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Visceral artery aneurysm, especially splenic artery aneurysm, is rare and is usually associated with pregnancy. When such aneurysms rupture, they can be fatal, and they often require emergency surgery. This case report includes a review of the literature and describes a effective multidisciplinary approach to managing this type of aneurysm. We describe the treatment of a ruptured splenic artery aneurysm and the careful coordination of obstetric, vascular surgery, and intensive care teams. The uniqueness of this case arose from the metal embolization coil that was found to have fallen off from a recently embolized ruptured splenic artery aneurysm. The management of this ruptured splenic artery aneurysm and iatrogenic foreign body insult required a combination of multiple specialties to provide life-saving treatment. Such cases should be managed by multidisciplinary teams if institutional resources allow for it.

Chronic venous insufficiency (CVI) causes severe symptoms and complications in the general population, but the prevalence, related risk factors, and treatment of CVI are unknown among nurses. The demographics and occupational factors of nurses from a university hospital were collected by questionnaires, and the presentation of CVI was confirmed by the specialist vascular surgeons. A total of 1606 participants were enrolled, and the prevalence of CVI was 7.5%. After multivariate adjustment, CVI was positively related to deep venous thrombosis history (OR 6.44, 95% CI 2.73-15.22), increased standing time (OR 2.21, 95% CI 1.20-4.10), and increased time in night shift rotation (OR 2.01, 95% CI 1.29-3.14). CVI was negatively related to oral contraceptives (OR .43, 95% CI .21-.87). Of the participants, 72.5% with CVI received compression therapy. For them, wearing compression stockings with a pressure of >20 mmHg or for >4 h/day significantly increased the rate of symptom relief, while the length of compression stockings made no difference. Thus, it was beneficial for nurses to spend less time standing and shorten their time in night shift rotation. Wearing compression stockings with sufficient pressure and for enough time was recommended for CVI symptom relief.

Objectives Emergency treatment of patients with severe subphrenic vascular trauma often adopts resuscitative thoracotomy or endovascular balloon. This case report proposes a non-invasive method to treat patients with vascular trauma, mainly through ultrasound-guided positioning of the proximal aorta and applying pressure to occlude the aorta and limit the distal blood flow, using bedside ultrasound to achieve accurate compression, continuous monitoring of its efficacy, and early detection of the recovery of autonomic circulation in patients with cardiac arrest. Methods We introduced a case of left iliac artery injury caused by a knife wound and subsequent cardiac arrest. Results We tried to externally compress the proximal aorta under bedside US guidance to achieve and maintain the recovery of the autonomic circulation. This allowed the patient to be transferred from the emergency department to the operating room. Conclusion This case demonstrated that ultrasound-guided proximal external aortic compression can be used as a bridge for further treatment of patients with vascular trauma, such as resuscitative thoracotomy or endoaortic balloon or covered stent occlusion.

Background: Intravenous lobular capillary hemangioma (IVLCH) of the neck is a kind of rare benign tumor of vein. Purpose: In this paper, we report two female patients who were hospitalized because of neck masses. Results: The tumors in the neck veins of our patients were white oval masses with pedicle, clearly defined and of different sizes. Their immunohistochemical staining results showed CD31 (+), CD34 (+), SMA (+), ERG (+). The pathological diagnosis was intravenous lobular capillary hemangioma. Conclusions: Due to the location, morphology and immunohistochemistry, This lesion needs to be distinguished from other intravascular lesions such as thrombus, hemangiosarcoma and papillary endothelial hyperplasia.

Objective To summarize the current research progress of machine learning and venous thromboembolism. Methods The literature on risk factors, diagnosis, prevention and prognosis of machine learning and venous thromboembolism in recent years was reviewed. Results Machine learning is the future of biomedical research, personalized medicine, and computer-aided diagnosis, and will significantly promote the development of biomedical research and healthcare. However, many medical professionals are not familiar with it. In this review, we will introduce several commonly used machine learning algorithms in medicine, discuss the application of machine learning in venous thromboembolism, and reveal the challenges and opportunities of machine learning in medicine. Conclusion The incidence of venous thromboembolism is high, the diagnostic measures are diverse, and it is necessary to classify and treat machine learning, and machine learning as a research tool, it is more necessary to strengthen the special research of venous thromboembolism and machine learning.

Pulsating varicose veins are a very rare clinical manifestation and mostly have been reported with tricuspid regurgitation or right ventricular dysfunction. The exact etiology and treatment options for this disease are rarely reported in the literature. In this article, we described a 45-year-old woman who had varicose veins in her both lower limbs when she came to our department. Venous ultrasound showed arterial-like pulsations in both superficial and deep veins of the lower extremities, and echocardiography showed severe tricuspid regurgitation. We gave the patient compression therapy for elastic stockings, and the patient's symptoms were significantly relieved. In addition, in this article, we reviewd other cases reported in the current literature and discussed appropriate treatment options for this disease

This meta-analysis was conducted to investigate whether compression stockings were necessary after endovenous thermal ablation of varicose veins.Electronic databases, including MEDLINE, EMBASE, and the Cochrane Library database, were searched from inception to 10 March 2021 to identify all the related trials.Random or fixed effects models were used to generate pooled mean difference (MD) or standardised mean difference (SMD) for continuous data, risk ratios (RRs) for dichotomous data, and related 95% confidence intervals (95% CIs). The quality of evidence was graded with a specific tool (GRADEpro GDT) from the GRADE working group.A total of seven randomised controlled trials (RCTs) comprising 1 146 patients were included in this meta-analysis. Wearing compression stockings was correlated with lower post-operative pain scores from a 0 to 100 mm visual analogue scale (MD -8.00; 95% CI -12.01 - -3.99; p.001). No difference was observed between wearing compression stockings or not in quality of life (SMD 0.45; 95% CI 0.14 - 1.04), major complications (RR 0.64; 95% CI 0.26 -1.59), target vein occlusion rates (RR 0.99; 95% CI 0.96 - 1.02), or time to return to work (MD -0.43; 95% CI 1.06 - 0.19).After endovenous thermal ablation of varicose veins, wearing compression stockings was not associated with a better outcome except for mild pain relief. Post-operative compression stockings may be unnecessary after endovenous thermal ablation.

Background and Objectives: Very few investigations and studies have been conducted on the provided information about varicose veins in web-based media worldwide. The present study aimed to investigate the categorization, characteristics, scientificity, and accuracy of such videos uploaded to YouTube. Materials and Methods: YouTube was searched during November 2019, and the search keywords were "varicose vein", "varicose veins", and "varicose veins of lower extremities". The videos collected by retrieval were classified as useful, partially useful, and completely useless based on their scientific content, contemporariness, and accuracy. The analysis was mainly performed on the data collected from videos that were categorized as useful. Results: In total, 635 (75.6%) out of 840 collected videos were excluded. Most videos on the website were uploaded by medical staff (31%, n=64). Based on the results, among the videos included in the data analysis, videos uploaded by official agencies were viewed more times than those uploaded by others. In addition, most of the useful videos were uploaded by official institutions. Conclusions: Official institutions should provide more web-based videos with up-to-date, complete, and accurate information about varicose veins. Furthermore, effective search tools are needed for the identification of the videos uploaded by academic sources and institutions.

Ultrasonography of patients with venous ulcers showed subcutaneous tissue calcification （STC）in some patients. However, calcification is rarely included in venous ulcer-related changes. The aim of this study was to evaluate the prevalence and morphological changes of STC in patients with ultrasonographically diagnosed with venous ulcers. A total of 80 legs of 40 patients with venous ulcers (28 women and 12 men, mean age 48 years, range 18-83 years) were included in this study. After ultrasonographic evaluation of the patient's deep, superficial, and perforating veins, continue to use ultrasonography to examine the patient's subcutaneous tissue for the presence of STC. According to the CEAP (Clinical, Etiological, Anatomical, Pathophysiological) classification of Group C, 18 legs were classified as C5 and 62 as C6. STC was present in 38 of the 80 legs, most of which were patients classified as C6.STC are easily detected by ultrasound, especially in the injured area of the leg in C6 patients. STC may be associated with chronic inflammation of the subcutaneous tissue. It is recommended to remove it from the ulcer bed to promote ulcer healing and prevent recurrence. Further studies are needed to determine its prognostic significance and other possible clinical implications.

BACKGROUND We performed this single-centre prospective study, aimed to analyse the safety and efficacy of ultrasound-guided foam sclerotherapy for primary isolated small saphenous vein (SSV) insufficiency. METHODS From June 2017 to June 2019, patients with primary SSV insufficiency and receiving ultrasound-guided foam sclerotherapy were included in this study. The collected data included demographics of patients, clinical treatment results, occlusion rate and the patient's venous clinical severity score (VCSS) before and after surgery at 6-month follow-up. RESULTS A total of 26 patients (14 women and 12 men) underwent ultrasound-guided sclerotherapy in 26 lower limbs, and were followed up at 1 week, 1 month and 6 months after surgery. Short-term complications included two severe pain during injection, one with vasovagal syncope, four with hyperpigmentation and two phlebitis. During 6-month follow-up, 22 were found to have complete thrombosis, and four showed partial thrombosis. There was a clear inverse relationship between SSV occlusion and SSV diameter (r = -0.502, P

Venous lower limb ulcers are very common and affect ~1% of the general population. The human acellular amniotic membrane (HAAM), which is isolated from the amniotic membrane (AM) via excluding the majority of cellular components, has lower antigenicity than the AM. The aim of the present study was to evaluate the effectiveness and safety of the HAAM, adopted to treat venous ulcers (VUs) of the lower extremities. The HAMM was isolated from the AM by the Stem Cells and Tissue Engineering laboratory at the West China Hospital of Sichuan University (Chengdu, China). HAMMs were grafted onto VUs in 4 patients, with follow-up evaluations performed on the 3rd day and at the end of the 1st, 2nd and 3rd week, and 2nd, 3rd and 6th month after the HAAMs were applied. The size and depth of the VU (determined based on whether the depth of VU reaches the tibial plane), the proportion of granulation tissue (whether >50%) and the degree of secretion (measured by asessing the degree of satuation in the outer gauze) and infection (assessed qualitatively via the appearance of purulence or peripheral swelling) were assessed. Pain score was monitored at the same intervals using a visual analog scale. Complete epithelialization (healed tissue) occurred in 2 cases: The first at the end of the 3rd week and the second, at the 2nd month following HAAM induction. In one of the remaining cases, ulcer size was reduced by >60%; however the ulcer size of the remaining case only reduced by 50%. Furthermore, purulence and secretion completely disappeared in all 4 cases. Additionally, the medical cost of HAAM treatment is substantially lower than that of AM treatment, skin autografts and biomaterial transplantation, thus alleviating the patients' financial burden. These findings suggest that HAMM was highly effective in treating VUs in patients. ispartof: EXPERIMENTAL AND THERAPEUTIC MEDICINE vol:16 issue:2 pages:1285-1289 ispartof: location:Greece status: published

Objective The aim of our study was to compare percutaneous vascular interventions (PVI) versus bypass surgeries (BSX) in patients with critical limb ischemia (CLI). Background Previous relevant reviews with limited numbers of included studies did not strictly confine the inclusion criteria to CLI, also involving patients with severe claudication, which may introduce bias in the decision-making of CLI revascularization. Current treatment strategies for CLI still remain controversial. Methods We performed a meta-analysis of all available randomized controlled trials and observational clinical studies comparing PVI with BSX in CLI patients. Primary endpoints included overall survival, amputation-free survival, 30-day mortality, and major adverse cardiovascular and cerebrovascular events. Results We identified 45 cohorts and 1 RCT in over 20,903 patients. In overall population, PVI reduced the risks of 30-day mortality [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.51-0.95), major adverse cardiovascular and cerebrovascular events (OR 0.42, 95% CI 0.29-0.61), and surgical site infection (OR 0.31, 95% CI 0.19-0.51), but increased the risks of long-term all-cause mortality [hazard ratio (HR) 1.16, 95% CI 1.05-1.27) and primary patency failure (HR 1.31, 95% CI 1.08-1.58). When compared with autogenous BSX, PVI was also associated with additional increased risks of long-term death or amputation (HR 1.41, 95% CI 1.02-1.94) and secondary patency failure (HR 1.51, 95% CI 1.17-1.95). In patients with infrapopliteal lesions, we found PVI had inferior primary patency (HR 1.39, 95% CI 1.10-1.75) compared with BSX. Conclusion For patients in good physical condition with long life-expectancy, BSX may represent a better choice compared with PVI, particularly when autogenous bypass is available. While enhanced perioperative care for cardiovascular events and surgical site should be considered in patients underwent BSX to achieve comparable short-term outcomes provided by PVI.

Background: Perioperative emotional disorders of patients underwent abdominal aortic aneurysm (AAA) repair is an emerging area of study, and preoperative mental distress of those patients remains poorly understood. The aim of this study was to investigate the prevalence and identify the risk factors of preoperative anxiety and depression in patients scheduled for AAA repair. Methods: A total of 189 patients who underwent elective AAA repair between 2015 and 2016 were included in this study. These patients were preoperatively evaluated by Hospital Anxiety and Depression Scale (HADS). Demographics and anxiety and depression scores of the patients were documented. Logistic regression was used to identify the independent risk factors of preoperative anxiety and depression. Results: A total of 150 AAA patients were included in final analysis. Of these 150 patients, 44 patients (29.3%) had borderline anxiety or clinical anxiety, and 42 patients (28.0%) were found to have borderline or clinical depression. Female (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.08–7.26), the American Society of Anesthesiologists (ASA) Grade 3/4 (OR: 4.34, 95% CI: 1.13–16.68), higher education (OR: 1.44, 95% CI: 1.02–2.04), and abdominal or back pain (OR: 3.08, 95% CI: 1.20–7.87) were identified as significant independent risk factors of abnormal HADS-anxiety in overall patients; and higher level of education (OR: 1.87, 95% CI: 1.16–3.01) was predictive of anxiety in patients planned for endovascular aortic repair. Besides, higher body mass index (BMI) (OR: 1.18, 95% CI: 1.04–1.33) and abdominal or back pain (OR: 3.93, 95% CI: 1.70–9.11) were predictive of abnormal preoperative HADS-depression in overall patients. Conclusion: As for patients scheduled for AAA repair, female, higher ASA, higher level of education, and symptom may be independent risk factors for preoperative anxiety, and symptom and higher BMI may predict preoperative depression. Key words: Abdominal Aortic Aneurysm; Anxiety; Depression; Preoperative Care; Risk Factors

BACKGROUND: Currently, peripherally inserted central catheters (PICCs) are widely used; however, there are associated problems due to catheter-related thrombosis (CRT). According to the existing literature and guidelines, 3–6 months of anticoagulation therapy is recommended, but these recommendations are based on analogous deep vein thrombosis of the lower limbs. More specific management strategies need to be developed, and the safety and effectiveness of these strategies needs to be investigated. METHODS: Some studies have suggested that catheter removal alone is a reasonable option, especially for patients with a higher risk of bleeding. We conducted a retrospective study of hospitalized patients from a single center who were diagnosed with PICC-related thrombosis. Among the 85 patients who met the inclusion criteria, 63 patients were treated with catheter removal alone, and 22 patients received anticoagulation therapy after catheter removal. The progression of thrombosis and bleeding in the two groups were compared. Most patients who underwent catheter removal alone had hematological malignancies, and thrombocytopenia had occurred during chemotherapy. RESULTS: After PICC removal, no patients in the anticoagulation therapy group developed progressive thrombosis, while 10 patients in the catheter removal alone group developed progressive thrombosis or pulmonary embolism (PE), including one case of PE, four cases of secondary upper extremity deep vein thrombosis (UEDVT), and five patients showed obvious aggravation of thrombosis after catheter removal, and were administered repeated anticoagulant therapy. In the PICC removal + anticoagulation treatment group, major bleeding increased significantly (28.6% vs. 4.7%, P=0.006). CONCLUSIONS: Compared to the PICC removal + anticoagulation treatment group, the risk of major bleeding in the catheter removal alone group was significantly reduced. In some patients with an increased bleeding risk, catheter removal alone may be a safer and more effective option than catheter removal with anticoagulation treatment for CRT.

Venous aneurysms, including portal vein aneurysms (PVAs), rarely are encountered in clinical practice. PVAs may be intrahepatic or extrahepatic, and their origin may be congenital or acquired. Acquired lesions are associated with liver disease, trauma, or degenerative changes. Methods of management of PVAs include observation, resection, thrombectomy, or portal venous decompression. This article reports the resection of a large saccular PVA that we speculate was due to degenerative changes.

Rationale: Venous thoracic outlet syndrome (VTOS) secondary to subclavian arterial stent implantation is extremely rare. Here, we firstly report this disease and the endovascular intervention using covered-stents. Patient concerns: An 80-year-old man who had received an acceptable stent implantation for the treatment of a right subclavian arteriovenous malformation (AVM), presented with a gradually increasing swelling and pain in his right upper extremity. Diagnosis: The patient was diagnosed with right VTOS and recurrent subclavian AVM following ultrasonography and computed tomographic angiography. Interventions: We positioned a covered-stent in the subclavian artery to block the feeding arteries and successfully embolized the remaining branches with coils. Next, we performed successful dilation 3 times, followed by the positioning of another covered-stent in the right subclavian vein. Outcomes: The patient was free of all symptoms and the imaging procedures confirmed an acceptable thrombosis of the AVM with patent stents in the right subclavian artery and vein during the 6-month follow-up. Lessons: Venous stent implantation is an alternative to treat VTOS caused by subclavian arterial stents and it is essential to pay more attention to the incidence of VTOS following arterial stent implantation in the subclavian artery.

Sir,We read with interest the article by setor K. Kunutsor and colleagues on issues with cardiorespiratory fitness and venous thromboembolism risk [1]. We commend the authors’ effort in the researc...

Anticoagulation-related nephropathy may be a frequently overlooked diagnosis. Currently, there are no specific guidelines for the identification and management of anticoagulation-related nephropathy, but this is an urgent matter because of the increasing number of diseases and patients requiring anticoagulant treatment. This article discussed the research progress and controversial topics of anticoagulation-related nephropathy, and this disease is valued which be paid attention to.

Backgrounds Carotid body tumors (CBTs) are rare neoplasms and some of them produce catecholamine. Although operations for catecholamine-producing CBTs are safe, the relationship between prognosis and endocrine function has not been analyzed before. Methods Patients diagnosed with CBTs in our department between 2009 and 2018 were analyzed. Plasma catecholamine was examined as a variable of surgical outcomes and prognosis by using statistical methods. Results Patients who suffered CBTs and underwent operations were divided into two groups according to their plasma catecholamine. Patients in the normal group had more or heavier surgical complications, such as neurological complications (P = .008) and blood loss (P = .03), than those in the high group. However, overall survival, local recurrence, and remote metastasis were not varied significantly in both groups. Conclusions A high level of plasma catecholamine was a predictor for the improved operative outcomes of CBTs. Hence, nonfunctional CBTs had further short-term surgical complications.

To review the various quality of life (QoL) scales specific for chronic venous diseases (CVDs) and provide guidance and a reference for researchers to select the ideal measurement scale before studying QoL in patients with CVDs. The EBSCO, Ovid, PubMed, Wanfang, and CNKI databases were searched for the keywords “vein,” “quality of life,” and “scale/questionnaire,” and various scales used to measure QoL in patients with CVDs. The QoL aspects were investigated and researched, and then, the search results were screened and summarized. A total of 10 major scales related to the QoL in patients with CVDs were included. The scales differed in dimension, reliability, validity, scoring method, evaluation method, and scope of application. The investigator should select the chronic venous disease QoL scale according to the research purpose and subjects, and then implement the scale to compare the specific aspects of QoL in patients with different CVDs.

Background Hemodialysis is a common treatment for end-stage renal disease, and maintenance of access patency remains a key issue. Angioplasty is recommended as the first choice for access stenosis, but it poses a risk of a high rate of restenosis. Stent graft placement can generate a high patency rate of dialysis access. This study aimed to compare the primary patency of the treatment area and access circuit between stent grafts and angioplasty in dialysis access failure. Materials and methods Three electronic databases, namely, PubMed, Cochrane Library of Systematic Reviews, and EMBASE, were searched from the database inception to September 2017 without language restriction. Randomized controlled trials comparing the primary patency of the treatment area and access circuit between stent graft and angioplasty were included. Two independent reviewers assessed the quality of the trials and extracted relevant data. Results Four trials satisfied our inclusion criteria. Our pooled results suggested that stent graft placement was associated with significantly higher primary patency of treatment area (hazard ratio: 0.65, 95% confidence interval: 0.55-0.77, P Conclusions The patency of hemodialysis access may be higher after stent graft placement combined with standard angioplasty than after angioplasty alone.