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Brain : a Journal of Neurology Jun 2020Recently, age-related timing dissociation between the superficial and deep venous systems has been observed; this was particularly pronounced in patients with normal...
Recently, age-related timing dissociation between the superficial and deep venous systems has been observed; this was particularly pronounced in patients with normal pressure hydrocephalus, suggesting a common mechanism of ventriculomegaly. Establishing the relationship between venous drainage and ventricular enlargement would be clinically relevant and could provide insight into the mechanisms underlying brain ageing. To investigate a possible link between venous drainage and ventriculomegaly in both normal ageing and pathological conditions, we compared 225 healthy subjects (137 males and 88 females) and 71 traumatic brain injury patients of varying ages (53 males and 18 females) using MRI-based volumetry and a novel perfusion-timing analysis. Volumetry, focusing on the CSF space, revealed that the sulcal space and ventricular size presented different lifespan profiles with age; the latter presented a quadratic, rather than linear, pattern of increase. The venous timing shift slightly preceded this change, supporting a role for venous drainage in ventriculomegaly. In traumatic brain injury, a small but significant disease effect, similar to idiopathic normal pressure hydrocephalus, was found in venous timing, but it tended to decrease with age at injury, suggesting an overlapping mechanism with normal ageing. Structural bias due to, or a direct causative role of ventriculomegaly was unlikely to play a dominant role, because of the low correlation between venous timing and ventricular size after adjustment for age in both patients and controls. Since post-traumatic hydrocephalus can be asymptomatic and occasionally overlooked, the observation suggested a link between venous drainage and CSF accumulation. Thus, hydrocephalus, involving venous insufficiency, may be a part of normal ageing, can be detected non-invasively, and is potentially treatable. Further investigation into the clinical application of this new marker of venous function is therefore warranted.
Topics: Adult; Aged; Aging; Brain Injuries, Traumatic; Cerebral Ventricles; Female; Femoral Vein; Humans; Hydrocephalus; Hydrocephalus, Normal Pressure; Iliac Vein; Magnetic Resonance Imaging; Male; Middle Aged; Nervous System Malformations; Popliteal Vein; Tomography, X-Ray Computed
PubMed: 32372102
DOI: 10.1093/brain/awaa125 -
Journal of Vascular Surgery. Venous and... Sep 2019Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on... (Review)
Review
BACKGROUND
Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on quality of life. Venous disorders can be attributed to a combination of vascular compression with a high burden of activity.
OBJECTIVE
This article promotes increased awareness of these uncommon conditions specific to the athlete by summarizing pathophysiology, clinical features, investigation, and treatment protocols for use in clinical practice. Prognostic outcomes of these management regimens are also discussed, allowing for clinicians to counsel these high-functioning individuals appropriately. With the aim of providing an overview of sport-related venous pathology, a literature review was undertaken identifying articles that were independently reviewed by the authors.
RESULTS
Lower limb venous thrombosis has been identified in young, high-functioning athletes attributed to both compression-related venous trauma, associated with repetitive movements resulting in intimal damage, and blunt trauma. The diagnosis and treatment follow the same protocols as for the general population. Of note, early ambulation is advocated, with an aim to return to premorbid (noncontact) function within 6 weeks. Athletes performing high-intensity repetitive upper limb movement, such as baseball players, are predisposed to upper limb deep venous thrombosis (DVT). Diagnosis follows the same protocols as for lower extremity DVT; however, the optimal treatment strategy remains debated. Current guidelines advocate the use of anticoagulation alone. A specific subset of primary upper limb DVT is effort thrombosis, where there is compression at the level of the thoracic outlet. Thrombolysis with first rib resection is indicated in the acute setting within 14 days. In cases of complete occlusion, surgical decompression with venous reconstruction may be required. Popliteal vein entrapment syndrome is also discussed. This entity has been identified as an overuse injury associated with popliteal vein compression. Duplex ultrasound examination is indicated as a first-line investigation, with conservative noninvasive options considered as an initial management strategy. Chronic venous insufficiency or persistent symptoms may require subsequent surgical decompression.
CONCLUSIONS
Key conditions including upper extremity and lower extremity venous thrombosis, venous aneurysms, Paget-Schroetter syndrome (effort thrombosis), and popliteal vein entrapment syndrome are discussed. Further studies evaluating long-term outcomes on morbidity for current treatment regimens in upper extremity DVT, effort thrombosis, venous thoracic outlet syndrome, and popliteal venous entrapment syndrome are required.
Topics: Aneurysm; Athletic Injuries; Humans; Risk Factors; Thoracic Outlet Syndrome; Treatment Outcome; Vascular System Injuries; Veins; Venous Insufficiency; Venous Thrombosis; Wounds, Nonpenetrating
PubMed: 31231058
DOI: 10.1016/j.jvsv.2019.03.012 -
Journal of Clinical Neuroscience :... Dec 2022
Topics: Humans; Cranial Sinuses; Sinus Thrombosis, Intracranial; Brain Injuries, Traumatic
PubMed: 35513976
DOI: 10.1016/j.jocn.2022.04.034 -
Prehospital Emergency Care 2022Traumatic hemorrhage is the leading cause of preventable death, and its effects are often evident within the first 24 hours of hospital admission. We investigated the...
Traumatic hemorrhage is the leading cause of preventable death, and its effects are often evident within the first 24 hours of hospital admission. We investigated the relationship between prehospital lactate measurement and administration of hospital blood products and life-saving interventions (LSIs) within 24 hours of hospital admission. We included trauma patients with recorded prehospital venous lactate transported by a single critical care transport service to a Level I trauma center between 2012 and 2019. We abstracted vital signs, mission type, anatomic location of injury, prehospital administration of crystalloid and blood products, and hospital LSIs started within 24 hours of admission. We used logistic regression to determine the association of prehospital lactate and in-hospital administration of blood products in groups with or without hypotensive patients. We investigated the effect of prehospital lactate concentration on secondary outcomes such as LSIs and mortality. We included 2,170 patients transported from the scene or emergency department (ED), of whom 1,821 (84%) were normotensive. The median concentration of prehospital lactate was 2.10 mmol/L for the main population (IQR = 1.40-3.30) and 2.00 mmol/L for the normotensive subgroup (IQR = 1.30-2.90). A higher prehospital lactate concentration was associated with higher odds of needing early hospital blood products in the whole study population (OR = 1.12, (95% CI 1.06-1.20), p < 0.01) and in the normotensive subgroup (OR = 1.13, (95% CI 1.03-1.22), p = 0.01). These positive associations were also observed with the secondary outcome of hospital LSIs, and higher prehospital lactate was also associated with higher odds of mortality (OR = 1.32, (95% CI 1.20-1.45), p < 0.01). Higher concentrations of prehospital lactate were associated with the need for in-hospital blood transfusion within 24 hours of admission. The relationship between lactate and blood transfusion persisted among normotensive patients. Further work is needed to incorporate prehospital lactate into decision support tools for prehospital blood administration.
Topics: Emergency Medical Services; Emergency Service, Hospital; Humans; Injury Severity Score; Lactic Acid; Retrospective Studies; Trauma Centers; Vital Signs; Wounds and Injuries
PubMed: 34550050
DOI: 10.1080/10903127.2021.1983096 -
Journal of Neurosurgery Jul 2020Cerebral venous thrombosis (CVT) is increasingly recognized in traumatic brain injury (TBI), but its complications and effect on outcome remain undetermined. In this...
OBJECTIVE
Cerebral venous thrombosis (CVT) is increasingly recognized in traumatic brain injury (TBI), but its complications and effect on outcome remain undetermined. In this study, the authors characterize the complications and outcome effect of CVT in TBI patients.
METHODS
In a retrospective, case-control study of patients included in the Oslo University Hospital trauma registry and radiology registry from 2008 to 2014, the authors identified TBI patients with CVT (cases) and without CVT (controls). The groups were matched regarding Abbreviated Injury Scale 1990, update 1998 (AIS'98) head region severity score 3-6. Cases were identified by AIS'98 or ICD-10 code for CVT and CT or MR venography findings confirmed to be positive for CVT, whereas controls had no AIS'98 or ICD-10 code for CVT and CT venography or MR venography findings confirmed to be negative for CVT. All images were reviewed by a neuroradiologist. Rates of complications due to CVT were recorded, and mortality was assessed both unadjusted and in a multivariable logistic regression analysis adjusting for initial Glasgow Coma Scale score, Rotterdam CT score, and Injury Severity Score. Complications and mortality were also assessed in prespecified subgroup analysis according to CVT location and degree of occlusion from CVT. Lastly, mortality was assessed in an exploratory subgroup analysis according to the presence of complications from CVT.
RESULTS
The CVT group (73 patients) and control group (120 patients) were well matched regarding baseline characteristics. In the CVT group, 18% developed venous infarction, 11% developed intracerebral hemorrhage, and 19% developed edema, all representing complications secondary to CVT. Unadjusted 30-day mortality was 16% in the CVT group and 4% in the no-CVT group (p = 0.004); however, the difference was no longer significant in the adjusted analysis (OR 2.24, 95% CI 0.63-8.03; p = 0.215). Subgroup analysis by CVT location showed an association between CVT location and rate of complications and an unadjusted 30-day mortality of 50% for midline or bilateral CVT and 8% for unilateral CVT compared with 4% for no CVT (p < 0.001). The adjusted analysis showed a significantly higher mortality in the midline/bilateral CVT group than in the no-CVT group (OR 8.41, 95% CI 1.56-45.25; p = 0.032).
CONCLUSIONS
There is a significant rate of complications from CVT in TBI patients, leading to secondary brain insults. The rate of complications is dependent on the anatomical location of the CVT, and midline and bilateral CVT is associated with an increased 30-day mortality in TBI patients.
Topics: Adult; Brain Injuries, Traumatic; Case-Control Studies; Cerebral Veins; Female; Follow-Up Studies; Humans; Intracranial Thrombosis; Male; Middle Aged; Mortality; Norway; Prospective Studies; Retrospective Studies; Venous Thrombosis
PubMed: 32707558
DOI: 10.3171/2020.4.JNS20511 -
Vascular Jun 2022We aimed to evaluate emergency vascular complications of the lumbar disc reconstructive surgery in this study.
OBJECTIVES
We aimed to evaluate emergency vascular complications of the lumbar disc reconstructive surgery in this study.
METHOD
Between March 2006 and February 2020, nine patients (six males and three females; mean age: 53.4 ± 9.6 years; range: 38-64 years) who underwent emergent vascular intervention during lumbar spinal disc reconstructive surgery in our clinic were included in this retrospective study.
RESULT
The left common iliac artery injury, the left common iliac artery and left common iliac vein injuries, bilateral common iliac artery and abdominal aortic injuries, and vena cava inferior injury with left common iliac vein and right common iliac vein injuries were detected in two, three, two, and two patients, respectively. In addition, 16 mm Dacron tube graft interposition and graft patch plasty were performed in one and two patients who had an abdominal aortic injury, respectively. Also, 8 mm polytetrafluoroethylene straight graft interposition was performed in two patients with left common iliac artery injury, and lateral wall repair was performed in other patients. Graft patch plasty and 8 mm polytetrafluoroethylene graft interposition were performed in one patient with vena cava inferior injury and left common iliac vein injury, respectively. Also, lateral wall repair was performed in other patients with venous injuries. Deep venous thrombosis had developed in three patients, and one patient of these had a pulmonary embolism.
CONCLUSION
The incidence of vascular injury after the lumbar disc surgery is relatively low; however, the emergency vascular operation should be performed as soon as possible.
Topics: Adult; Female; Humans; Iliac Vein; Male; Middle Aged; Polytetrafluoroethylene; Retrospective Studies; Vascular Surgical Procedures; Vascular System Injuries; Vena Cava, Inferior
PubMed: 34102928
DOI: 10.1177/17085381211021671 -
DNA and Cell Biology Jul 2021The vascular endothelium, which plays an essential role in maintaining the normal shape and function of blood vessels, is a natural barrier between the circulating blood... (Review)
Review
The vascular endothelium, which plays an essential role in maintaining the normal shape and function of blood vessels, is a natural barrier between the circulating blood and the vascular wall tissue. The endothelial damage can cause vascular lesions, such as atherosclerosis and restenosis. After the vascular intima injury, the body starts the endothelial repair (re-endothelialization) to inhibit the neointimal hyperplasia. Endothelial progenitor cell is the precursor of endothelial cells and plays an important role in the vascular re-endothelialization. However, re-endothelialization is inevitably affected and by factors, which can be divided into two types, namely, promotion and inhibition, and act on different links of the vascular re-endothelialization. This article reviews these factors and related mechanisms.
Topics: Animals; Arteries; Cell Movement; Endothelial Progenitor Cells; Endothelium, Vascular; Humans; Signal Transduction; Vascular System Injuries; Veins
PubMed: 34061680
DOI: 10.1089/dna.2021.0082 -
Journal of Neuroimaging : Official... Nov 2019Variations in the venous drainage of the central nervous system can have imaging and clinical findings that mimic pathology, presenting a challenge for neuroimagers and... (Review)
Review
Variations in the venous drainage of the central nervous system can have imaging and clinical findings that mimic pathology, presenting a challenge for neuroimagers and clinicians. Patients with these variants may undergo unnecessary testing, and patients with pathology may receive delayed diagnoses because of overlap with benign findings. Consequently, the accurate identification of venous variations on cross-sectional imaging and angiography and their potential causes are critical for differentiating benign imaging variants from potential pathologic processes requiring further evaluation. For example, in the epidural space, benign dilation of the epidural venous plexus may be mistaken for evidence of a fistula, abscess, or metastasis. Hypoplasia of a dural venous sinus or an arachnoid granulation may mimic venous sinus thrombosis. The superior ophthalmic vein may demonstrate benign dilation in intubated patients, mimicking thrombosis, increased intracranial pressure, orbital varix, inflammatory pseudotumor, or other conditions. Furthermore, certain venous variations, such as the occipital sinus or emissary veins, may complicate surgery or herald pathology and should be reported. In addition, some supposedly benign variations, such as the developmental venous anomaly, can be complicated by pathology. The objective of this review article is to provide a descriptive and pictorial review of common anatomic and physiologic variations in the venous drainage system of the brain, spine, and orbits that can mimic pathology. Neuroimaging findings of related pathologies and differences in clinical presentations will also be discussed to assist in the approach to differential diagnosis.
Topics: Brain; Central Nervous System Vascular Malformations; Cerebral Veins; Cranial Sinuses; Hematoma, Epidural, Cranial; Hematoma, Epidural, Spinal; Humans; Neuroimaging
PubMed: 31529762
DOI: 10.1111/jon.12664 -
Vascular and Endovascular Surgery Jan 2022Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to... (Review)
Review
Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to the small and large bowel by a rich system of collaterals. Because fewer than 100 such injuries have been described in the literature, they pose challenges in both diagnosis and management and can unfortunately result in high mortality rates. Prompt diagnosis, surgical intervention, and resuscitation can lead to improved outcomes. Here, we review the literature surrounding traumatic injuries of the SMA/SMV and discuss management strategies.
Topics: Abdomen; Humans; Mesenteric Artery, Superior; Mesenteric Veins; Treatment Outcome; Vascular System Injuries
PubMed: 34533371
DOI: 10.1177/15385744211042491 -
JPMA. the Journal of the Pakistan... Jun 2020Inferior vena caval (IVC) injuries are uncommon and challenging to treat. Less than 5% of patients with penetrating abdominal trauma and less than 0.5% of patients with... (Review)
Review
Inferior vena caval (IVC) injuries are uncommon and challenging to treat. Less than 5% of patients with penetrating abdominal trauma and less than 0.5% of patients with blunt abdominal trauma have this injury. Patient can present with intraperitoneal haemorrhage or with a contained retroperitoneal haematoma. Mostly it is associated with other abdominal structures injuries. Most commonly injured segment is infrarenal IVC. Operative strategy is different for each segment of injured vein. Infrahepatic injuries are exposed by medial visceral rotation. Retrohepatic and suprahepatic injuries need infrequent exposures. Mortality remains high and range between 31-51% for the patient brought alive to the operative room. Glasgow coma scale, level of injury, haemodynamic status at presentation and free blood in the peritoneal cavity are some of the predictive factors for mortality in these patients.
Topics: Abdominal Injuries; Glasgow Coma Scale; Hematoma; Humans; Vena Cava, Inferior; Wounds, Nonpenetrating
PubMed: 32810108
DOI: 10.5455/JPMA.21107