Search

The inhibitor of apoptosis protein survivin has long been of interest in the cancer literature for its role in both the regulation of cell proliferation and the inhibition of apoptosis. A growing body of literature has implicated survivin in the maladaptive pathways following vascular injury and, in particular, in the growth of vascular smooth muscle cells that comprise the hyperplastic neointimal lesions that characterize midterm vein bypass graft failure and restenosis following angioplasty and stenting. This review focuses on the emerging role of survivin in the regulation of smooth muscle cell growth and its implications for the prevention of restenosis following revascularization procedures. The expression, regulation, and function of survivin are addressed, as well as the current state of understanding regarding the effects of survivin inhibition in vitro and in vivo.

Endovascular therapeutic hypothermia has been shown to preserve neurological function and improve outcomes; however, its use and potential complications have not been fully described in patients with traumatic head injuries. We believe that the use of endovascular cooling leads to deep venous thrombosis (DVT) in this high-risk population. We performed a retrospective review of 11 patients with severe head injuries admitted to our Level I trauma center surgical intensive care unit who underwent intravascular cooling. Duplex sonograms were obtained after 4 days at catheter removal or with clinical symptoms that were suspicious for DVT. Patients had a mean age of 23.2 (range, 16–42) years and an Injury Severity Score of 31.9 (range, 25–43). The overall incidence of DVT was 50 per cent. The DVT rate was 33 per cent if catheters were removed in 4 days or less and 75 per cent if removed after 4 days (risk ratio = 2.25; odds ratio = 6; P = ns). An elevated international normalized ratio upon admission was protective against DVT (no DVT = 1.26 vs DVT = 1.09; P = 0.02). Inferior vena cava filters were placed in most patients with DVT. The use of endovascular cooling catheters is associated with increased risk of DVT in patients with traumatic head injuries. Therefore, we discourage the use of endovascular cooling devices in this patient population.