Venous Research Articles

Hemodynamic Insights Into the Asymmetrical Medullary Vein Sign on T2* Imaging in Hyperacute M1 Occlusion.

Background In treating acute ischemic stroke (AIS), asymmetrical vein signs (AVS) on blood-oxygen-level-dependent imaging reflect increased deoxyhemoglobin levels due to increased oxygen extraction fraction. Meanwhile, although veins connecting pial and deep venous systems, such as transcerebral veins, are well studied, dynamic observation of these veins remains challenging. This study aimed to elucidate the venous flow of the deep white matter (DWM), focusing on medullary AVS in patients with hyperacute cardioembolic M1 occlusion. Methods This retrospective cross-sectional study involved 50 patients with AIS caused by M1 occlusion who received mechanical thrombectomy at Kameda Medical Center from July 2018 to December 2021. The study investigated medullary AVS and their association with angiographic collateral flow grades and occlusion locations. Welch's t-test was used for continuous variables, while Fisher's exact test was employed for categorical variables. Results A total of 41 patients were eligible for analysis. No significant association was found between medullary AVS and angiographic collateral flow grade (p=1.000); however, a significant association was observed between proximal M1 occlusion and medullary AVS (p=0.006), supporting the hypothesis that medullary AVS is significantly influenced by ischemic conditions in the territory of lenticulostriate arteries. Conclusion Three possible mechanisms for medullary AVS were considered: local ischemia in the DWM, ventriculopetal ischemic venous flow from the pial veins, and ventriculofugal ischemic venous flow from the basal ganglia. The results of the present study and the fact that the DWM is exclusively perfused by the cortical arteries favor the ventriculofugal flow hypothesis as the mechanism of medullary AVS. Although direct observation of the veins in the DWM by cerebral angiography is challenging, it can be deduced indirectly.

Deciphering Neuro-Ophthalmic Presentations of Carotid Cavernous Fistulas: A Comprehensive Analysis of Venous Flow Dynamics and Clinical Implications

Background: Carotid cavernous fistulas (CCFs) are abnormal arteriovenous connections between the carotid arterial system and the cavernous sinus, presenting with complex neuro-ophthalmic manifestations due to the redirection of arterial blood into the venous system. This study systematically reviews the diverse neuro-ophthalmic presentations of CCFs, emphasizing the influence of venous flow dynamics. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science, focusing on keywords such as "carotid cavernous fistula," "neuro-ophthalmic presentations," and "optic nerve compression." Recent and historical studies were analyzed to assess the neuro-anatomical impacts on neuro-ophthalmic symptoms from CCFs. This review aimed to consolidate knowledge and refine diagnostic and therapeutic strategies for CCF management. Results: The findings demonstrated that the neuro-ophthalmic presentations were quite distinctive, depending on the direction of venous flow. Anterior flow, overall, was associated with proptosis, conjunctival arterialization, and red, dilated vessels. In contrast, posterior flow was associated with cranial nerve complications, most notably abducens nerve palsy and trigeminal neuralgia, manifesting as double vision and facial pain, respectively. It therefore seems that the symptomatology and severity of CCFs is heavily dependent on the direction of blood flow. Conclusion: The flow direction through the veins is of significant importance in the clinical presentation and prognosis of CCFs. These dynamics must be appreciated to improve diagnosis and allow for optimal treatment, thus averting the risk of fatal complications. In this review, the need for tailored therapeutic strategies through detailed vascular and neuro-ophthalmologic analysis is outlined.

Residual Ultrasound-Enhancing Agents Mimicking Portal Venous Gas.

Sonographic detection of mobile echogenic foci within the main portal vein and its branches or within the liver parenchyma extending along the portal triads to the periphery of the liver is an alarming finding that has been associated with portal venous gas in the setting of bowel ischemia. Ultrasound-enhancing agents (UEAs) have been widely utilized in abdominal ultrasound for evaluation of organ neoplasms and vascular patency as well as in echocardiography for the evaluation of cardiac function. The appearance of UEAs on abdominal ultrasound can resemble gas like that seen in the portal venous system and liver in patients with bowel ischemia; therefore, UEA residuals should always be a part of the differential diagnosis of echogenic foci when seen on abdominal ultrasounds with preceding recent UEA administration. In this observational study, we present a series of cases with suspected portal venous gas suspicious for bowel ischemia that turned out to be a result of residual or persistent UEA from the recent contrast-enhanced echocardiography. Discussion of this phenomenon and its potential explanation is provided.

Transcatheter bicuspid venous valve prostheses: fluid mechanical performance testing of artificial nonwoven leaflets

BackgroundChronic venous insufficiency (CVI) is a common disease with a high prevalence. Incompetent venous valves are considered as one of the main causes. Besides compression therapy, various surgical therapies are practiced, whereby the reconstruction of valves is of central importance. There is an unmet clinical need, no valve prosthesis is commercially available to date. This work introduces two versions of a patented prosthetic bicuspid valve design made of electrospun thermoplastic silicone polycarbonate polyurethane (TSPCU) nanofiber leaflets attached in a nitinol stent, and their performance in static and pulsatile operation.ResultsThe valves mainly fulfill the requirements widely accepted in literature. Valves of both versions were functional in the physiological pressure range up to 50 mmHg with design specific differences.ConclusionsThe here introduced design versions act as a platform technology and can be tailored for an intended implantation site. Evaluation of the original and modified valve concept demonstrated efficacy, with limitations at higher loads for original design. At the current state, the modification is preferable for fabrication, as one processing step is eliminated. Moreover, specific design recommendations could be drawn for valves of similar basic structure. Future work will focus on long-term performance and biocompatibility prior to the initiation of preclinical in vivo studies.

Clinical evaluation of the PowerGlide Pro midline catheter– dwell time, complications and outcomes for various medications including prostaglandins

PurposeThe PowerGlide Pro™ Midline Catheter is a peripheral venous access device with a length of 8–10 cm, allowing the tip to reach far into the venous system. The aim of this study was to evaluate the dwell time of the catheter. Secondary endpoints included suitability for specific medications (e.g. prostaglandins) and assessment of complications.MethodsBetween January 2019 and November 2021, 50 patients were included in the study. Data on patient demographics, placement characteristics, complications and reasons for removal, were collected.ResultsPlacement was technically successful in 92% (n = 46) of cases. In all cases, veins of the upper extremity were punctured (34 basilic veins, 7 brachial veins, 6 cephalic veins, and 3 median cubital veins). The average dwell time was 6.1 days (1–17 days). A significant difference between duration and medication administered could not be demonstrated.ConclusionsThe longer maximum dwell time compared to a standard peripheral venous catheter makes it particularly suitable for intravenous therapy for more than 7 days or patients who have poor peripheral vein status.

Intramural Ventricular Arrhythmias: How to Crack a Hard Nut.

Successful catheter ablation of ventricular arrhythmias depends on identifying the critical tissues that sustain the arrhythmia. Increasingly, the intramural space is being recognized as an important source of idiopathic and reentrant ventricular arrhythmias, representing a common cause of ablation failure. A systematic approach to mapping and ablating these arrhythmias is key to optimize outcomes. Intramural ventricular arrhythmias are common in certain anatomical locations such as the left ventricular ostium or the interventricular septum. In these cases, mapping of the septal coronary veins provides an opportunity to explore the intramural compartment of the septum to perform activation mapping, entrainment and/or pace mapping. When an intramural arrhythmia is identified, ablation may require radiofrequency application from multiple sites, prolonged lesions, or special ablation techniques such as bipolar ablation or transvenous ethanol injection. Identification of intramural ventricular arrhythmias depends on comprehensive mapping that should include the coronary venous system, and ablation often requires advanced techniques. This paper provides a guide on when to suspect an intramural ventricular arrhythmia in the electrophysiology laboratory and how to approach mapping and ablation in these challenging cases.

Celostna ultrazvočna ocena kongestije pri bolnikih s srčnim popuščanjem – kaj moramo vedeti?

In clinical practice, the assessment of congestion in patients with heart failure is most often based on history, clinical examination, and chest X-ray. Clinical symptoms and signs of congestion or signs of congestion on the radiograph appear only in moderate or severe congestion, which can lead to a delay in the diagnosis and appropriate treatment of patients with heart failure. Ultrasound assessment of pulmonary and systemic venous congestion enables more accurate and early identification of congestion, enables better adjustment of diuretic therapy, and represents an important risk assessment for predicting the treatment outcome in patients with heart failure. For clinical use, ultrasound evaluates systemic venous congestion in the inferior vena cava, internal jugular, hepatic, portal, and interlobar renal veins. In contrast, pulmonary congestion is evaluated with lung ultrasound. Due to the ease of implementation and interpretation, the ultrasound assessment of congestion is accessible to both beginners and those who are not skilled in ultrasound examination of the heart and opens the possibility of using the method to a wide range of doctors who encounter patients with heart failure. In the article, we present individual ultrasound methods for assessing systemic venous and pulmonary congestion, their advantages and disadvantages, and explain the interpretation of the obtained values.

Transcatheter Interventions in Adults With Fontan Palliation.

The Fontan circuit is associated with chronically elevated systemic venous pressures and decreased cardiac output, often leading to circuit failure. Managing Fontan circuit failure is complex and requires multiple therapeutic options. Transcatheter interventions have emerged as a reliable approach. They can alleviate obstructions and improve cyanosis by enhancing pulmonary blood flow and oxygen saturation. These procedures can also increase cardiac output and reduce systemic venous pressure, contributing to patient stabilization. In addition, they help mitigate volume overload and decrease the risk of bleeding during heart or combined heart and liver transplants. In recent years, percutaneous interventions have rapidly evolved and become a key therapeutic option for addressing various aspects of Fontan circuit failure. These interventions should be considered integral to the management strategy for this specific patient population.

Giant Carotid-Cavernous Fistula with Complete Shunt

Patient is a 37-year-old male with a history of head trauma surgery 8 years ago, admitted for persistent pulsatile exophthalmos and intracranial murmur. Angiography results showed: blood from the right internal carotid artery(RICA) flowed directly into the cavernous sinus(CS), with the arterial system above the CS not visualized; early visualization of the right venous sinus system; dilation of the right superior ophthalmic vein(SOV) and the medial canthal vein. Bilateral anterior and middle cerebral arteries were perfused through the left internal carotid artery(LICA). We diagnosed a right-sided carotid cavernous fistula(CCF). After a comprehensive preoperative assessment, we chose spring coil embolization treatment, which resulted in the disappearance of symptoms post-treatment. Three month later, upon follow-up, the patient reported no longer hearing intracranial murmur, and auscultation of the right temporal region revealed no abnormal sounds.

Occipital neuralgia as an initial manifestation of atypical Lemierre syndrome: A case report.

Lemierre syndrome is a life-threatening but treatable septic thrombosis of the internal jugular vein (IJV) derived from a craniocervical bacterial infection. Metastatic septic embolization is common. However, diagnostic delay and poor prognosis remain a problem, largely due to the diverse clinical presentations and unclear symptomatology of Lemierre syndrome. In contrast, occipital neuralgia is a common disease typically treated with symptomatic therapy in emergency settings, as most cases are not life-threatening. The present case involved a 70-year-old female with Lemierre syndrome stemming from Streptococcus anginosus infection originating in sinusitis or periodontitis. The onset was characterized by headache with typical occipital neuralgia, a severe trigger point in the posterior neck ipsilateral to the infected IJV, and reduced sensation of the C2 nerve root area. Given the anatomical relationship of the cranial venous emissary system into the posterior cervical venous plexus, the case highlights the potential for the neighboring occipital nerve to be directly involved in Lemierre syndrome. Interestingly, despite Lemierre syndrome typically arising from pharyngeal bacterial infections and infected IJV located in the "anterior" neck, many prior case reports have described "occipital" or "posterior" pain at the head or neck. History taking and physical examination remain essential to identify the causes of these posterior/occipital symptoms, since imaging investigations, as in this case, often fail to identify them. Early recognition of occipital neuralgia as a potential initial symptom of Lemierre syndrome could lead to earlier diagnosis and treatment, potentially improving patient outcomes.

Anatomy of spinal CSF loss in the American alligator (Alligator mississippiensis)

AbstractA variety of anatomical techniques, imaging modalities, dyes and contrast agents, were used to document the mechanisms/routes whereby spinal cerebrospinal fluid (CSF) would move beyond the confines of the spinal dura in the American alligator, Alligator mississippiensis. Three pathways for CSF loss were identified: spinal arachnoid granulations, perineural flow along the spinal nerves, and lymphatic drainage (both along the surface of the dura and at the venous plexus surrounding the spinal ganglion). These same three pathways for spinal CSF loss have been documented in mammals, suggesting that they may be a common feature of (at least) amniotes. Crocodilians, including A. mississippiensis, have the largest epidural venous sinus system of any vertebrate, the present study suggests that, as in mammals, the venous complex of the alligator plays a direct role in regulating the absorption of CSF from the spinal compartment.

Surgical treatment of locally advanced kidney cancer in the T3a–с stage

BACKGROUND: Kidney cancer is a common pathologic condition, which ranks the 3rd place among urologic cancers. In 4–10% of patients, while growing it metastasizes upward the venous vessels up to the thoracic vena cava and right atrium. Selection of the optimal tactics for surgical treatment of such patients still remains a complex and unsolved task. AIM: To assess the surgical treatment findings for the patients suffered from kidney cancer with tumor invasion in the renal and inferior vena cava. MATERIALS AND METHODS: 115 patients with renal cell carcinoma complicated by tumor invasion into renal and inferior vena cava have been operated in North-Western State Medical University named after I.I. Mechnikov from 2003 to 2023. They were 76 (66.1%) men and 39 (33.9%) women, their mean age was 67.0 ± 4.1. Stage T3a covered 53 (46.1%), T3b — 33 (28.7%) and T3c 29 (25.2%) patients. Metastatic lesion of one lymph node was observed in 21 (18.3%) and of multiple nodes in 6 (5.2%) patients. Distant metastases were found in 26 (22.6%) patients: in the lungs in 9.6% and in the adrenal glands in 5.2%. All patients were treated with radical nephrectomy, removing blood trombi from the inferior vena cava system. Eight (7.0%) of them, received the treatment by the method developed in the clinic, which consists in preliminary endovascular extraction of the cranial trombus part. Another 3 (2.6%) patients were treated using cardiopulmonary bypass machine. RESULTS: Early postoperative complications developed in 36 (31.4%) patients. The most common and severe of them were pulmonary embolism (4.4%) and acute cardiovascular insufficiency (10.4%). These complications appeared the causes of death of 4 patients. The mortality rate was 3.5%. The three year survival rate in the T3a group was 70.6%, T3b group — 66.0% and T3c group — 50.6% (p 0.05). CONCLUSIONS: Nephrectomy with vena cava thrombectomy is a radical surgical treatment. Its complexity increases as the tumor thrombus spreads further through the venous system and in some cases requires an interdisciplinary approach.

Cerebral Arterial Inflow and Venous Outflow Assessment Using 4D Flow MRI in Adult and Pediatric Patients

Background and Purpose: The cerebral circulation is highly regulated to maintain brain perfusion, keeping an equilibrium between the brain tissue, cerebrospinal fluid (CSF) and blood of the arterial and venous systems. Cerebral venous drainage abnormalities have been implicated in multiple cerebrovascular diseases. The purpose of this study is to evaluate the relationship between the arterial inflow (AI) and the cerebral venous outflow (CVO) and their correlation with the cardiac outflow in healthy adults and children to understand the role of the emissary veins in normal venous drainage. Materials and Methods: A total of 31 healthy volunteers (24 adults (39.5 ± 16.0) and seven children (3.4 ± 2.2)) underwent intracranial 4D flow with full circle of Willis coverage and 2D PC-MRI at the level of the transverse sinus for measurement of the AI and CVO, respectively. The AI was calculated as the sum of the flow values in the bilateral internal carotid and basilar arteries. The CVO was calculated as the sum of the flow values in the bilateral transverse sinuses. The cardiac outflow was measured via 2D PC-MRI with retrospective ECG gating with images acquired at the proximal ascending aorta (AAo) and descending (DAo) aorta. The ratios of the AI/AAo flow and CVO/AI were calculated to characterize the fraction of cerebral arterial inflow in relation to cardiac outflow and venous blood draining through the transverse sinuses, respectively. Results: The AI and CVO were significantly correlated (r = 0.81, p < 0.001). The CVO constituted approximately 60–70% of the AI. The CVO/AI ratio was significantly lower in children versus adults (p = 0.025). In adults, the negative correlation of the AI with age remained strong (r = −0.81, p < 0.001). However, the CVO was not significantly associated with age. Conclusion: The CVO/AI ratio suggests an important role of the emissary veins, accounting for approximately 30–40% of venous drainage. The lower CVO/AI ratio in children, although partially related to decreased AI with age, suggests a greater role of the emissary veins in childhood, which strongly decreases with age.

The correlation between metabolic dysfunction-associated steatotic liver disease (MASLD) grades and hemodynamic alterations of the portal, hepatic, and splenic vein and spleen size.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is the most prevalent chronic liver condition worldwide, affecting over 25% of the population. Fatty infiltration in MASLD leads to hemodynamic changes in hepatic circulation, which can be quantitatively assessed using Color Doppler Ultrasonography (US). In this study, we aimed to investigate the correlation of Color Doppler US findings of the portal, hepatic, and splenic venous system within various degrees of MASLD. Between 2021 and 2024, 104 patients referred to Mousavi Hospital at Zanjan University of Medical Sciences were enrolled. Participants were divided into four groups based on the degree of hepatic fatty infiltration on biopsy results: normal, grade 1, grade 2, and grade 3, with 26 subjects in each group (13 men and 13 women). All patients were biopsy proved. Gray-scale and Color Doppler US were used to assess portal and splenic vein peak systolic velocity (PSV), portal and splenic vein diameter, hepatic vein waveform, and spleen size. The Spearman rank correlation was employed to evaluate the relationship between these variables under non-parametric conditions. A significant negative correlation was found between portal vein PSV and MASLD grade (r = - 0.499, p = 0.000). A significant difference was also observed in hepatic venous waveform abnormality between different grades of MASLD (p = 0.043). Accordingly, portal vein PSV and splenic vein PSV had a significantly positive correlation (r = 0.209, p = 0.033). We also observed a positive correlation between the portal vein and splenic diameter (r = 0.210, p = 0.032). Increasing MASLD severity is associated with reduced portal vein PSV and more pronounced abnormalities in hepatic vein flow. Routine assessment of portal and hepatic vein flow using Color Doppler US is recommended to accurately diagnose and monitor the effects of MASLD on hepatic circulation, potentially improving disease management and patient outcomes.

Paraganglioma and phaeochromocytoma in adult Fontan patients.

The purpose of this study was to address the gap in knowledge in the incidence, presentation and imaging features of PPGL in Fontan patients. It has been hypothesised in the literature that Fontan circulation patients have an increased incidence of these tumours. This study is the largest cohort of adult Fontan patients in North America. The Fontan procedure is a palliative procedure for single ventricle congenital heart disease where the systemic venous return is directed into the pulmonary circulation. Fontan patients are at increased risk of developing several extracardiac complications including phaeochromocytoma and paraganglioma (PPGL). This retrospective single-centre study includes all adult patients who were treated between 1 September 2015 and 1 September 2022 in a tertiary referral centre for adult congenital heart disease. Imaging and electronic medical records were retrospectively searched for the presence of PPGL. Five hundred and forty-seven Fontan patients were included in the study. Three patients had PPGL with an incidence of 0.5%. Two patients were diagnosed with paraganglioma and one with phaeochromocytoma. All patients were female. Median age of Fontan procedure was 1.8 years (range: 1.75-27 years). Median age of PPGL diagnosis was 19 years (range: 12-39 years). Median time from Fontan operation to diagnosis of PPGL was 12 years (range: 10.3-17.2 years). Fontan patients are at increased risk of PPGL. Clinically, the diagnosis of PPGL is challenging as symptoms and serum markers can be confounding in this population; however, the imaging features of PPGL remain typical making the role of the radiologist crucial.

Abstract 4135311: Cryptogenic stroke associated with a double interatrial septum treated with surgical closure

Introduction: A double atrium septum is a rare congenital anomaly characterized by a double-walled atrial septum with persistent interatrial space. This could be an asymptomatic presentation but also serve as a nidus of thromboembolic complications. We hereby present a case of a 57-year-old female with a cryptogenic stroke found to have a patent foramen ovale and double atrial septum. Case Description: A 57 year-old-female with a past medical history of hypertension presented with acute complaints of word-finding difficulty, left-sided neck pain and lightheadedness after a head strike while swimming. She was found to have a right-sided cerebellar stroke. A carotid artery ultrasound showed no evidence of atherosclerotic disease. Her lipid profile was normal. A transthoracic echocardiogram showed a patent foramen ovale with a positive bubble study revealing a large right to left shunt with Valsalva. A transesophageal echocardiogram confirmed a patent foramen ovale with an incidental finding of a double atrial septum with extreme redundancy of septal issue. The patient had a surgical closure of the interatrial septum and resection of the accessory interatrial septum tissue. She developed chronic post-sternotomy pain and subsequently had sternal wire removal. Discussion: A double atrial septum is a rare congenital anomaly seen as two parallel interatrial septa accompanied by a distinct echo-lucent midline space that expands during systole and contracts during diastole. It can happen embryologically by either the abnormal development of the septum secundum, resorption failure of the superior portion of the septum primum, or the persistence of the left venous valve of the sinus venosus. Typically, individuals with double atrial septum are asymptomatic, but they may encounter cardioembolic events due to the potential thrombi formation in the interatrial space. Communication between the septa increases the likelihood of such events. Unlike atrial fibrillation/flutter, there are currently no established criteria for initiating anticoagulation therapy for double atrial septum, primarily due to its rarity. Some options include antiplatelet agents, oral anticoagulation therapy, and percutaneous or surgical PFO closure. Surgical closure provides a permanent closure of the defect, thereby preventing future paradoxical emboli without the potential risks associated with long-term anticoagulation.

Physical activity in patients with chronic venous insufficiency: Its relation with disease severity, pain, fatigue, and functionality

Purpose: Chronic venous insufficiency (CVI) is a progressive disease of the venous system caused by a variety of factors that impair the return of venous blood to the heart. The aim of the study was to evaluate the physical activity level in patients with CVI and its relation with disease severity, pain, fatigue, functionality. Methods: In all, 105 CVI patients (28.6% male, 71.4% female, mean age was 44.91±10.74 years) were enrolled in this study. Physical activity was evaluated with the International Physical Activity Questionnaire-Short Form (IPAQ-SF); disease severity, by Venous Clinical Severity Score (VCSS); the intensity of pain was determined by the Visual Analog Scale (VAS); fatigue level with the Fatigue Severity Scale (FSS); functionality was assessed with the Lower Extremity Function Scale (LEFS). Results: There was a significant negative correlation between IPAQ-SF-vigorous and VCSS, VASrest, VASactivity, VASnight (r: -0.818, p

Portal venous gas in a domestic shorthair cat with large cell lymphoma

AbstractPortal venous gas is defined as air within the portal venous system, whereas pneumobilia is defined as gas within the biliary tract. This report describes an 11.5‐year‐old female spayed domestic shorthair being managed for large cell lymphoma. While being hospitalised, the patient was noted to have evidence of portal venous gas on diagnostic imaging. The case study highlights common underlying causes of portal venous gas and pneumobilia in addition to diagnostic options and findings for evaluation. The most common cause of portal venous gas is bowel necrosis. Ultrasound and computed tomography scan are the most sensitive diagnostic methods in differentiation. Being familiar with the radiographic signs of and potential underlying causes of portal venous gas and pneumobilia may allow for more prompt investigations of potentially life‐threatening underlying causes. If recent surgical manipulation to the hepatobiliary/hepatoenteric system is not present and there is no history of trauma, then further diagnostic workup should be performed to evaluate for an underlying cause. Treatment of portal venous gas and pneumobilia is based on treating the suspected underlying cause.

High VExUS grades are linked to cardiac function in general ICU patients.

Even though initially considered as a new standard in systemic venous congestion assessment, the semi-quantitative Doppler ultrasound-based Venous Excess Ultrasound Grading System (VExUS) showed inconsistent associations with outcomes in general intensive care unit (ICU) patients. It is unclear why VExUS is so effective in predicting outcomes in some cohorts and not in others. The determinants of higher VExUS have not been studied in a general ICU cohort. The aim of this study was to determine the factors associated with higher VExUS (≥ 2) in a general ICU cohort. We performed a post-hoc analysis of a prospective, observational cohort, including adult patients within 24 hours of ICU admission and expected ICU length of stay longer than 2 days. Collected data included patients' hemodynamic status (including ultrasound evaluation) at several points in time: ICU admission, day 1, day 2, day 5, and the last day of ICU stay. We analyzed 514 hemodynamic evaluations in 145 patients. 96/514 (18.7%) had a VExUS grade ≥ 2. The univariable followed by multivariable mixed-effects logistic regression analyses only found a statistically significant association between VExUS ≥ 2 and right ventricle S wave (OR 0.85 (0.74;0.97), p = 0.02) and left ventricle E/A ratio (OR 2.34, 95% CI (1.27;4.33), p = 0.006). The current study has elucidated that higher VExUS is primarily associated with cardiac comorbidities and ultrasound parameters of left- and right-sided cardiac systolic and/or diastolic function in general ICU patients.

Case report of varicose veins treatment in patient with a prosthetic mitral valve

This clinical case may be of interest in situations where a patient with varicose veins of the lower limbs and concomitant heart disease, who is on long-term anticoagulant therapy and is scheduled to undergo minor surgery, may present the possibility of endovenous laser ablation (EVLA) against the background of warfarin use. Patient, G., 68 years old, with rheumatic combined mitral valve disease (mitral valve replacement in 2019, permanent atrial fibrillation), also had varicose vein disease of the lower limbs. History included acute cerebrovascular accident (19.01.2023). Duplex Ultrasonography Screening (DUS) showed failure of the left great saphenous vein valve. Hypocoagulation was also observed in coagulogram and the risk of bleeding on HAS-BLED score was average. On Caprini score, the risk was very high. Endovenous laser ablation of the large saphenous vein on the left side was performed. During follow-up examinations, there were no signs of bleeding from puncture sites. The target trunk was obliterated in dynamics at DUS. Therefore, it is possible to carry out EVLA of a large subcutaneous vein while taking therapeutic doses of warfarin without switching to bridge therapy. Endovascular laser ablation allowed it to be done with less risk of bleeding and, against the background of taking warfarin, reduced the risk of thrombosis.