patient cohorts, inclusive of developing standardized measures of vortex behavior, is required to explore the prognostic role of LA vortex analysis in patients with atrial disease.

Liver Transplantation in Patients With Complete Portal Vein Thrombosis: Renoportal or Varicoportal Anastomosis Using Cryopreserved Vein Grafts

BackgroundDespite technical developments in transplantation surgery, complete portal vein thrombosis still remains a challenge for restoration of adequate portal vein inflow. Renoportal or varicoportal anastomosis provides an effective alternative solution for patients with complete portal vein thrombosis. This study describes our experience with renoportal and varicoportal anastomosis during liver transplantation. Patients and methodsBetween January 2014 and May 2016, 5 patients with complete portal vein thrombosis underwent extra-anatomic portal anastomosis. In 3 cases, varicoportal anastomosis was performed and for the others, end-to-end renoportal anastomosis. We used iliac cryopreserved vein grafts to restore portal anastomosis in 3 cases. Epidemiology, risk factors, surgical techniques, complications, and outcomes of these procedures were evaluated over short- and long-term follow-ups. ResultsThe follow-up time is 3 years for our first renoportal case, which was performed in a cadaveric liver transplantation; it was also first nationwide case. The other renoportal anastomosis was practiced in a living donor liver transplantation and the follow-up time is 8 months. The patient and graft survival rates were 100% at the last follow-up. The follow-up times are 10.9 and 4 months for the patients with varicoportal anastomosis. One of these patients died due to recurrence of hepatocellular carcinoma. The other two patients are alive with good graft functions. ConclusionOur experience suggests that reno-varicoportal anastomosis is a useful technique for patients with complete portal vein thrombosis and cryopreserved grafts may be safely used.

Correction of extrahepatic portal hypertension in pediatric patient after liver transplantation

Introduction. Liver transplantation is a multi-component and complex type of operative treatment. Patients undergoing such a treatment sometimes are getting various complications. One of these complications is a portal hypertension associated with portal vein stenosis.Materials and methods. In 6 years after the left lateral section transplantation from living donor in a pediatric patient the signs of portal hypertension were observed. Stenosis of the portal vein was revealed. Due to this fact percutaneous transhepatic correction of portal vein stenosis was performed.Results. As a result of the correction of portal blood flow in the patient a positive trend was noted. According to the laboratory and instrumental methods of examination the graft had a normal function, portal blood flow was adequate. In order to control the stent patency Doppler ultrasound and MSCT of the abdominal cavity with intravenous bolus contrasting were performed. Due to these examinations the stent function was good, the rate of blood flow in the portal vein due to Doppler data has reached 80 cm/sec, and a decrease of the spleen size was noted.Conclusion. Diagnosis and timely detection of portal vein stenosis in patients after liver transplantation are very important for the preservation of graft function and for the prevention of portal hypertension. In order to do that, ultrasound Doppler fluorimetry examination needs to be performed to each patient after liver transplantation. In cases of violation of the blood flow in the portal vein CT angiography performance is needed. Percutaneous transhepatic stenting of portal vein is a minimally invasive and highly effective method of correction of portal hypertension. Antiplatelet therapy and platelet aggregation control are the prerequisites for successful stent function.

Experimental Machine Liver Perfusion Ex Vivo: First Russian Case-Report

Background/Objectives: The article describes preclinical trials of a new apparatus for normothermic machine perfusion of the donor liver that was designed and developed in the Central Research Institute of Robotics and Technical Cybernetics (Saint-Petersburg, Russia). Methods: An experimental study of a new apparatus for isolated perfusion of donor liver was performed on the isolated pig liver. Microcirculation parameters were controlled using computerized dopplerography ultrasound for blood flow studies MM-E-K. Findings: The device consists of the following components - two pumps for pumping fluids in two hydraulic circuits; container, wherein the sealed package is a liver transplant; pump control system; touch screen for setting input and output; uninterruptible power supply to provide mobile functions. Porcine liver was isolated, explanted and after 30 minutes of warm ischemia time it was placed into the apparatus from the pig after induced cardiac death. Liver was perfused with a perfusate of an original composition maintaining its viability. The developed apparatus maintained separate peristaltic blood flow in portal vein at 1.5 l/min and in common hepatic artery at 0.3 l/min, which corresponds to the physiological parameters. Perfusion using the developed apparatus for machine perfusion allowed restoring and preserving the functional state of the liver after 30 minutes of warm ischemia time, as evidenced by spontaneous recovery of the bile outflow, color and texture of the liver graft. Biochemical data values stabilize at physiological levels within 40 minutes after the start of perfusion. Applications/Improvements: The perfusion device is designed to restore and maintain the viability of the donor organ (liver) using extracorporeal flow normothermic perfusion of donor organs.

Thrombosis after transjugular intrahepatic portosystemic shunt: an ominous sign?

Transjugular intrahepatic portosystemic shunt (TIPS) is increasingly used for the treatment of complications of portal hypertension, especially variceal bleeding and ascites refractory to conventional therapy (1,2). Development of thrombosis after TIPS placement is an uncommon complication, which was reported to occur in only 3% to 10% of patients when bare stents were used in several large series (3-6). Thrombosis usually develops acutely either at the time the stent is being deployed or within several days of TIPS placement (2,6). The cause of the thrombosis may be leakage of bile into the shunt, hypercoagulable syndromes, stent mispositioning, suboptimal stent sites, or inadequate coverage of the TIPS tract with sufficient stent (2,7-12). The direct result of thrombosis development is occlusion of the TIPS device, blocking flow in the portal vein and directly resulting in the recurrence of the complication of portal hypertension in addition to potentially causing bowel ischemia as a result of venous congestion in cases of thrombosis extending into the splenic and mesenteric veins (7). Thrombosis can be identified by Doppler ultrasound and patency can be re-established by repeat catheterization (2,7). The development of acute thrombosis also can be effectively prevented by prophylaxis anticoagulation or using e-PTFE-coated stents (13,14). One randomized controlled trial (RCT) showed that use of phenprocoumon (an anticoagulant) was associated with a lower rate of complete occlusion within the first three months following TIPS placement (13). In the RCT by Bureau (14), no early thrombosis was observed in the e-PTFE covered stent-graft group (n=39) as compared with three cases in the covered stent-graft group (n=41). A recent RCT also showed that early thromboses were less frequent in patients receiving covered stent TIPS compared with those receiving bare stents (10/67 in bare stent group vs. 3/63 in the covered stent group) (15).

Brachiocephalic Arteriovenous Fistula for Hemodialysis through the Median Antecubital Vein.

In patients unsuitable for radiocephalic fistula creation, the next option is brachiocephalic fistula. In such patients, we exploited the venous interconnections in the cubital fossa for median cubital vein-Brachiocephalic arteriovenous fistula (AVF) creation. In this article, we describe our experience in the creation of such technical variant of the brachiocephalic fistula AVF, its success and associated complications. A retrospective review of such AVF created between September 2014 and August 2015 was done. The data collected included demographics, co-morbidities, basic disease, operative details, patency, complications, and mortality. A total of 68 vascular access surgeries were done which included 26 (38.2%) brachiocephalic AVF using the median antecubital vein. The mean cephalic vein diameter and mean flow rate were 7.18 mm and 1415 ml/min, respectively 2 months after fistula creation. The primary and secondary failure rates were 3.87% and 7.69% respectively. Complications included aneurysm (7.69%), edema (19.23%), hematoma (11.53%), and wound infection (3.8%). Using reverse flow in the median antecubital vein is a safe and simple way to perform brachiocephalic AVF before brachiobasilic AVF and grafts.

MAY–THURNER SYNDROME OF MEN

May–Thurner syndrome is a complex disease diagnosed. Most often it occurs in young men with unrealized fatherhood. From September 2015 to December 2016 164 men are examined with suspected varicocele. The diagnosis of May–Thurner syndrome is confirmed in 6 patients (2.7 %). The average age of patients with May–Thurner syndrome was 26.4 ± 4.4g (17–38 years old). If you suspect a May–Thurner syndrome, diagnostic algorithm appropriate to start with a search of the asymmetry of blood flow in the iliac veins according to Doppler ultrasound. The optimum therapeutic tactics in these patients will be left intravascular stenting iliac veins in identifying positive pressure gradient in it more than10 mmHg compared with the inferior vena cava.

ROLE OF PULMONARY HYPERTENSION IN THE DEVELOPMENT OF CIRRHOTIC CARDIOMYOPATHY

Aim. To investigate the presence of pulmonary hypertension (PH) in patients with viral liver cirrhosis (LC) and its impact on some indicators of portal hemodynamics, and echocardiographic parameters. Material and methods. The study included 95 patients with viral LC. The median age was 41.7 [33.2;46] years, median disease duration – 3.9 [2.6;6.9]-years. Group 1 consisted of 72 patients without PH – systolic pulmonary arterial pressure (SPAP)<30 mm Hg., group 2 – 23 patients with SPAP3139 mm Hg., control group included 19 healthy subjects. Doppler echocardiography (DEchoCG) and tissue DEchoCG were performed, and diameter,-mean flow velocity in the portal and inferior vena cava were measured. Results: PН was diagnosed in 24% patients with LC who had the enlargement diameter of portal, inferior vena cava veins, and reduced mean blood-flow velocity in the portal vein (p<0.001). According to the DEchoCG data, in patients with LC without PH, left ventricular remodeling occurs with an-increase in its mass and systolic volume; pulmonary artery dilatation and diastolic ventricular dysfunction are also revealed in comparison with the control-group (p<0.001). The revealed abnormalities especially increased in patients with PH, they also showed dilatation of the left atrium and decrease-in the contractility of ventricular myocardium (p <0.001). In patients with LC complicated by PH, a strong correlation was found between the diameter-of the portal vein and blood flow velocity in pulmonary artery (r=0.65, p<0.05), between the diameter of the inferior vena cava and right ventricle-rapid filling flow (r=0.93, p<0.05), between the diastolic function of the right ventricle (E/A) and the blood flow velocity in the portal vein (r=0.73;-p<0.05). The revealed correlations testify to high probability of development of collateral circulation – portal-pulmonary anastomoses. Conclusion: Detected hemodynamic disorders in viral LC indicate an important role of PH in the development of cirrhotic cardiomyopathy.Keywords: heart, рulmonary аrtery, cirrhosis of the liver.

Changes Porto-hepatic Blood Flow in Patients with Cirrhosis of the Liver, Combined with Chronic Bronchitis

The objective: study the features of porto1hepatic blood flow in patients with alcoholic liver cirrhosis (ALC) in conjunction with chronic bronchitis (CB) according to Doppler ultrasound.&#x0D; Patients and methods. The study involved 60 patients who were hospitalized, 20 ALC patients in stage B according to Child-Pugh without CB (Ist group), 20 ALC patients in stage B according to Child-Pugh combined with CB in the acute phase (IInd group), 20 patients exacerbation of chronic bronchitis, for which there was no evidence of digestive system diseases (IIIrd group). All patients underwent a complex ultrasonic research techniques scanning in B-mode, the VD-mode, color duplex scanning using «Hitachi EUB 7000» ultrasonic scanner connected to the Doppler flourimetr was visualized main arterial and venous vessels of hepatic and splenic pools.&#x0D; Results. Changes porto-hepatic blood flow were most pronounced in patients with ALC in combination with CB when compared with patients of groups I and III (p&lt;0,05) according to the obtained Doppler indices: diameter of the hepatic artery was 5,55±0,19 mm, portal vein – 12,60±0,17 mm, where increased by 159,12% and 53,56%, respectively (p&lt;0,05) higher than those in healthy individuals.&#x0D; The diameter of the splenic artery and splenic vein at the ALC for combination with CB significantly increased compared with control on 31,13% and 35,67%, respectively (p&lt;0,05).&#x0D; Linear and volumetric blood flow rate in portal vein decreased in this group of patients, 60,24% and 22,68%, respectively (p&lt;0,05) compared with healthy individuals, the linear velocity of blood flow in the splenic vein also significantly slowed down compared to the control on 41,06% (p&lt;0,05), and the volumetric blood flow velocity v. lienalis grew by 155,80% (p&lt;0,05).&#x0D; Among the characteristics of the arterial blood flow hepato-splenic system Gosling pulsatility index (PI) and Pursello resistance index (RI) of hepatic artery also Pursello resistance index (RI) of splenic artery significantly grew in ALC patients in combination with CB 147,20%, 65,49% and 32,31%, respectively (p&lt;0,05) compared with the control group.&#x0D; Maximal systolic velocity of blood flow in the hepatic artery of patients – grew by 8,95% (p&lt;0,05). End diastolic blood flow velocity in the hepatic artery tended to decrease on 13,36% (p&lt;0,05) compared with healthy individuals.&#x0D; Conclusion. Violation of porto-hepatic blood flow in patients with ALC is characterized by its redistribution in the veins of the portal system in the direction of the spleen with a decrease in the average linear and the volumetric velocity in the portal and hepatic veins, increasing the resistance index in the interlobar arteries.