Venous Congestion Research Articles

PREVALENCE OF CEREBRAL VENOUS DRAINAGE STENOSES ON RETROSPECTIVELY ANALYZED CTA FOR STROKE TRIAGE

Abstract Cerebral venous congestion (CVC) has been identified as a hypothetic cause of cognitive impairment. Prior work has estimated that 15-30% of the population may have jugular venous narrowing, a potential cause of CVC, based on reviews of CT angiography (CTA) performed at a large academic medical center. However, few comprehensive studies exist. Therefore, for the current work, we reviewed fifty CTAs that were obtained for ischemic stroke triage and thrombectomy planning at a comprehensive stroke center in Hawaii (Queens Hospital, Honolulu HI). These brain CTAs were analyzed for arterial and venous variants and other abnormalities that might place the patient at increased risk for arterial injury and/or venous congestion, both of which may result in cognitive decline. The CTAs were analyzed retrospectively for every known level of venous and arterial stenosis, and CVC-associated pre-morbid symptoms were analyzed. Preliminary data support the hypothesis that venous anatomical anomalies may be a risk factor for cognitive impairment. CVC may be an under-diagnosed contributor to cognitive impairment, particularly in older patients.

Clinical characterisation of women with persistent genital arousal disorder: the iPGAD-study

Persistent Genital Arousal Disorder (PGAD) is a rare condition—mostly in women—where patients perceive prolonged genital arousal without any sexual desire or stimulation. Etiopathological considerations reach from peripheral to central issues over local disturbance of the pudendal nerve to neuropathy, psychosocial, and pharmacological theories. Since well controlled clinical studies about PGAD in conjunction with a mental and somatic health status are missing, this study is a detailed clinical investigation of PGAD patients compared to healthy controls. 26 women who fulfilled diagnostic criteria for PGAD were compared to 26 age matched healthy controls. Investigations included comparison of vegetative, gynaecological and sexual history, psychiatric features as well as a (neuro-)radiological, neurophysiological and gynaecological examination. Moreover, a detailed clinical characterisation of PGAD symptoms was performed. PGAD symptoms were mostly characterised as tingling or prickling and were permanently present. In over 80%, PGAD symptoms were located in the clitoris. Almost 70% reported radiations to other regions of the body. Most frequent trigger factors were tight clothes, mental stress, driving a car/bus/bicycle and sexual intercourse. Relieving factors were mainly distraction, relaxation, physical exercise, masturbation and swimming. In group comparisons, PGAD presented with significant higher rates of sexual dysfunctions, spontaneous orgasms, swelling of the genitals, extraordinary lubrication as well as higher rates in depression, agoraphobia, generalized anxiety disorder and lifetime panic disorder. Significantly more PGAD patients were diagnosed with restless legs symptoms. In contrast childhood traumatization, somatization disorder, suicidality, gynaecological as well as neurophysiological examination of the pudendal nerve were not different between the groups. MRI of the brain, pelvis and spinal cord was unsuspicious and incidental findings - including Tarlov cysts or pelvic venous congestion - were equally distributed among the groups. In summary, our study provides a careful characterization of women with PGAD highlighting a serious mental burden, most probably as a consequence of PGAD. With the current set of clinical investigations there was no evidence of a clear causal relationship to a specific clinical finding as it has been previously discussed. Future studies and additional techniques will have to further explore where and how in the peripheral or central nervous systems PGAD develops.

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome.

This study investigated the prevalence of embryonic and connective tissue elements in the filum terminale (FT) of patients with tethered cord syndrome (TCS), examining both typical and pathological histology. The FT specimens from 288 patients who underwent spinal cord detethering from 2013 to 2021 were analyzed. The histopathological examination involved routine hematoxylin and eosin staining and specific immunohistochemistry when needed. The patient details were extracted from electronic medical records. The study found that 97.6% of the FT specimens had peripheral nerves, and 70.8% had regular ependymal cell linings. Other findings included ependymal cysts and canals, ganglion cells, neuropil, and prominent vascular features. Notably, 41% showed fatty infiltration, and 7.6% had dystrophic calcification. Inflammatory infiltrates, an underreported finding, were observed in 3.8% of the specimens. The research highlights peripheral nerves and ganglion cells as natural components of the FT, with ependymal cell overgrowth and other tissues potentially linked to TCS. Enlarged vessels may suggest venous congestion due to altered FT mechanics. The presence of lymphocytic infiltrations and calcifications provides new insights into structural changes and mechanical stress in the FT, contributing to our understanding of TCS pathology.

Venous thromboemboliс complications and tuberculosis: is there an interaction?

Venous thromboembolic complications (VTEC) haven’t lost their status as an important medical and social problem for many decades. There are about 300 thousand people die from VTEC in Russia every year. Another significant problem for our country is tuberculosis. Tuberculosis is one of the most common severe infections in the world, most often occurs as a chronic disease and can induce VTEC due to a variety of synergistically acting factors. Previously published studies examined the interaction between tuberculosis and VTEC, but they were based on the data obtained from countries with a high incidence of tuberculosis and a low prevalence of venous thrombosis. An analysis of the literature has shown that tuberculous inflammation determines all three interrelated components of the Virchow’s triad: endothelium inflammatory damage, venous stasis and hypercoagulability. In addition, treatment regimens for the disease with the inclusion of rifampicin also contribute to the development of VTEC due to the pronounced procoagulant properties of the drug. Another equally important agent that potentiates hypercoagulation is the HIV virus, which affects the endothelium and immunocompetent cells. Currently available epidemiological data indicate that HIV infection is associated with an increased risk of VTEC in 2-10 times compared to the general population of the same age. In this context, tuberculosis and HIV/TB co-infection can be considered as a large reversible risk factor for the development of VTEC and included in the prognostic risk assessment scales for acute venous thrombosis and embolism.

Overlap of histological features of pigmented purpuric dermatosis and kaposi sarcoma – pseudo kaposi sarcoma

Pseudokaposi sarcoma can be congenital or acquired. Due to prolonged venous stasis, leads to peripheral tissue hypoxemia, which results in neovascularisation and fibroblast proliferation. Treatment includes rectification of the underlying pathology such as graded compression stockings or compression pumps for venous stasis and ulcer management with regular wound care. Medical management includes oral antibiotics, along with compression therapy with good results. Our patient presented mild lower limb pitting edema unilaterally with erythematous barely elevated plaque over the anterior aspect of the lower limb.

Endovascular treatment of sciatic pain from venous congestion in the pelvis

Klippel-Trénaunay Syndrome (KTS) is a vascular disorder characterized by a combination of vascular malformations (capillary, lymphatic, and venous) and limb overgrowth. Pelvis involvement is less frequent and is often underrecognized. We report a case of a patient affected by KTS with persistent sciatic pain. Phlebography demonstrated significant pelvic venous congestion mainly due to reflux at the level of the sacral plexus venous. A minimally invasive approach was successfully utilized to treat reflux with complete pain regression.

Dural Arteriovenous Fistula Presenting as Acute Unilateral Vestibulopathy

Intracranial dural arteriovenous fistula (dAVF) is characterized by an abnormal connection between branches of arteries and veins in the dura mater. Clinical manifestations of dAVF vary depending on their location, feeder arterial supply, amount of shunting, and most importantly, their venous drainage pattern. Acute vertigo has been rarely reported as an initial presentation of dAVF due to venous congestion in the brainstem. We report a patient who presented with acute right vestibulopathy without any brainstem signs in dAVF involving the transversesigmoid sinus. The patient showed abnormal caloric response but normal head impulse in the affected ear. Without any treatment, the patient’s symptoms gradually improved with a normalization of right canal paresis. Follow-up cerebral angiography also revealed a spontaneous regression of the shunt flow and reduction of venous drainage at the right transverse-sigmoid sinus. Based on the results of vestibular function tests and cerebral angiography, acute vertigo in our patient may be ascribed to impaired reabsorption of endolymph by focal venous congestion.

Ultrasonographic assessment of pulmonary and Central venous congestion in experimental heart failure.

Pulmonary and systemic congestion as a consequence of heart failure are clinically recognized as alarm signals for clinical outcome and mortality. Although signs and symptoms of congestion are well detectable in patients, monitoring of congestion in small animals with heart failure lacks adequate noninvasive methodology yet. Here, we developed a novel ultrasonography-based scoring system to assess pulmonary and systemic congestion in experimental heart failure, by using lung ultrasound (LUS) and imaging of the inferior vena cava (Cava), termed CavaLUS. CavaLUS was established and tested in a rat model of supracoronary aortic banding and a mouse model of myocardial infarction, providing high sensitivity and specificity while correlating to numerous parameters of cardiac performance and disease severity. CavaLUS, therefore, provides a novel comprehensive tool for experimental heart failure in small animals to noninvasively assess congestion.NEW & NOTEWORTHY As thorough, noninvasive assessment of congestion is not available in small animals, we developed and validated an ultrasonography-based research tool to evaluate pulmonary and central venous congestion in experimental heart failure models.

Virtual Noncontrast Reconstructions on Contrast-Enhanced Dual-Energy CT for the Differentiation of Vertebral Venous Congestion and Sclerotic Metastasis.

Virtual Noncontrast Reconstructions on Contrast-Enhanced Dual-Energy CT for the Differentiation of Vertebral Venous Congestion and Sclerotic Metastasis.

Transoral Robotic Surgery for a Rare Case of Venolymphatic Malformation in Parapharyngeal Space.

Venous malformations are low flow endothelial malformations with aberrant and ectatic venous channels. They are defects in vascular growth which causes functional and cosmetic impairment. Gradual growth in size of the lesion occurs due to venous congestion or thrombosis. Venous malformations in parapharyngeal space are a rare entity and are difficult to diagnose. Case Report. 13year old boy presented with a history of hyposmia and progressive difficulty in breathing for a duration of 2.5years. MRI face and neck with contrast showed a 4.5 × 4.3x3.6cm lesion in the left parapharyngeal space. CT angiogram of brain and neck demonstrated a heterogeneously enhancing mass in the left parapharyngeal region. PET scan illustrated an ill-defined mass in the left pre styloid parapharyngeal space. Biopsy from the lesion showed features consistent with venolymphatic malformation. Flexible laryngoscopy showed a bulge over the left soft palate region with narrowing of nasopharyngeal lumen. Patient underwent transoral robotic surgery for complete excision of the mass. Post-operative period was uneventful. He has been on follow up for the past 1year with no evidence of any residual or recurrent disease. Venolymphatic malformation is a rare lesion in the parapharyngeal space which is difficult to diagnose pre operatively. Surgical excision is the preferred modality of treatment for deep seated lesions in the parapharyngeal space. The advent of transoral robotic surgery have reduced the morbidity and improved clearance for such cases.

Evaluation of Liver Pathology among the Samples Received in Autopsy Section, Sir T Hospital, Bhavnagar

Background & Aims: Liver is the most vulnerable organ to a variety of metabolic, toxic, microbial and circulatory insults. Involvement of liver in various disease processes may be primary (e.g., alcoholism) or secondary to other organs like cardiac causes or extrahepatic infections.The aim of this study is to evaluate the histopathological spectrum of liver diseases inautopsy cases. Material and Method: This prospective study comprises of 150 liver specimens obtained from autopsies received at Autopsy section, Department of Pathology, Government Medical College and Sir T General Hospital, Bhavnagar during the period of 1 year from 1st July 2021 to 30th June 2022. Histopathological findings of cases were recorded, analysed and expressed as frequencies and percentage. Result: A total of 150 specimens were studied. Age ranges from 8 months to 80 years, with M:F ratio of 4:1. Normal histology was found in 8 (5.33%) cases. Important findings included Fatty change in 59 (39.33%), Congestion in 42 (28.00%), Chronic Venous Congestion in 9 (6.00%), chronic hepatitis in 5 (3.33%), steatohepatitis in 5 (3.33%) and cirrhosis in 9 (6.00%) cases. Causes of death were: Other illness in 82 (54.67%), Sudden death in 22 (14.67%), Accidental in 21 (14%), Brought dead in 12 (8%), Suicidal in 9 (6%), Alcohol poisoning in 2 (1.33%) and Hepatic encephalopathy in 2 (1.33%) cases. Conclusion: Autopsy examination is very important in understanding the magnitude of clinically silent liver lesions. In this study asymptomatic fatty liver was the most common silent liver disease followed by Congestion. Keywords: -Liver pathology, Autopsy, Fatty change, Congestion, Cirrhosis.

Huoxin pill protects verapamil-induced zebrafish heart failure through inhibition of oxidative stress-triggered inflammation and apoptosis

Heart failure (HF) is a major and growing public health concern. Although advances in medical and surgical therapies have been achieved over the last decades, there is still no firmly evidence-based treatment with many traditional Chinese medicines (TCMs) for HF. Huoxin Pill (HXP), a TCM, has been widely used to treat patients with coronary heart disease and angina pectoris. However, the underlying molecular mechanism is poorly understood. In this study, using a verapamil-induced zebrafish HF model, we validated the efficacy and revealed the underlying mechanism of HXP in the treatment of HF. Zebrafish embryos were pretreated with different concentrations of HXP followed by verapamil administration, and we found that HXP significantly improved cardiac function in HF zebrafish, such as by effectively alleviating venous congestion and increasing heart rates. Mechanistically, HXP evidently inhibited verapamil-induced ROS and H2O2 production and upregulated CAT activity in HF zebrafish. Moreover, transgenic lines Tg(mpx:EGFP) and Tg(nfkb:EGFP) were administered for inflammation evaluation, and we found that neutrophil infiltration in HF zebrafish hearts and the activated NF-kB level could be reduced by HXP. Furthermore, HXP significantly downregulated the level of cell apoptosis in HF zebrafish hearts, as assessed by AO staining. Molecularly, RT‒qPCR results showed that pretreatment with HXP upregulated antioxidant-related genes such as gpx-1a and gss and downregulated the expression of the stress-related gene hsp70, proinflammatory genes such as tnf-α, il-6 and lck, and apoptosis-related indicators such as apaf1, puma and caspase9. In conclusion, HXP exerts a protective effect on verapamil-induced zebrafish HF through inhibition of oxidative stress-triggered inflammation and apoptosis.

Surface to Perforator Index: Assessing the Importance of the Number of Perforators in Successful Harvesting of the Anterolateral Thigh Flap.

The use of perforator flaps has become more popular with improvement of surgical technique, technology, as well as understanding of microvascular anatomy. The selection of well-perfused angiosomes is critical to the successful outcome of patients undergoing free tissue transfer. The number of perforators that are needed is dependent upon the surface area of the flap being harvested; however, there have been no studies to assess the optimal surface area supplied by each perforator. We hypothesized that the smaller the surface area supplied by each perforator correlated with fewer flap-related complications in the harvesting of the anterolateral thigh (ALT) flap. All ALT flaps harvested from 2015 to 2021 at our institution were retrospectively reviewed. The surface area of the flap harvested was calculated as A = πab, where a is the long radius and b is the short radius of the ellipse. The surface-perforator index (SPI) was calculated for each flap by dividing the surface area of the ALT flap by the number of perforators supplying the flap. Our primary outcomes were flap-related complications that included: partial flap loss, dehiscence, and venous congestion. A total of 106 patients were identified. Twenty-four patients (22.6%) developed perforator-related complications. An increasing SPI and SPI to body surface area were strongly associated with development of complications (adjusted odds ratio [95% confidence interval], adjusted p: 1.02 [1.01, 1.03], < 0.001and 1.23 [1.12, 1.42], p < 0.001). An SPI of greater than 150 cm2/perforator was associated with a higher probability of complications (p < 0.001). Flap-related complications are significantly related to the number of perforators supplying the flap. The smaller the surface area supplied by a single perforator correlates with significantly fewer flap-related complications. SPI is a new index that may be used as a predictive tool to aid in identifying flaps that may be more prone to complications in free tissue transfer.

Pseudo-chilblain lesions in children during the COVID-19 pandemic

Introduction and objective: During the COVID-19 pandemic, a range of uncommon cutaneous symptoms were observed, which were linked to the SARS-CoV-2 infection. These dermatological symptoms in the form of reddish or purple-coloured lesions on the fingers and toes, accompanied by blisters and ulcerations, were termed as “COVID fingers/toes” – a pseudo-chilblain cutaneous manifestation of COVID-19. The aetiopathogenesis of pseudo-chilblain lesions has not been conclusively determined. At first, SARS-CoV-2 infection was regarded as an evident cause of chilblains. Various studies conducted over a two-year period have not managed to plausibly confirm its direct implications. Materials and methods: The study was of a retrospective nature. The analysis involved clinical symptoms, results of selected laboratory tests, as well as capillaroscopy of the microcirculation in 15 children diagnosed with skin lesions of chilblain-like morphology. Results: All patients from the study population presented with lesions in distal body parts which were of erythematous or oedematous morphology, and resembled chilblains. None of the hospitalised patients suffered from fever or presented with other systemic symptoms. The reverse transcription polymerase chain reaction test for SARS-CoV-2 was negative in all the patients. SARS-CoV-2 antibodies were found in 5 out of 9 patients tested for their presence. Microcirculation abnormalities were diagnosed in 80% of the patients. In none of the children did capillaroscopy image correspond with microangiopathy characteristic of inflammatory connective tissue diseases. Frequent abnormalities found in more than two fingers/toes were: pericapillary oedema (57%), dilated capillaries (42.8%), venous stasis (35.7%), presence of branched and tortuous capillaries (28.5%). Conclusions: Pseudo-chilblain lesions observed during the SARS-CoV-2 pandemic are probably secondary to multifactorial epiphenomenon.

Pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest for salvage mandibular reconstruction: Case and technique.

In the era of free flap reconstruction, mandibular defects are routinely reconstructed with osseous free flaps, and non-free flap bony reconstruction options are limited. A patient with T4N0 mandibular squamous cell carcinoma underwent resection with fibula free flap reconstruction of a parasymphyseal to angle defect. After free flap failure due to venous congestion, the flap was explanted. He declined additional free flap reconstruction and elected to proceed with pedicled osteomyocutaneous pectoralis major with rib. In this case presentation, we discuss the technical details of harvest of this flap using the 6th rib. The pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest, which is infrequently described in the literature, remains a viable option for bony reconstruction, particularly in the salvage setting.

A systematic review of the scientific evidence of venous supercharging in autologous breast reconstruction with abdominally based flaps

BackgroundAbdominally based free flaps are commonly used in breast reconstruction. A frequent complication is venous congestion, which might contribute to around 40% of flap failures. One way to deal with it is venous supercharging. The primary aim of this study was to investigate the scientific evidence for the effects of venous supercharging.MethodsA systematic literature search was conducted in PubMed, CINAHL, Embase, and Cochrane library. The included articles were critically appraised, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.ResultsThirty-six studies were included. Most studies had serious study limitations and problems with directness. Three studies report ‘routine’ use of venous supercharging and performed it prophylactically in patients who did not have clinical signs of venous congestion. Seventeen studies report on flap complications, of which one is a randomised controlled trial demonstrating statistically significant lower complication rates in the intervention group. The overall certainty of evidence for the effect of a venous supercharging on flap complications, length of hospital stay and operative time, in patients without clinical signs of venous congestion, is very low (GRADE ⊕ ⊕ ⊝ ⊝), and low on and surgical takebacks (GRADE ⊕ ⊕ ⊝ ⊝). Twenty-one studies presented data on strategies and overall certainty of evidence for using radiological findings, preoperative measurements, and clinical risk factors to make decisions on venous supercharging is very low (GRADE ⊕ ⊝ ⊝ ⊝).ConclusionThere is little scientific evidence for how to predict in which cases, without clinical signs of venous congestion, venous supercharging should be performed. The complication rate might be lower in patients in which a prophylactic venous anastomosis has been performed.Trial registrationPROSPERO (CRD42022353591).

Circular Configuration of Torcular Herophili Presenting as Childhood Headache: 2D Computational Fluid Dynamic Analysis with a Proposed Mechanism.

This case report presents a rare anatomical variant of the torcular Herophili, characterized by a circular configuration and the absence of the left transverse sinus. A 12-year-old child presented with intermittent holocranial headaches, and imaging revealed the circular torcular Herophili along with mild ventricular enlargement. The straight sinus drained into the left side of the circular torcular Herophili. Following lumbar puncture and cerebrospinal fluid (CSF) drainage, the child experienced symptom improvement. During a 6-month follow-up, the patient remained asymptomatic, without further headaches or academic disruptions. Similar to a previously reported case, the circular torcular Herophili with unilateral absent transverse sinus may be associated with impaired CSF absorption due to altered blood flow through abnormal venous anatomy. We performed two-dimensional computational fluid dynamic analysis of simulated flow through a synthetic model and showed that this circular configuration is associated with venous stasis. The venous stasis in the sinus may impair CSF absorption through the arachnoid granulations causing hydrocephalus and explaining the headache. Close monitoring and follow-up are recommended for patients with this variant. Further investigation is needed to better understand the clinical implications and underlying mechanisms of such torcular Herophili variations.

Reconstruction of Achilles Tendon Skin Defect Using Single-Stage Reverse Sural Artery Island Flap

Wound complications following open repair of a ruptured Achilles tendon are common and require immediate skin cover. This study analyses the use of a reverse sural artery island flap to cover skin defects over an exposed intact Achilles tendon. Thirteen patients with postoperative wound complications over the tendoachilles were operated upon. All wounds were debrided and reconstructed with a single-stage reverse sural artery island flap. Within 5 weeks of flap cover, 12 wounds healed completely, while 1 flap had superficial necrosis at the margin in a diabetic patient. This eventually healed and did not compromise the final result. None of the flaps had venous congestion. In our hands, reconstructing skin defects following wound complications after Achilles tendon repair with islanded reverse sural artery flap is a reliable and safe option. Level of Evidence: Level IV.

Cerebrovascular Changes in Dementia Patients with Alzheimer’s Disease and Vascular Parkinsonism

AbstractBackgroundWhen examining patients with dementia, it is necessary to clearly differentiate the developed cerebrovascular and microcirculatory changes. We present the features of cerebral angioarchitectonics and microcirculation in Alzheimer’s disease (AD) and vascular parkinsonism (VP).MethodsThe research included 155 patients. The examination included assessment of CDR, TDR, MMSE, cerebral MRI, CT, scintigraphy (SG), rheoencephalography (REG), cerebral multi‐gated angiography (MUGA).Patients were divided into:• 93 people aged 34‐80 (mean age 67.5): men ‐ 32 (34.40%), women ‐ 61 (65.59%), suffering from AD. According to dementia severity, patients were subdivided: (TDR‐0) ‐ 10, (TDR‐1) ‐ 29, (TDR‐2) ‐ 36, (TDR‐3) ‐ 18 people;• 62 people aged 52‐80 (mean age 77): men ‐ 48 (77.42%), women ‐ 14 (22.58%), suffering from VP. According to dementia severity, patients were subdivided: no dementia ‐ 30 people, dementia at level (CDR‐1) ‐ 32 people.ResultsIn AD patients, changes in angioarchitectonics and microcirculation are manifested in:• Absence of calcium salts deposits and atherosclerotic changes in intracerebral vessels;• Increased tortuosity of distal intracranial arteries;• Reduction of the capillary bed in the temporal and frontoparietal regions;• Development of multiple, large arteriovenous shunts with early venous discharge of arterial blood in the same regions;• Development of abnormal, intracerebral venous trunks;• Development of intracerebral stagnation of venous blood.These changes are called “Discirculatory angiopathy of Alzheimer’s type” (DAAT).In patients with VP, changes in angioarchitectonics and microcirculation are manifested in:• Multiple calcium salts deposits with atherosclerotic changes in intracranial vessels, mainly in the thalamus, basal ganglia, and pons;• Local decrease in subcortical cerebral capillary blood flow in the same regions;• Development of local subcortical small intracerebral arteriovenous shunts;• Absence of expressed intracerebral venous blood stagnation.ConclusionsDiscirculatory angiopathy of Alzheimer’s type (DAAT), regardless of dementia severity, is an AD‐specific cerebrovascular and microcirculatory lesion of the brain, unconnected with atherosclerotic process.In patients with VP, regardless of dementia, vascular and microcirculatory changes are atherosclerotic in nature. Capillary bed lesions, presence of arteriovenous shunts are subcortical in nature, mainly in the region of the thalamus, basal ganglia, and bridge. Marked venous stasis does not occur in this case.

A Case of AVM of the Foot with Venous Stasis Ulceration Located More Peripheral Than the Lesion

A Case of AVM of the Foot with Venous Stasis Ulceration Located More Peripheral Than the Lesion