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The Journal of Invasive Cardiology Feb 2023The authors comment on certain points of the Akhar article from the April 2022 issue of the JIC. In their letter, they differentiate between chronic total occlusions and...
The authors comment on certain points of the Akhar article from the April 2022 issue of the JIC. In their letter, they differentiate between chronic total occlusions and functional occlusions and discuss spontaneous recanalizations and the appearance of multiple intraluminal channels.They question whether the thrombotic occlusion of the right coronary artery was because of atherothrombosis or thromboembolism of both the right coronary artery and pulmonary circulation. The authors also mention that the index case needs a detailed evaluation of the hypercoagulable state to explain thrombosis of both the pulmonary and coronary circulation.
Topics: Humans; Thrombosis; Vascular Diseases; Coronary Vessels; Coronary Circulation; Coronary Angiography
PubMed: 36735876
DOI: 10.25270/jic/22.00127 -
Biomechanics and Modeling in... Oct 2019The ability of a blood clot to modulate blood flow is determined by the clot's resistance, which depends on its structural features. For a flow with arterial shear, we...
The ability of a blood clot to modulate blood flow is determined by the clot's resistance, which depends on its structural features. For a flow with arterial shear, we investigated the characteristic patterns relating to clot shape, size, and composition on the one hand, and its viscous resistance, intraclot axial flow velocity, and shear distributions on the other. We used microfluidic technology to measure the kinetics of platelet, thrombin, and fibrin accumulation at a thrombogenic surface coated with collagen and tissue factor (TF), the key clot-formation trigger. We subsequently utilized the obtained data to perform additional calibration and validation of a detailed computational fluid dynamics model of spatial clot growth under flow. We then ran model simulations to gain insights into the resistance of clots formed under our experimental conditions. We found that increased thrombogenic surface length and TF surface density enhanced the bulk thrombin and fibrin generation in a nonadditive, synergistic way. The height of the platelet deposition domain-and, therefore, clot occlusivity-was rather robust to thrombogenic surface length and TF density variations, but consistently increased with time. Clot viscous resistance was non-uniform and tended to be higher in the fibrin-rich, inner "core" region of the clot. Interestingly, despite intraclot structure and viscous resistance variations, intraclot flow velocity variations were minor compared to the abrupt decrease in flow velocity around the platelet deposition region. Our results shed new light on the connection between the structure of clots under arterial shear and spatiotemporal variations in their resistance to flow.
Topics: Arteries; Blood Flow Velocity; Calibration; Computer Simulation; Fibrin; Fluorescence; Humans; Hydrodynamics; Kinetics; Microfluidics; Models, Cardiovascular; Thrombin; Thromboplastin; Thrombosis; Vascular Resistance
PubMed: 31055691
DOI: 10.1007/s10237-019-01154-0 -
World Journal of Gastroenterology Nov 2015Hepatic artery thrombosis is a serious complication after liver transplantation which often results in biliary complications, early graft loss, and patient death. It is... (Review)
Review
Hepatic artery thrombosis is a serious complication after liver transplantation which often results in biliary complications, early graft loss, and patient death. It is generally thought that early hepatic artery thrombosis without urgent re-vascularization or re-transplantation almost always leads to mortality, especially if the hepatic artery thrombosis occurs within a few days after transplantation. This series presents 3 cases of early hepatic artery thrombosis after living donor liver transplantation, in which surgical or endovascular attempts at arterial re-vascularization failed. Unexpectedly, these 3 patients survived with acceptable graft function after 32 mo, 11 mo, and 4 mo follow-up, respectively. The literatures on factors affecting this devastating complication were reviewed from an anatomical perspective. The collective evidence from survivors indicated that modified nonsurgical management after liver transplantation with failed revascularization may be sufficient to prevent mortality from early hepatic artery occlusion. Re-transplantation may be reserved for selected patients with unrecovered graft function.
Topics: Adolescent; Arterial Occlusive Diseases; Constriction, Pathologic; Female; Hepatic Artery; Humans; Liver Transplantation; Living Donors; Male; Middle Aged; Reoperation; Thrombolytic Therapy; Thrombosis; Treatment Failure
PubMed: 26640351
DOI: 10.3748/wjg.v21.i44.12729 -
Journal of Clinical Pathology Mar 1963The rarity of hepatic infarction in the human being is commonly explained as due to the double blood supply via the hepatic artery and the portal vein. This explanation...
The rarity of hepatic infarction in the human being is commonly explained as due to the double blood supply via the hepatic artery and the portal vein. This explanation cannot be accepted, because, if the arterial blood supply alone is arrested the portal blood supply does not protect the liver from infarction. The factor of importance is that the arterial blood supply comes by three different routes and it is difficult to obstruct these collateral supplies simultaneously. Infarction of the liver can be caused by thrombosis or ligation of the main hepatic artery between the origin of the right gastric artery and the hilum of the liver, but the more common causes are infected emboli or polyarteritis nodosa; these presumably interfere not only with the main arterial supply but also with some of the collateral arterial supply.
Topics: Arteries; Hepatic Artery; Humans; Infarction; Liver Diseases; Polyarteritis Nodosa; Portal Vein; Thrombosis
PubMed: 14018909
DOI: 10.1136/jcp.16.2.133 -
Annals of Hepatology 2009Hepatic artery thrombosis (HAT) is relatively infrequent, but possibly a devastating complication of orthotopic liver transplantation (OLT). It often requires urgent... (Review)
Review
Hepatic artery thrombosis (HAT) is relatively infrequent, but possibly a devastating complication of orthotopic liver transplantation (OLT). It often requires urgent retransplantation. Two main forms of HAT are recognized as early and late HAT (diagnosis within or after 30 days following LT). Early HAT typically results in graft failure. Late HAT features biliary obstruction, cholangitis, and hepatic abscess formation. We report here the case of a patient of Wilson's disease who presented twelve years post-liver transplant symptoms typical of acute HAT and hepatic infarction. On diagnostic imaging, celiac axis and hepatic artery were thrombosed, resulting in ischemic necrosis of the left hepatic lobe. The resulting sepsis and transient hepatic insufficiency were managed conservatively, and repeat OLT was avoided. The patient remains stable more than one year later. To the best of our knowledge this case report is unique in the literature for the unusually long interval between OLT and late acute HAT, as well as celiac and portal vein occlusion. The acute presentation of sub massive hepatic necrosis is also uncharacteristic of late HAT and more typical of acute HAT. This report describes our experience in managing this and a literature review of the topic.
Topics: Adult; Celiac Artery; Hepatic Artery; Humans; Infarction; Liver; Liver Transplantation; Male; Portal Vein; Thrombosis; Tomography, X-Ray Computed
PubMed: 20009144
DOI: No ID Found -
British Journal of Pharmacology Dec 19941. The antithrombotic action of argatroban, a synthetic thrombin inhibitor, was studied in three models of thrombosis in the rat, and in the tail transection bleeding...
1. The antithrombotic action of argatroban, a synthetic thrombin inhibitor, was studied in three models of thrombosis in the rat, and in the tail transection bleeding time test. Heparin was studied as a reference anticoagulant. 2. In the model of venous thrombosis induced by thromboplastin followed by stasis of the abdominal vena cava, argatroban had an ED50 of 125 micrograms kg-1, when administered as an i.v. bolus 5 min prior to the thromboplastin injection: the ED50 of heparin was 42 micrograms kg-1, where ED50 is the dose which reduces the weight of the thrombus by 50% compared with that of the control animals. When the two compounds were administered by continuous i.v. infusion, argatroban (ED50 = 1.5 micrograms kg-1 min-1) had the same potency as heparin (ED50 = 1.2 micrograms kg-1 min-1). 3. Argatroban was active in the arterio-venous shunt model with an ED50 of 0.6 mg kg-1 when the compound was given as a bolus. The ED50 of heparin was 0.04 mg kg-1 under the same conditions. The two compounds had ED50 values of 6 micrograms kg-1 min-1 (argatroban) and 3 micrograms kg-1 min-1 (heparin), when administered by continuous i.v. infusion. 4. When tested against occlusive arterial thrombus formation by electrical stimulation of the left carotid artery, both compounds given as either an i.v. bolus or a continuous infusion led to dose-dependent increases in the duration of post-lesion vessel patency. Heparin bolus was more active than argatroban on a weight basis, in that 2 mg kg-1 gave a similar increase in the time to occlusion as 8 mg kg-1 argatroban. As in the other models, when given as continuous infusions, argatroban (111% increase in time to occlusion at 20 tg kg-1, min-1) had similar activity to that of heparin (180% increase at 25 jg kg-1 min-1) on a weight basis. Hoever, the antithrombotic effects of argatroban were accompanied by only moderate changes in the coagulation parameters (thrombin time and activated partial thromboplastin time, APTT), whereas, even at a subthreshold dose of heparin (12.5 pg kg-1 min-1), both the thrombin time and the APTT were greater than 150 s.5. Infusions of both compounds caused dose-dependent increases in the tail transection bleeding time,with the dose of argatroban that doubles the bleeding time (11 I g kg-1 min-1) being five times greater than that of heparin (EDI, = 2.2 fig kg-1 min-1).6. These data show that, when administered as an intravenous infusion, argatroban is a potent antithrombotic agent in rat models of venous 'mixed' and arterial thrombosis, this effect can be obtained with a lower degree of systemic anticoagulation than with heparin in the arterial model, and argatroban has a lower haemorrhagic potential than that of heparin.
Topics: Animals; Arginine; Arteriovenous Shunt, Surgical; Bleeding Time; Carotid Arteries; Electric Stimulation; Fibrinolytic Agents; Heparin; Male; Pipecolic Acids; Rats; Sulfonamides; Tail; Thrombophlebitis; Thrombosis
PubMed: 7889274
DOI: 10.1111/j.1476-5381.1994.tb17126.x -
International Journal of Molecular... Aug 2019Factors promoting thrombosis such as von Willebrand factor (vWF) and P-selectin are essential for the development of atherosclerosis (AS) and arterial thrombosis. The...
Factors promoting thrombosis such as von Willebrand factor (vWF) and P-selectin are essential for the development of atherosclerosis (AS) and arterial thrombosis. The processing, maturation and release of vWF are regulated by autophagy of vascular endothelial cells. The Sirt1/FoxO1 pathway is an important pathway to regulate autophagy of endothelial cells, therefore the Sirt1/FoxO1 pathway may be an important target for the prevention of thrombosis. We investigated the role of ox-LDL in the release of vWF and P-selectin and the expression of Sirt1 and FoxO1 by Western Blot, Flow Cytometry, ELISA, and tandem fluorescent mRFP-GFP-LC3. We found that vWF and P-selectin secretion increased and Sirt1/FoxO1 pathway was depressed in human umbilical vein endothelial cells (HUVEC) when treated with ox-LDL. Moreover, the expression of autophagy-related protein LC3-II/I and p62 increased. Then, we explored the relationship between autophagy regulated by the Sirt1/FoxO1 pathway and the secretion of vWF and P-selectin. We found that Sirt1/FoxO1, activated by the Sirt1 activators resveratrol (RSV) and SRT1720, decreased the secretion of vWF and P-selectin, which can be abolished by the autophagy inhibitor 3-MA. The expression of Rab7 increased when Sirt1/FoxO1 pathway was activated, and the accumulation of p62 was decreased. Autophagy flux was inhibited by ox-LDL and Sirt1/FoxO1 pathway might enhance autophagy flux through the promotion of the Rab7 expression. Taken together, our data suggest that by enhancing autophagy flux and decreasing the release of vWF and P-selectin, the Sirt1/FoxO1 pathway may be a promising target to prevent AS and arterial thrombosis.
Topics: Arteries; Autophagy; Biomarkers; Cells, Cultured; Disease Susceptibility; Epithelial Cells; Forkhead Box Protein O1; Gene Expression; Gene Silencing; Human Umbilical Vein Endothelial Cells; Humans; Lipoproteins, LDL; Signal Transduction; Sirtuin 1; Thrombosis; von Willebrand Factor
PubMed: 31450612
DOI: 10.3390/ijms20174132 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Nov 2020Thrombosis of a hemodialysis arteriovenous fistula (AVF) is a serious complication that needs urgent treatment. Most cases are treated surgically, but recently,... (Observational Study)
Observational Study
OBJECTIVE
Thrombosis of a hemodialysis arteriovenous fistula (AVF) is a serious complication that needs urgent treatment. Most cases are treated surgically, but recently, endovascular strategies have become a viable alternative. This study is an evaluation of the success and patency rate of percutaneous balloon angioplasty of thrombosed hemodialysis fistulas using a drug-coated balloon (DCB) contrasted with a standard balloon (SB).
METHODS
The data of 33 patients with a thrombosed native hemodialysis AVF treated percutaneously in a tertiary care center were analyzed retrospectively. Success of the procedure was defined as restoration of flow with less than 30% residual stenosis and resumption of dialysis through the hemodialysis AVF. The success rate of the procedure and the patency rate at 1, 6, and 12 months were evaluated. The effect on patency of a DCB was compared to that of a SB.
RESULTS
Twenty-five radiocephalic and 8 brachiocephalic thrombosed hemodialysis AVFs were treated during the study period. Flow was restored in 23 thrombosed fistulas, a success rate of 69.7%. The patency rate of successfully treated fistulas was 95.6% at 1 month, 76.1% at 6 months, and 57.9% at 12 months. Ten of the 23 re-established AVFs were treated with a DCB and the remainder were treated with a SB. The patency of the fistulas treated with a DCB was similar to that of a SB at 1 month (100% vs 92.3%, respectively; p=0.393). The patency rate of a DCB was greater than that of a SB at 6 months (88.9% vs 66.7%, respectively; p=0.258) and 12 months (75% vs 45.4%, respectively; p=0.219).
CONCLUSION
Percutaneous intervention for thrombosed hemodialysis AVFs is a safe, minimally invasive, and effective procedure. There was a positive trend in the patency rate of patients treated with a DCB at 6 and 12 months compared with a SB.
Topics: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon; Arteriovenous Shunt, Surgical; Brachial Artery; Female; Femoral Artery; Follow-Up Studies; Humans; Male; Middle Aged; Radial Artery; Renal Dialysis; Reperfusion; Retrospective Studies; Thrombosis; Time Factors; Vascular Patency; Young Adult
PubMed: 33257611
DOI: 10.5543/tkda.2020.33027 -
Journal of Vascular Surgery Jan 2021The severe acute respiratory syndrome novel coronavirus-2 pandemic is affecting almost every country in the world. Even if the major symptoms of coronavirus disease-2019...
The severe acute respiratory syndrome novel coronavirus-2 pandemic is affecting almost every country in the world. Even if the major symptoms of coronavirus disease-2019 are respiratory, different symptoms at presentation are now recognized. Venous thromboembolism has been reported in infected patients and few but increasing cases of arterial thrombosis have been described. We report a case of acute aortoiliac and lower limb artery occlusions in a patient presenting with severe coronavirus disease-2019 infection. The mechanism of the occlusion seemed to be distal embolization from a floating thrombus in the aortic arch caused by a major inflammatory state and virus infection. The patient underwent aortoiliac and lower limb artery mechanical thrombectomy, but required unilateral major amputation.
Topics: Acute Disease; Amputation, Surgical; Aortic Diseases; Arterial Occlusive Diseases; COVID-19; Humans; Iliac Artery; Male; Middle Aged; Thrombectomy; Thrombosis; Treatment Outcome
PubMed: 33075454
DOI: 10.1016/j.jvs.2020.10.018 -
Journal of the American College of... Apr 2002The purpose of this study was to evaluate the potential of magnetic resonance (MR) to detect arterial thrombotic obstruction and define thrombus age. BACKGROUND;... (Comparative Study)
Comparative Study
OBJECTIVES
The purpose of this study was to evaluate the potential of magnetic resonance (MR) to detect arterial thrombotic obstruction and define thrombus age. BACKGROUND; Arterial thrombi underlie the clinical consequences of atherosclerosis and are not reliably detected by current noninvasive diagnostic techniques.
METHODS
Carotid thrombi were induced in swine (n = 7) by arterial injury. Serial high-resolution in vivo MR images were obtained using black-blood T1-weighted (T1W) and T2-weighted (T2W) sequences in a clinical 1.5T MR system at 6 h, 1 day and at 1, 2, 3, 6 and 9 weeks. At each time point one animal was sacrificed and the occluded carotid artery processed for histopathology. Thrombus signal intensity (SI) was normalized to that of the adjacent muscle. Thrombus age was assessed based on MR appearance by two blinded independent observers.
RESULTS
Thrombus appearance and relative SI revealed characteristic temporal changes in multicontrast-weighted MR images, reflecting histologic changes in the composition. Acute thrombus appeared very bright on the T2W images, facilitating the detection. Signal intensity was 197 +/- 25% at 6 h, peaking at 1 week (246 +/- 51%), reaching a plateau by 6 weeks (120 +/- 15%). At six weeks, complete thrombus organization was confirmed histologically. The T1W images had similar pattern with lower SI than T2W. Age definition using visual appearance was highly accurate (Pearson's chi-square with 4 df ranging from 96 to 132 and Cohen's kappa at 0.81 to 0.94). Agreement between observers was substantial (Pearson chi-square with 4 df = 91.5, kappa = 0.79).
CONCLUSIONS
Magnetic resonance imaging is a promising tool to noninvasively detect arterial thrombosis. Measurement of SI and the characteristic visual appearance of the thrombus have the potential to define thrombus age.
Topics: Age Factors; Animals; Arterial Occlusive Diseases; Carotid Artery, Common; Disease Models, Animal; Image Enhancement; Magnetic Resonance Imaging; Models, Cardiovascular; Observer Variation; Radiography; Reproducibility of Results; Sensitivity and Specificity; Swine; Thrombosis
PubMed: 11955857
DOI: 10.1016/s0735-1097(02)01754-0