Parsonsfalk6545

Venous thromboembolism (VTE) concomitant to acute limb ischemia (ALI) is rarely reported. The aim of the study was to investigate characteristics and identify clinical indicators of VTE in patients with ALI.

Electronic medical record was used to identify patients diagnosed with ALI from January 2013 to June 2019. Eligible patients were categorized as VTE or non-VTE based on the presence or absence of concomitant VTE. Univariate analysis and multivariate analysis for indicators of VTE were performed.

A total of 153 patients with 161 ischemic limbs were enrolled. Venous duplex ultrasound (DUS) for 149 patients (157 ischemic limbs) revealed deep vein thrombosis (DVT) in 38 (24.2%) ischemic limbs of 37 (24.8%) patients. Five femoral DVTs were found intraoperatively. Six patients had pulmonary embolism (PE) and three of them died. In all, 43 (28.1%) ALI patients were diagnosed with VTE. They were treated with trans-arterial catheter-directed thrombolysis (N.=22), embolectomy (N.=9), primary amputation (N.=4) and anticoagulation alone (N.=8). The univariate analysis indicated that symptoms ≥ 2 days [odds ratio (OR) 3.42, 95%CI1.54-7.62], Rutherford classification IIb-III (OR 9.17, 95%CI 2.10-40.12), leg swelling (OR 4.44, 95%CI 2.07-9.53), neutrophil ratio ≥0.80 (OR 3.92, 95%CI 1.72-8.93) and positive D-dimer (OR 8.44, 95%CI 3.65-19.53) were indicators of VTE concomitant to ALI. In the multivariate analysis, leg swelling and positive D-dimer appeared to be independent indicators.

VTE commonly occurs to ALI. Venous DUS for DVT screening should be considered for ALI patients who present one or more of these indicators.

VTE commonly occurs to ALI. Venous DUS for DVT screening should be considered for ALI patients who present one or more of these indicators.

The CHA<inf>2</inf>DS<inf>2</inf>-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, female gender) score is used to estimate thromboembolic risk in atrial fibrillation (AF). Current studies have shown that CHA<inf>2</inf>DS<inf>2</inf>-VASc score can predict adverse clinical outcomes in coronary artery disease, stroke, and many diseases irrespective of the presence of AF. The usefulness of CHA<inf>2</inf>DS<inf>2</inf>-VASc score in predicting mortality of peripheral arterial disease (PAD) patients is unknown. In this study, we aimed to evaluate the predictive value of the CHA<inf>2</inf>DS<inf>2</inf>-VASc score for mortality of PAD patients.

A total of 396 patients diagnosed with PAD for the first time in our clinic between January 2010-July 2016 were included in this study. Patients were divided into two groups as deceased (gro;inf>2</inf>DS<inf>2</inf>VASc score is directly related with mortality in PAD patients. The CHA<inf>2</inf>DS<inf>2</inf>VASc score may be a useful and practical scoring method to identify high-risk patients, and further future studies are needed to assess the role of CHA<inf>2</inf>DS<inf>2</inf>VASc score in PAD.

VASc score in PAD.

To report a novel staged hybrid technique to treat complex juxtarenal abdominal aortic aneurysm (JAAA) associated with at least one iliac artery aneurysm (IA) with no adequate distal fixation zone.

The novel technique herein described has two main "staged" steps. The first step consists in creating an adequate distal fixation zone by endovascular means; after hypogastric embolization an iliac stent-graft has placed from 5 mm above the aortic bifurcation to the external iliac artery. The second step is the surgical resection of the JAAA and graft placement sutured distally to the stent-graft which was always performed the day after.

The five cases included (mean age 74 years), were rejected for fenestrated or branched endovascular aortic repair or iliac branch devices. Four tube grafts and one aorto-bi-iliac graft were sutured to one stent-graft (N.=3), two stent-grafts in iliac kissing configuration (N.=1) and to a main body of a bifurcated stent-graft (N.=1). Mean follow-up duration was 14 (4-27) months with no mortality. Technical success was obtained in all cases (2 suprarenal clamping). Postoperative complications included two pleural effusions, two transient gluteal intermittent claudications, and one renal failure.

The technique herein described seems to be a feasible and cost-effective alternative treatment for selected concomitant complex JAAAs and IAs unsuitable for totally endovascular treatment.

The technique herein described seems to be a feasible and cost-effective alternative treatment for selected concomitant complex JAAAs and IAs unsuitable for totally endovascular treatment.Portal hypertension is a clinical syndrome characterized by an increase in the portal pressure gradient, defined as the gradient between the portal vein at the site downstream of the site of obstruction and the inferior vena cava. The most frequent cause of portal hypertension is cirrhosis. In patients with cirrhosis, portal hypertension is the main driver of cirrhosis progression and development of hepatic decompensation (ascites, variceal hemorrhage and hepatic encephalopathy), which defines the transition from compensated to decompensated stage. In decompensated patients, treatments aim at lowering the risk of death by preventing further decompensation and/or development of acute-on-chronic liver failure. Decompensated patients often pose a complex challenge which typically requires a multidisciplinary approach. The aims of the present review were to discuss the current knowledge regarding interventional treatments for patients with portal hypertension complications as well as to highlight useful information to aid hepatologists in their clinical practice. selleck compound Specifically, we discussed the indications and contraindications of transjugular intra-hepatic portosystemic shunt and for the treatment of gastro-esophageal variceal hemorrhage in patients with decompensated cirrhosis (first section); we reviewed the use of interventional treatments in patients with hepatic vein obstruction (Budd-Chiari Syndrome) and in those with portal vein thrombosis (second section); and we briefly comment on the most frequent applications of selective splenic embolization in patients with and without underlying cirrhosis (third section).