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Annals of Vascular Surgery Nov 2020Few cases of arterial thromboembolisms have been reported after novel coronavirus disease 2019 (COVID-19) in case of severe infection or in elderly patients. We report a...
INTRODUCTION
Few cases of arterial thromboembolisms have been reported after novel coronavirus disease 2019 (COVID-19) in case of severe infection or in elderly patients. We report a case of femoral arterial thrombosis in a young patient after nonsevere infection.
CASE DESCRIPTION
A common femoral artery thrombosis extended in the first third of superficial and profunda femoral arteries associated with tibial posterior and popliteal artery thrombosis was diagnosed in a 24-year-old man complaining of right lower limb pain for one month. The evolution was good after anticoagulation and antiaggregant treatments and thrombectomy. Etiologic assessment was negative except for nonsevere COVID-19.
DISCUSSION
COVID-19 accesses host cells via angiotensin-converting enzyme 2 protein, abundant in the lungs, which is also expressed by endothelial cells and is associated with important inflammatory syndrome and coagulopathy, leading to vascular lesions. Thrombosis prevalence is not fully established and seems to be higher in case of major inflammation and in the intensive care unit (ICU). Arterial thromboembolisms are described in many vascular territories, each time in elderly patients, or in case of severe infection. We described a femoral arterial thrombosis in a young patient with negative etiological assessment except nonsevere COVID-19. Treatment consists in anticoagulation and antiaggregant drugs and thrombectomy. Preventing venous thromboembolism treatment is recommended in case of severe infection or in the ICU, but there is no clear recommendation for arterial thromboembolism prevention. This case should lead us to be very careful of the arterial event risk even if the infection is nonsevere and the patient is young.
Topics: Anticoagulants; Arterial Occlusive Diseases; Betacoronavirus; COVID-19; Combined Modality Therapy; Coronavirus Infections; Diagnosis, Differential; Femoral Artery; Humans; Male; Pandemics; Platelet Aggregation Inhibitors; Pneumonia, Viral; SARS-CoV-2; Thrombectomy; Thrombosis; Young Adult
PubMed: 32736027
DOI: 10.1016/j.avsg.2020.07.013 -
Neurology India 2021
Topics: Carotid Arteries; Humans; Thrombosis
PubMed: 34169892
DOI: 10.4103/0028-3886.319231 -
Experimental and Clinical... May 2022We aimed to examine management of double hepatic artery reconstruction in patients under going living-donor liver transplant.
OBJECTIVES
We aimed to examine management of double hepatic artery reconstruction in patients under going living-donor liver transplant.
MATERIALS AND METHODS
Between January 2002 and June 2014, one thousand thirty-six living-donor liver transplants were performed at the Liver Transplant Institute of Malatya Inonu University. Living liver grafts with a single hepatic artery were used in 983 living-donor liver transplants, while grafts with double hepatic artery branches were used in 53 living-donor liver transplants. All of the liver grafts with double hepatic artery branches were right lobe grafts. Hepatic artery anastomosis technique and the other medical data of recipients who used grafts with double hepatic arteries were analyzed retrospectively.
RESULTS
A double hepatic artery anastomosis was created in 43 recipients, while a single anastomosis was created in the remaining 10 because of ligation of the nondominant hepatic artery branch. In 40 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right and left hepatic artery. In the remaining 3 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right hepatic artery and large segment 4 hepatic arteries. Postoperative complications related with hepatic artery anas-tomoses developed in 3 recipients: hepatic artery thrombosis (n = 1), hepatic artery aneurysm (n = 1), and hepatic artery stenosis (n = 1). A recipient with hepatic artery aneurysm immediately underwent a retransplant. A recipient with a hepatic artery thrombosis relapsed and required retransplant, which was treated with thrombectomy on postoperative day 10. A recipient with hepatic artery stenosis was followed conservatively. In our series, the incidence of complications related with double hepatic artery anastomosis was found to be 6.9%.
CONCLUSIONS
According to our experiences, a double hepatic artery anastomosis does not increase the risk of hepatic artery thrombosis and can be performed safely by surgeons who are experienced with hepatic vascular reconstructions in a living-donor liver transplant recipient.
Topics: Constriction, Pathologic; Hepatic Artery; Humans; Liver Transplantation; Living Donors; Retrospective Studies; Thrombosis; Treatment Outcome; Vascular Diseases
PubMed: 26767402
DOI: 10.6002/ect.2015.0108 -
PloS One 2021Management of vascular infections represents a major challenge in vascular surgery. The use of cryopreserved vascular allografts could be a feasible therapeutic option,...
INTRODUCTION
Management of vascular infections represents a major challenge in vascular surgery. The use of cryopreserved vascular allografts could be a feasible therapeutic option, but the optimal conditions for their production and use are not precisely defined.
AIMS
To evaluate the effects of cryopreservation and the duration of storage on the thrombogenicity of femoral artery allografts.
METHODS
In our prospective study, eleven multi-organ-donation-harvested human femoral arteries were examined at five time points during storage at -80°C: before cryopreservation as a fresh native sample and immediately, one, twelve and twenty-four weeks after the cryopreservation. Cross-sections of allografts were perfused with heparin-anticoagulated blood at shear-rates relevant to medium-sized arteries. The deposited platelets and fibrin were immunostained. The thrombogenicity of the intima, media and adventitia layers of the artery grafts was assessed quantitatively from the relative area covered by fibrin- and platelet-related fluorescent signal in the confocal micrographs.
RESULTS
Regression analysis of the fibrin and platelet coverage in the course of the 24-week storage excluded the possibility for increase in the graft thrombogenicity in the course of time and supported the hypothesis for a descending trend in fibrin generation and platelet deposition on the arterial wall. The fibrin deposition in the cryopreserved samples did not exceed the level detected in any of the three layers of the native graft. However, an early (up to week 12) shift above the native sample level was observed in the platelet adhesion to the media.
CONCLUSIONS
The hemostatic potential of cryopreserved arterial allografts was retained, whereas their thrombogenic potential declined during the 6-month storage. The only transient prothrombotic change was observed in the media layer, where the platelet deposition exceeded that of the fresh native grafts in the initial twelve weeks after cryopreservation, suggesting a potential clinical benefit from antiplatelet therapy in this time-window.
Topics: Adult; Allografts; Arteries; Blood Platelets; Cryopreservation; Female; Fibrin; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Platelet Adhesiveness; Thrombosis; Time Factors
PubMed: 34293054
DOI: 10.1371/journal.pone.0255114 -
Journal of the Royal College of... Jan 1976
Topics: Arteries; Blood Platelets; Endothelium; Hemostasis; Thrombosis
PubMed: 1246022
DOI: No ID Found -
Critical Care (London, England) Jun 2002In order to evaluate the complications and risk factors associated with peripheral arterial catheters used for haemodynamic monitoring, we reviewed the literature... (Review)
Review
In order to evaluate the complications and risk factors associated with peripheral arterial catheters used for haemodynamic monitoring, we reviewed the literature published from 1978 to 2001. We closely examined the three most commonly used arterial cannulation sites. The reviewed papers included a total of 19,617 radial, 3899 femoral and 1989 axillary artery catheterizations. Factors that contribute to higher complication rates were investigated. Major complications occurred in fewer than 1% of the cases, and rates were similar for the radial, femoral and axillary arteries. We conclude that arterial cannulation is a safe procedure.
Topics: Axillary Artery; Bacterial Infections; Catheterization, Peripheral; Critical Care; Femoral Artery; Humans; Monitoring, Intraoperative; Radial Artery; Risk Factors; Thrombosis
PubMed: 12133178
DOI: 10.1186/cc1489 -
HPB : the Official Journal of the... Aug 2014Portal vein arterialization (PVA) has been used as a salvage inflow technique when hepatic artery (HA) reconstruction is deemed impossible in liver transplantation (LT)... (Review)
Review
BACKGROUND
Portal vein arterialization (PVA) has been used as a salvage inflow technique when hepatic artery (HA) reconstruction is deemed impossible in liver transplantation (LT) or hepatopancreatobiliary (HPB) surgery. Outcomes and the management of possible complications have not been well described.
METHODS
The present study analysed outcomes in 16 patients who underwent PVA during the period from February 2005 to January 2011 for HA thrombosis post-LT (n = 7) or after liver resection (n = 1), during curative resection for locally advanced HPB cancers (requiring HA interruption) (n = 7) and for HA resection without reconstruction (n = 1). In addition, a literature review was conducted.
RESULTS
Nine patients were women. The median age of the patients was 58 years (range: 30-72 years). Recovery of intrahepatic arterial signals and PVA shunt patency were documented using Doppler ultrasound until the last follow-up (or until shunt thrombosis in some cases). Of five postoperative deaths, two occurred as a result of haemorrhagic shock, one as a result of liver ischaemia and one as a result of sepsis. The fifth patient died at home of unknown cause. Three patients (19%) had major bleeding related to portal hypertension (PHT). Of these, two underwent re-exploration and one underwent successful shunt embolization to control the bleeding. Four patients (25%) had early shunt thrombosis, two of whom underwent a second PVA. After a median follow-up of 13 months (range: 1-60 months), 10 patients (63%) remained alive with normal liver function and one submitted to retransplantation.
CONCLUSIONS
Portal vein arterialization results in acceptable rates of survival in relation to spontaneous outcomes in patients with completely de-arterialized livers. The management of complications (especially PHT) after the procedure is challenging. Portal vein arterialization may represent a salvage option or a bridge to liver retransplantation and thus may make curative resection in locally advanced HPB cancers with vascular involvement feasible.
Topics: Adult; Aged; Arterial Occlusive Diseases; Female; France; Hepatectomy; Hepatic Artery; Humans; Liver Transplantation; Male; Middle Aged; Phlebography; Portal Vein; Reoperation; Salvage Therapy; Thrombosis; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler; Vascular Patency; Vascular Surgical Procedures
PubMed: 24329988
DOI: 10.1111/hpb.12200 -
Clinical and Applied... 2022Deep vein thrombosis of the lower limbs is a common disease in vascular surgery. Approximately 20-50% of deep vein thrombosis patients develop post-thrombotic syndrome,...
OBJECTIVE
Deep vein thrombosis of the lower limbs is a common disease in vascular surgery. Approximately 20-50% of deep vein thrombosis patients develop post-thrombotic syndrome, which can severely affect the patient's quality of life. However, the precise science of the pathophysiology of the progression of the post-thrombotic syndrome remains unclear. Studies have demonstrated that patients with post-thrombotic syndrome of the lower limbs have impaired arterial wall endothelial function. Nevertheless, there is little research on the different impacts of post-thrombotic syndrome on the arterial wall endothelial function between the affected limbs and the healthy limbs. This study aims to assess this difference.
METHODS
A total of 60 patients treated for the post-thrombotic syndrome of the lower limbs were included. The flow-mediated dilation (FMD%) and nitroglycerin-mediated dilation (NMD%) were measured to assess the different endothelial function alterations of the common femoral arterial wall between the affected limb and the healthy limb.
RESULTS
No significant differences in the common femoral artery diameter between the affected limbs and the healthy limbs were discovered (8.94 ± 0.92 mm vs 8.75 ± 1.0 mm, P = 0.710). The flow-mediated dilation of the common femoral artery of the affected limbs were significantly lower compared to the healthy limbs (FMD%: 3.21 ± 1.07% vs 5.19 ± 1.35%, P = 0.001). However, there was no significant difference in the nitroglycerin-mediated dilation of the common femoral artery between the affected limbs and the healthy limbs( NMD%: 13.37 ± 1.78% versus 14.45 ± 2.14%, P = 0.083).
CONCLUSIONS
Our results demonstrated the association between post-thrombotic syndrome and deteriorated endothelial functional properties of the arterial wall of the lower limbs. Endothelial dysfunction of the arteries wall was more severe in the affected lower limbs with the post-thrombotic syndrome than in the healthy limbs. The mentioned findings may partly explain the pathophysiology of the progression post-thrombotic syndrome of the lower limbs.
HIGHLIGHTS
tudies have demonstrated that patients with post-thrombotic syndrome of the lower limbs have impaired arterial wall endothelial function. Our results demonstrated the endothelial dysfunction of the arteries wall was more severe in the affected lower limbs with the post-thrombotic syndrome than in the healthy limbs. Our findings may partly explain the pathophysiology of the progression post-thrombotic syndrome of the lower limbs.
Topics: Arteries; Brachial Artery; Endothelium, Vascular; Humans; Lower Extremity; Nitroglycerin; Postthrombotic Syndrome; Quality of Life; Vascular Diseases; Vasodilation
PubMed: 35924373
DOI: 10.1177/10760296221117473 -
Biomedicine & Pharmacotherapy =... Feb 2020Arterial thrombosis (AT) causes various ischemia-related diseases, which impose a serious medical burden worldwide. As an inhibitor of myosin II, blebbistatin has an...
Arterial thrombosis (AT) causes various ischemia-related diseases, which impose a serious medical burden worldwide. As an inhibitor of myosin II, blebbistatin has an important role in thrombosis development. We investigated the effect of blebbistatin on carotid artery ligation (CAL)-induced carotid AT and its potential underlying mechanism. A model of carotid AT in mice was generated by CAL. Mice were divided into three groups: CAL model, blebbistatin-treated, and sham-operation. After 7 days, blood vessels were harvested from mice in each group. The procoagulant activity of tissue factor (TF) was tested by a chromogenic assay, and thrombus severity assessed by histopathology scores. Expression of non-muscle myosin heavy chain II A (NMMHCIIA), TF, glycogen synthase kinase 3β (GSK3β), and nuclear factor-kappa B (NF-κB) was detected by immunohistochemical and immunofluorescence staining. mRNA expression was measured by quantitative polymerase chain reaction. Blebbistatin (1 mg/kg) inhibited development of carotid AT, reduced infiltration of inflammatory cells, and prevented vascular-tissue damage, relative to the model group. Furthermore, blebbistatin also reduced the procoagulant activity of TF. Immunohistochemical and immunofluorescence data demonstrated that, compared with the model group, blebbistatin intervention reduced expression of NMMHCIIA, TF, GSK3β, p65, and p-p65 in carotid-artery endothelia in the CAL-induced AT model, but it increased levels of p-GSK3β. Blebbistatin could inhibit expression of NMMHCIIA mRNA in the CAL model. Overall, our data demonstrated that blebbistatin could inhibit TF expression and AT development in arterial endothelia (at least in part) via GSK3β/NF-κB signaling.
Topics: Animals; Arteries; Cytoskeletal Proteins; Glycogen Synthase Kinase 3 beta; Heterocyclic Compounds, 4 or More Rings; Male; Mice; Mice, Inbred C57BL; Myosin Type II; NF-kappa B; Signal Transduction; Thrombosis
PubMed: 31918291
DOI: 10.1016/j.biopha.2019.109775 -
Journal of Atherosclerosis and... Mar 2010There is growing evidence that venous thrombotic and arterial atherosclerotic diseases are interrelated. This presumption is supported by the similar ethiopathogenesis,...
AIM
There is growing evidence that venous thrombotic and arterial atherosclerotic diseases are interrelated. This presumption is supported by the similar ethiopathogenesis, risk factors and clinical appearance of the two diseases. We investigated whether the prevalence of preclinical indicators of atherosclerosis is higher in patients with spontaneous venous thrombosis than in healthy subjects. Further, we studied the extent of preclinical deterioration of the arterial wall in different beds of the arterial system.
METHODS
Forty seven patients of both sexes (mean age, 52.3+/-14.3 years) with idiopathic venous thrombosis and 44-age matched controls were studied. Using ultrasound, bifurcations of the carotid and femoral arteries were investigated and intima-media thickness plus the presence and thickness of atherosclerotic plaques were determined.
RESULTS
The intima-media was on average, and in all beds investigated, significantly thicker in patients than in controls (0.94 mm +/-0.29 vs. 0.71 mm +/-0.15, p<0.001). The prevalence of atherosclerotic plaques was higher in patients (33/47 vs. 15/44, p<0.001). Furthermore, the number of plaques per individual, the number of arterial segments involved, and total plaque thickness were significantly longer in patients than in controls.
CONCLUSION
The findings showed a close interrelationship between idiopathic venous thrombosis and preclinical atherosclerotic changes in different arterial territories. This could mean that in patients with primary arterial or venous disease, the arterial and venous vessel walls deteriorate simultaneously, and that common local or systemic factors influence the clinical appearance of either or both diseases.
Topics: Age Factors; Aged; Atherosclerosis; Carotid Arteries; Case-Control Studies; Female; Femoral Artery; Humans; Male; Middle Aged; Regression Analysis; Tunica Intima; Tunica Media; Ultrasonography; Venous Thrombosis
PubMed: 20103975
DOI: 10.5551/jat.3079