Vein Group Research Articles

Narrowing abdominal aorta and vein is a simple and useful method for preparing a mice model of gestational hypertension

Hypertensive disorder of pregnancy (HDP) is a major cause of maternal morbidity and mortality, fetal growth restriction (FGR), and premature delivery. Soluble fms-like tyrosine kinase-1 (sFLT-1) is significantly elevated in pre-eclamptic women. Making animal models of hypertensive pregnancy is costly and requires advanced equipment. We established a gestational hypertension (GH), one of the HDP subtypes, mouse model by narrowing the abdominal aorta and vein together with a medical drip tube on day 10.5 of gestation. Systolic and diastolic blood pressure on day 18.5 of gestation in the narrowed aorta and vein (NAV) group were significantly higher than those in the control group. Fetal weight decreased in the NAV group. Serum sFLT-1 was significantly increased in the NAV group on day 18.5 of gestation compared to the control group. After delivery, blood pressure and serum sFLT-1 level did not differ between the NAV and the control groups. These parameters normalized postpartum. We established a novel GH mouse model through an easy operative procedure using a simple device. In this NAV model, blood pressure and serum sFLT-1 level were increased on day 18.5 of gestation, and normalized promptly after delivery. The mouse model mimics human GH, and is suitable for the development of other treatments.

Weighted Gene Co-expression Network Analysis for RNA-Sequencing Data of the Varicose Veins Transcriptome.

ObjectiveVaricose veins are a common problem worldwide and can cause significant impairments in health-related quality of life, but the etiology and pathogenesis remain not well defined. This study aims to elucidate transcriptomic regulations of varicose veins by detecting differentially expressed genes, pathways and regulator genes.MethodsWe harvested great saphenous veins (GSV) from patients who underwent coronary artery bypass grafting (CABG) and varicose veins from conventional stripping surgery. RNA-Sequencing (RNA-Seq) technique was used to obtain the complete transcriptomic data of both GSVs from CABG patients and varicose veins. Weighted Gene Co-expression network analysis (WGCNA) and further analyses were then carried out with the aim to elucidate transcriptomic regulations of varicose veins by detecting differentially expressed genes, pathways and regulator genes.ResultsFrom January 2015 to December 2016, 7 GSVs from CABG patients and 13 varicose veins were obtained. WGCNA identified 4 modules. In the brown module, gene ontology (GO) analysis showed that the biological processes were focused on response to stimulus, immune response and inflammatory response, etc. Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis showed that the biological processes were focused on cytokine-cytokine receptor interaction and TNF signaling pathway, etc. In the gray module, GO analysis showed that the biological processes were skeletal myofibril assembly related. The immunohistochemistry staining showed that the expression of ASC, Caspase-1 and NLRP3 were increased in GSVs from CABG patients compared with varicose veins. Histopathological analysis showed that in the varicose veins group, the thickness of vascular wall, tunica intima, tunica media and collagen/smooth muscle ratio were significantly increased, and that the elastic fiber/internal elastic lamina ratio was decreased.ConclusionThis study shows that there are clear differences in transcriptomic information between varicose veins and GSVs from CABG patients. Some inflammatory RNAs are down-regulated in varicose veins compared with GSVs from CABG patients. Skeletal myofibril assembly pathway may play a crucial role in the pathogenesis of varicose veins. Characterization of these RNAs may provide new targets for understanding varicose veins diagnosis, progression, and treatment.

Low thalamostriate venous quantitative susceptibility measurements correlate with higher presenting NIH stroke scale score in emergent large vessel occlusion stroke.

ObjectiveHyperacute stroke affects various patient subgroups who may benefit from different management strategies. Magnetic resonance imaging (MRI) quantitative susceptibility mapping (QSM) is a recent MRI technique for measuring deoxyhemoglobin levels. The results of QSM thus have the potential to act as a quantitative biomarker for predicting the success of endovascular interventions.MethodsTwenty-five patients with M1 occlusions were evaluated retrospectively. QSM measurements were obtained based on susceptibility-weighted imaging sequences from the most prominent veins in each of the four standard regions of interest: the cortical and thalamostriate veins ipsilateral and contralateral to the side of the stroke. The results were analyzed using Wilcoxon’s signed rank test and compared with presenting National Institutes of Health stroke scale (NIHSS) score.ResultsCortical veins ipsilateral to the stroke showed the greatest elevation in susceptibility compared with all other vein groups. Both ipsilateral and contralateral thalamostriate vein susceptibilities showed strong inverse correlation with presenting NIHSS score.ConclusionThalamostriate vein susceptibility shows a strong inverse correlation with presenting NIHSS in adult patients with hyperacute stroke who are selected for endovascular intervention by advanced imaging.

Comparison of venous repair results using either arterial or vein grafts in a crush-avulsion injury model

Background/aim Venous insufficiency after replantation or revascularization is one of the most common causes of limb loss in either the short or the long term. The aim of this study was to evaluate the results of a new technique to overcome venous insufficiency.Materials and MethodsA crush-avulsion type of injury was formed in the femoral veins of rats of 3 separate groups. In the control group, primary repair was applied to the damaged veins and the remaining 2 groups were repaired with either an arterial graft or a vein graft. The success rates of anastomosis were then compared.Results In the control group the patency rate was 25% in the 2nd hour, 12.5% on the 2nd day, and 12.5% on the 10th day. The patency rate in the vein group was 87.5% in the 2nd hour, 50% on the 2nd day, and 37.5% on the 10th day, whereas the patency rates in the artery group were 100% in the 2nd hour, 87.5% on the 2nd day, and 75% on the 10th day.ConclusionMicrosurgery requires experience and patience. It can be considered that the use of arterial grafts for venous repair in replantation after crush-avulsion type amputations can increase the success rate of replantation.

VENOUS DRAINAGE OF KIDNEY;

Background: In the era of changing trends in favour of laparoscopic andminimally invasive surgery, a better understanding of renal veins is of paramount importance. Although various classifications of renal veins have been proposed,none is without shortcomings. We investigated the drainage pattern of renal veins in cadavers and aim to address the shortcomings in previous classifications by proposing a new classification of renal veins. Study Design: Observational cross-sectional study. Setting: Embalmed cadavers or autopsy cases in anatomy and forensic departments of various medical colleges of Lahore (Fatima Jinnah, King Edwards, Allama Iqbal). Period: One year from Feb2008 to Jan2009. Methods: The kidneys and inferior vena cava were well exposed incases with well-preserved renal vessels and kidneys. A mixture of gelatin and Indian ink were injected into inferior vena cava which in turn filled renal veins. Renal vein patterns were studied. We report frequencies in the proposed renal vein groups and subgroups. Results: A total of 50 pairs of kidneys were studied (50 right, 50 left). The renal veins were classified into five groups (A-E) depending on number and arrangement of primary tributaries that formed renal vein.All groups were further divided into three sub groups (1, 2 and 3) depending on whether or not an additional renal vein or any other variant pattern existed, except group E. Subgroup1 represented normal renal vein across all groups. Groups A, B, C consisted of renal veins formed by union of 2, 3, 4 primary tributaries respectively, all from anterior aspect. Group D consisted of renal veins where a posterior primary tributary existed. While group E included renal veins formed by any other number or pattern of primary tributaries. Group A was the most frequent type overall (40%), more common on the right side (56% vs 24%). Group B was the most frequentgroup on the left side (38%). The least frequent group was group E with equal frequency on both sides (6%), closely preceded by group D, which was more frequent on the left side (12% vs 2%). The only statistically significant difference in relation to major groups between right and left kidneys was in group A (56% vs 24% respectively; P=0.001). Conclusion: We proposed a comprehensive classification of renal veins taking into account their variant and anomalous patterns and tributaries not previously considered by other classifications.Future studies in diverse populations with bigger sample are warranted to investigate some of the patterns not observed in this study.

An unusual cause of postmenopausal vaginal haemorrhage: a case report

BackgroundPost-menopause vaginal haemorrhage is typically related to gynaecological malignancies. Bleeding from vaginal varices rarely occurs, especially in nonpregnant women. Moreover, nonpregnancy-related causes of vaginal varicosities include portal hypertension, especially that caused by liver cirrhosis, pelvic congestion syndrome and Klippel-Trenaunay syndrome or Parkes-Weber syndrome. Here, we report an unusual cause of nonpregnancy-associated vaginal variceal bleeding.Case presentationA 55-year-old postmenopausal woman presented in our outpatient department with complaints of recurrent bloody vaginal discharge. A group of varicose veins and several haemorrhagic spots were found on her vaginal wall during a vaginal speculum examination. Genital cancers were excluded by colposcopy and transvaginal ultrasonography; furthermore, a pelvic arteriovenous fistula was not found on a pelvic computed tomography (CT) scan. However, congenital varicosities and deep arteriovenous shunts were observed in her left leg on arterial angiography. Moreover, vaginal bleeding was improved after resolution of the underlying deep arteriovenous shunts in her left leg. Therefore, congenital arteriovenous shunts and elevated inferior vena cava pressure might be responsible for her recurrent vaginal varicose bleeding.ConclusionHaemorrhage due to vaginal varices is easily detected with a vaginal speculum examination. However, diagnosis and treatment of the original disease are important after bleeding is controlled.

Vein Versus Prosthetic Graft for Femoropopliteal Bypass Above the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Conflicting evidence exists surrounding which conduit material is preferable in above-knee femoropopliteal bypass surgery. We performed a systemic review of electronic information sources to identify randomized controlled trials (RCTs) comparing vein versus prosthetic grafts in above-knee femoropopliteal bypasses. Eight RCTs reporting 1271 grafts (608 saphenous vein and 663 prosthetic) in 1132 patients were included. At 5 years, the vein group had significantly higher primary patency (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.17-2.55, P = 0.006), primary assisted patency (OR: 4.02, 95% CI: 2.84-5.70, P < 0.0001), and secondary patency (OR: 1.83, 95% CI: 1.20-2.80, P = 0.005) rates compared with the prosthetic group. The vein group required significantly fewer reinterventions (OR: 0.33, 95% CI: 0.18-0.60, P = 0.0003). There was no significant difference in 30-day mortality (risk difference: -0.01, 95% CI: -0.02 to 0.01, P = 0.34), 30-day morbidity (OR: 1.58, 95% CI: 0.61-4.06, P = 0.35), major amputation (OR: 0.71, 95% CI: 0.43-1.18, P = 0.19), or overall survival (OR: 0.95, 95% CI: 0.70-1.30, P = 0.76) when comparing vein versus prosthetic grafts. Our analysis supports the use of the saphenous vein in above-knee femoropopliteal bypass grafting owing to its superiority in primary, primary assisted, and secondary patency rates and less need for reintervention when compared with prosthetic grafts.

Liver regeneration therapy through the hepatic artery-infusion of cultured bone marrow cells in a canine liver fibrosis model.

BackgroundWe previously reported regenerative therapies for decompensated cirrhosis based on peripheral venous drip infusion using non-cultured whole bone marrow (BM) cells, or the less invasive cultured BM-derived mesenchymal stem cells (BMSCs). Here, we assessed the efficacy and safety of hepatic arterial infusion using cultured autologous BMSCs, comparing it with peripheral infusion, using our established canine liver fibrosis model.MethodsCanine BM cells were harvested and cultured, and the resultant BMSCs were returned to carbon tetrachloride (CCl4)-induced liver cirrhosis model canines via either a peripheral vein (Vein group) or hepatic artery (Artery group). A variety of assays were performed before and 4, 8, and 12 weeks after BMSC infusion, and liver fibrosis and indocyanine green (ICG) half-life (t1/2) were compared to those in a control group that received CCl4 but not BMSCs. The safety of this approach was evaluated by contrast-enhanced computed tomography (CT) and serial blood examinations after infusion.ResultsFour weeks after infusing BMSCs, a significant improvement was observed in the Vein group (n = 8) compared to outcome in the Control group (n = 10), along with a decrease in ICG t1/2. In the Artery group (n = 4), ICG t1/2 was significantly shorter than that in the Vein group at 8 weeks (Δt1/2: −3.8 ± 1.7 min vs. +0.4 ± 2.4 min; p < 0.01) and 12 weeks (Δt1/2: −4.2 ± 1.7 min vs. +0.4 ± 2.7 min; p < 0.01) after BMSC administration. Post-infusion contrast-enhanced CT showed no liver infarction, and blood tests showed no elevations in either serum lactate dehydrogenase concentrations or hypercoagulability.ConclusionsWe confirmed the efficacy and safety of the hepatic arterial infusion of cultured autologous BMSCs using a canine model, thereby providing non-clinical proof-of-concept.

Safety of different tip positions for umbilical vein catheterization

Objective To analyze the safety of indwelling neonatal umbilical vein catheter (UVC) at high or low tip positions. Methods We retrospectively analyzed 155 neonates with indwelling UVC in Guangdong Women and Children Hospital from March 2015 to May 2016. According to the position of the catheter tip, these infants were divided into high position group (the tip was at the same level as the central vein) or low position (the tip was below the portal vein) group. Several parameters including indwelling time, liver function, liver B-ultrasound and catheter-related bloodstream infections in the two groups were analyzed. Data were statistically analyzed using Mann-Whitney U test, Wilcoxon signed rank sum test or Chi-square test. Results (1) A total of 155 infants were enrolled in this study. Their gestational age ranged from 25 to 41 weeks and their birth weight were 700 g to 4 690 g. UCV was inserted at the age of 0.5-8.0 d for 0-12 d. In the low position group, seven cases ended in early extubation due to fluid extravasation caused by shallow insertion. The indwelling time of the low position group was shorter than that of the high position group [M (P25-P75), 6 (4-7) d and 7 (5-7) d, Z=-2.580, P=0.010]. There were no significant differences in gender, gestational age, birth weight, and age at catheterization between the two groups. (2) No abnormality in the two groups was revealed by liver ultrasound. Complications such as neonatal necrotizing enterocolitis, thrombosis and embolism, air embolism and liver abscess were not reported. The proportion of liver function abnormalities in the high group was 6.9% (6/87), which was not statistically significant as compared with 4.4% (3/68) in the low position group (χ2=0.431, P=0.512). (3) Blood culture was performed for all cases, of which 116 (74.8%) were catheter culture (including 71 in the high position group and 45 in the low position group). The incidence of catheter-related bloodstream infection in the high position group was 5.6% (4/71) and the infection rate was 7.4 per thousand catheter days, while in the low position group these figures were 6.7% (3/45) and 8.0 per thousand catheter days, respectively. There was no significant difference between the two groups (χ2=0.052, P=0.820). (4) Results of catheter culture showed that seven cases were positive, including three for Staphylococcus haemolyticus (two in low position group and one in high position group), one for yeast-like fungus (high position group), one for Enterococcus faecium (high position group), one for Staphylococcus aureus (high position group) and one for Candida albicans (low position group). Conclusions The indwelling time of UVC at high tip position is longer than that at low position, and although there are no differences between the complications and the incidence of catheter-related bloodstream infection in the two groups, but its safety needs further study. Key words: Umbilical veins; Catheters, indwelling; Time; Infant, newborn

The Effect of Puncture Sites of Portal Vein in TIPS with ePTFE-Covered Stents on Postoperative Long-Term Clinical Efficacy

Purpose To evaluate the effect of puncture sites of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS) on long-term clinical efficacy. Methods A retrospective review was performed, including consecutive 171 patients who underwent TIPS with ePTFE-covered stents. All patients were divided into 3 groups according to the puncture site of the portal vein: intrahepatic bifurcation of the portal vein (group A, n = 88), right branch of the portal vein (group B, n = 48), and left branch of the portal vein (group C, n = 35). The Kaplan-Meier analysis was performed to assess the effect of different puncture sites on primary patency, the incidence of hepatic encephalopathy (HE), and survival. Results The primary restenosis rate was 29.8% (51/171). The total HE rate was 31.6% (54/171). The cumulative death rate was 19.3% (33/171). The Kaplan-Meier analysis showed that group C versus group A, group C versus group B, and group A versus group B were significantly different on the primary restenosis rate, respectively (χ2 = 11.49, P = 0.001; χ2 = 4.54, P = 0.033; and χ2 = 4.12, P = 0.046), and group C is better than the other two groups. What is more, group C versus group A and group C versus group B were significantly different on the incidence of HE, respectively (χ2 = 8.07, P = 0.004; χ2 = 9.44, P = 0.002), and group C is better than the other two groups. There was no significant difference on survival. Conclusion Choosing the left branch of the portal vein as the puncture site to create the shunt in TIPS with ePTFE-covered stents may decrease the incident of primary restenosis and HE significantly.

Feasibility of aorta after endarterectomy as middle hepatic vein reconstruction in living donor liver transplantation

Introduction: Cryopreserved iliac vein, Polytetrafluoroethylene (PTFE) grafts, and cryopreserved aorta without endarterectomy have been used as middle hepatic vein (MHV) conduits for right liver graft in living donor liver transplantation, but each has advantages and disadvantages. In this study, we started to use aorta after endarterectomy (AoE) without any additional patches and checked patency after engraftment. Method: From January 2015 to June 2018, 111 cases of adult LDLT with modified right lobe grafts using aorta after endarterectomy were performed at Asan Medical Center. Retrospective analysis of patency in these recipients were carried out and compared with control group who received iliac vein (n=436) during the same study period. All vessels were stored and prepared as cryopreservation. Patency of reconstructed MHV was assessed by computed tomography (CT) which was routinely followed at every week during in-hospital stay and at 1, 3, 6, and 12 months after LDLT. Result: Clinically significant stenosis of MHV requiring interventional stenting was occurred in three patients (2.7%) in AoE group, not significantly different from seventeen patients (3.9%) in iliac vein group (p=0.778). Aorta after endarterectomy showed 3-month patency rate of 91.6% and 1-year patency rate of 63.5%. Mean patency time of MHV with AoE 21.4±1.9 months. When compared to iliac vein group, which demonstrated 3-month and 1-year patency rate as 90.0% and 37.3%, respectively, AoE proved superior patency outcome (p=0.001). Mean patency time of iliac vein was 19.6±2.2 months. Conclusion: In this study, AoE showed an acceptable outcome and even better patency compared to iliac vein. Clinically significant complication of stenosis or obstruction of MHV was fairly low. Larger diameter with well-matched thickness to MHV branches, not requiring iliac artery patch, is of great advantage in AoE as interposition graft.

Oxidative Modified Fibrinogen in Cardiovascular Diseases

BackgroundCardiovascular diseases are linked with oxidative stress which is the source of reactive oxidative and nitrative species, contributors of post-translational modification. Fibrinogen due to its high concentration in blood is considered as one of the most sought of targets of oxidative stress substances. Post-translational modifications of fibrinogen might influence its physiological function, thus affect hemostasis in the terms of fibrin nets forming and architecture or interaction with platelets. The aim of this study was to observe influence of in vivo fibrinogen modifications on formation of fibrin net and to identify amino acid residues prone to changes related to oxidative stress.MethodsPlasma samples were collected from patients of The Military University Hospital Prague in the agreement with ethical committees of participating institutions and with informed consents from all subjects. Samples were divided into 4 groups: patients with acute coronary syndrome (A), patients with stroke (B), patients with thrombus localized in carotid vein (C) and control group (patients without coronary atherosclerosis; D). Fibrin net architecture was studied by scanning electron microscopy (Mira 3 LMH, Tescan Orsay Holding, a.s., Brno, Czech Republic). For identification of modified amino acids residue mass spectroscopy was used (Triple TOF 6600, Sciex). Molecular dynamics simulations of hydrated protein were performed in Gromacs software with Gromos force fields. Crystal structure 3GHG was used as a reference structure to which post-translational modifications were introduced manually in Yasara View.ResultsWe found extensive both qualitative and quantitative changes in the structure of fibrinogen molecule in all groups of patients. Oxidative stress level differed among patient groups and between the control group. Different oxidative changes caused by in vivo modifications of fibrinogen affected quite distinctly the architecture of fibrin net. Modified amino acids were detected in all three fibrinogen chains. In gamma chain the localisation of modified amino acid residues correlated with the part of fibrinogen important for fibrin polymerisation. The impact of the most pronounced post-translational modifications on the secondary structure of fibrinogen was described by molecular dynamics simulations.ConclusionsThe results show that the degree of impairment of fibrinogen functions in the cardiovascular diseases is related to the level of oxidative stress. Characterization of oxidative fibrinogen modification and its precise meaning to the function of fibrinogen in hemostasis appears to be extremely helpful to better understanding of thrombotic/bleeding complications linked with various cardiovascular diseases.AcknowledgmentsThis work was supported by the Ministry of Health, Czech Republic, no. 00023736, by the Academy of Sciences, Czech Republic no. P205/12/G118 and NV18-08-00149, by ERDF OPPK CZ.2.16/3.1.00/24001 and by the European Regional Development Fund and the state budget of the Czech Republic (project AIIHHP: CZ.02.1.01/0.0/0.0/16_025/0007428, OP RDE, Ministry of Education, Youth and Sports). DisclosuresNo relevant conflicts of interest to declare.

Discrimination between arterial and venous bowel ischemia by computer-assisted analysis of the fluorescent signal.

Arterial blood supply deficiency and venous congestion both play a role in anastomotic complications. Our aim was to evaluate a software-based analysis of the fluorescence signal to recognize the patterns of bowel ischemia. In 18 pigs, two clips were applied on the inferior mesenteric artery (group A: n = 6) or vein (group V: n = 6) or on both (group A-V: n = 6). Three regions of interest (ROIs) were identified on the sigmoid: P = proximal to the first clip; C = central, between the two clips; and D = distal to the second clip. Indocyanine Green was injected intravenously. The fluorescence signal was captured by means of a near-infrared laparoscope. The time-to-peak (seconds) and the maximum fluorescence intensity were recorded using software. A normalized fluorescence intensity unit (NFIU: 0-to-1) was attributed, using a reference card. The NFIU's over-time variations were computed every 10min for 50min. Capillary lactates were measured on the sigmoid at the 3 ROIs. Various machine learning algorithms were applied for ischemia patterns recognition. The time-to-peak at the ischemic ROI C was significantly longer in group A versus V (20.1 ± 13 vs. 8.43 ± 3.7; p = 0.04) and in group A-V versus V (20.71 ± 11.6 vs. 8.43 ± 3.7; p = 0.03). The maximal NIFU at ROI C, was higher in the V group (1.01 ± 0.21) when compared to A (0.61 ± 0.11; p = 0.002) and A-V (0.41 ± 0.2; p = 0.0005). Capillary lactates at ROI C were lower in V (1.3 ± 0.6) than in A (1.9 ± 0.5; p = 0.0071), and A-V (2.6 ± 1.5; p = 0.034). The K nearest neighbor and the Linear SVM algorithms provided both an accuracy of 75% in discriminating between A versus V and 85% in discriminating A versus A-V. The accuracy dropped to 70% when the ML had to identify the ROI and the type of ischemia simultaneously. The computer-assisted dynamic analysis of the fluorescence signal enables the discrimination between different bowel ischemia models.

Application value of multiple imaging techniques in the MDCT combined with assessment of vascular invasion using a tumor-to-vessel contact computed tomography grading system in preoperative evaluation of pancreatic cancer

Application value of multiple imaging techniques in the MDCT combined with assessment of vascular invasion using a tumor-to-vessel contact computed tomography grading system in preoperative evaluation of pancreatic cancer

Electrophysiological features and radiofrequency catheter ablation of supraventricular tachycardia in patients with persistent left superior vena cava

The electrophysiological features and roles of persistent left superior vena cava (PLSVC) in supraventricular tachycardia (SVT) are not known. The purpose of this study was to elucidate the electrophysiological features and roles of PLSVC in patients with SVT. We included 37 patients with PLSVC (mean age 43.5 ± 17.1 years; 35.1% men) and 510 patients without PLSVC (mean age 43.9 ± 18.8 years; 48.2% men) who underwent an electrophysiology study for SVT. The number of induced tachycardias, location of the slow pathway (SP) or accessory pathway (AP), and radiofrequency catheter ablation (RFCA) outcomes were compared between patients with and without PLSVC. During RFCA of the left AP, a coronary sinus (CS) catheter was placed into the left superior vena cava (left superior vena cava group) or the great cardiac vein (great cardiac vein group). The RFCA outcomes were compared between the groups. In patients with PLSVC, 40 tachycardias were induced: atrioventricular nodal reentrant tachycardia (AVNRT) (n = 19), atrioventricular reentrant tachycardia (n = 17), and focal atrial tachycardia (n = 4). Among patients with AVNRT, an SP in the CS was significantly more frequent in patients with PLSVC than in those without PLSVC (47.4% vs 3.8%; P < .001). In patients with the left AP, the number of RFCA attempts and recurrence were lower in the great cardiac vein group than in the left superior vena cava group. An SP in the CS is prevalent in patients with AVNRT and PLSVC. It is useful to place a CS catheter into the great cardiac vein in patients with a left AP and PLSVC.

Saphenous vein versus right internal thoracic artery as a Y-composite graft: Five-year angiographic and clinical results of a randomized trial

ObjectivesWe compared the 5-year graft occlusion rates and midterm clinical outcomes of saphenous vein composite grafts with those of right internal thoracic artery composite grafts in patients who were enrolled in the SAphenous VEin versus Right Internal Thoracic Artery as a Y-Composite Graft trial. MethodsOf 224 eligible patients with multivessel coronary artery disease who were randomized to undergo off-pump revascularization using the saphenous vein (saphenous vein group, n = 112) or right internal thoracic artery (right internal thoracic artery group, n = 112) as Y-composite grafts based on the in situ left internal thoracic artery from September 2008 to October 2011, 219 patients (saphenous vein group, n = 109; right internal thoracic artery group, n = 110) entered the analysis. A third limb conduit to lengthen the graft limb for complete revascularization was used in 47 patients (saphenous vein group vs right internal thoracic artery group, 8 vs 39). Postoperative 5-year (61.7 ± 5.2 months) angiograms were performed in 186 patients (84.9%; saphenous vein group = 95; right internal thoracic artery group = 91). Follow-up was complete in 97.7% (214/219) of patients with a median follow-up of 80.7 months. ResultsThe overall graft occlusion rate was 3.6% at 5 years (3.5% in the saphenous vein group vs 3.7% in the right internal thoracic artery group, P = .910). The 5-year occlusion rate of the second limb conduits in the saphenous vein group was 4.3% and was noninferior to that of the right internal thoracic artery group (2.4%) within the 95% 2-sided confidence interval of −1.4% to 5.2% (P < .001 for noninferiority). No statistically significant differences were found in the overall survival (P = .439) and the freedom from major adverse cardiac and cerebrovascular event rates (P = .354) at 5 and 8 years between the 2 groups. ConclusionsThe saphenous vein composite grafts were noninferior to the right internal thoracic artery composite grafts in terms of 5-year graft occlusion rates and midterm clinical outcomes.

Venous Anastomoses in Anterolateral Thigh Flaps for the Lower Extremity: Vessel Selection In Lieu of Obligatory Number.

Dual venous drainage for anterolateral thigh flaps has been proposed to protect against flap-related complications in head and neck applications. Here we report our experience with single vs dual venous anastomosis during lower extremity free-tissue transfer. All free anterolateral thigh flaps for lower extremity reconstruction from 2011 to 2017 were retrospectively reviewed. An algorithm was used to determine the type and number of venous anastomoses, emphasizing patient anatomy, venous quality, and size match. Patients were divided into single- and dual-venous-anastomosis groups. Univariate analysis determined differences between the groups. A multivariable analysis identified independent risk factors. Fifty patients met the inclusion criteria. Patient demographics, recipient sites, wound type, and flap characteristics were similar in 1 and 2 vein groups. Average follow-up was 9.6 months. Forty-two percent underwent single venous drainage anastomoses. Mean age was 52.7 years, 78.0% were male, and 60% had defects of the foot and ankle. Increased flap area and early dangling did not increase flap demise. Thirty-three percent of single-drainage patients and 31.0% of dual-drainage patients had a complication. A body mass index of greater than 30 kg/m 2 was a predictor for both flap complication ( P = 0.025) and partial flap loss ( P = 0.031) in univariate analysis. No independent predictors were found in multivariate analysis. The number of venous anastomoses, area, and dangling protocol did not influence outcomes while using our lower extremity vein method. Thoughtful evaluation of venous egress should outweigh the routine use of multiple veins in perforator flap reconstructions of the lower extremity.

The haemodynamic causes of skin changes in limbs with primary varicose veins.

To investigate the haemodynamic causes of skin changes in limbs with primary varicose veins, which were assessed with air plethysmography. Five hundred seventeen consecutive patients with axial reflux in the great saphenous vein (varicose vein group) and 248 normal subjects (normal group) were investigated. Varicose vein group patients were divided into two groups according to whether they did (C4-6) or did not (C2-3) have skin changes. Several parameters obtained using air plethysmography were compared among the normal group, C2-3 and C4-6 patients. Although there was no significant difference in the regurgitation index to quantify venous reflux in C2-3 and C4-6 patients, the maximum arterial inflow rate increased (normal group < C2-3 < C4-6), even in limbs with a small amount of venous reflux. This study suggests that it is not essential to increase the venous reflux rate in skin change development; rather, it is based on various pathophysiological conditions that increase the arterial inflow rate.

RETRACTED ARTICLE: Dose selection of central or peripheral administration of sufentanil affect opioid induced cough?: a prospective, randomized, controlled trial

BackgroundOpioid-induced cough (OIC) is one of the most common complications of opioids during anesthesia induction. This study was designed to assess the incidence of OIC mediated by different intravenous route.MethodsA total of 102(ASA I-II) scheduled for elective surgery under general anesthesia were randomly allocated into two groups: central vein group (group CV, n = 51) and peripheral vein group (group PV, n = 51). The incidence, onset time and severity of OIC were evaluated within 1 min just after sufentanil injection during induction. Meanwhile, heart rate (HR) and blood pressure (BP) were also recorded to assess the hemodynamic changes.ResultsThe incidence of OIC was 10/51 (20.4%) in group CV and 16/51 (32%) in group PV, patients received central venous administration of sufentanil experienced less OIC compared with those injected by peripheral venous route (P < 0.05), as well as a significantly lower incidence of severe OIC (P < 0.05). Nevertheless, the onset of OIC and hemodynamic data were comparable between two groups (P > 0.05).ConclusionOur study indicates that sufentanil administration by central venous route reduces the incidence and severity of OIC, but without significant changes in hemodynamic status.Trial registrationChinese Clinical Trial Registry with registration number ChiCTR-IOR-15006075. Registered 28 February 2015.

Importance of the temporal venous drainage to the petrosal approaches of the skull base

Objectives: The temporal venous drainage is essential to the favorable prognosis of the patients whose require subtemporal and petrosal approaches to the skull base. To obtain adequate exposure of the middle and posterior fossae the tentorial split is an important step. The aim of this paper is discuss the anatomical aspects of the venous patterns of the temporal lobe stressing the relevant correlations with the petrosal and tentorial approaches. Methods: The authors review the anatomic, surgical and radiological aspects of the temporal venous drainage with special concerning about the preservation of the temporal lobe integrity during the transtentorial and petrosal approaches. Results: The vein of Labbè is the most important vein of the lateral group of veins and it is present in almost 100% of the cases. The inferior system of veins is composed by three different groups of veins in the anterior, medial and posterior portions of the temporal lobe. The anteroinferior veins can be present in 70% of the temporal lobes, the medial-inferior veins in 40% and the posteroinferior in 90% of the cases. The anteroinferior and the posteroinferior groups of veins drain in an independent pattern of the lateral group in more than 10% of the cases. Conclusions: Despite of the preservation of the vein of Labbè during the transtentorial and petrosal approaches, temporal infarction has been observed as a complication of such approaches. The patterns of the venous drainage at the inferior temporal surface should be observed carefully in order to avoid temporal infarction. Angiographic preoperative studies are crucial to evaluate such venous anatomy. The correct positioning of the tentorial incisions according with the temporal venous anatomy and the intermittent gentle temporal retraction are the technical aspects, which permit the better final results.