ObjectiveTo evaluate the CT findings and causes of thrombosis formation after transjugular intrahepatic portosystemic shunt (TIPS). MethodsOne hundred forty-two patients with cirrhosis after TIPS were included. The imaging features of thrombus in the stent after TIPS were recorded and causes of thrombosis formation were analyzed. The presence, location and amount of thrombus, the location of ends of TIPS stent were analyzed. ResultsThe incidence of thrombosis formation after TIPS was 19.0% (27/142). The thrombus could locate around the upper end (7.4%), lower end (18.6%) of the stent and inside the stent (74.0%), there was significant differences in the incidence of stent thrombosis in different locations (P < 0.05). The thrombus might presented as little mural thrombus (12/27, 44.4%), marked thrombus (3/27, 11.1%) and thrombotic occlusion (12/27, 44.4%), there was a significant difference in the incidence of stent thrombosis with different thrombus volume (P < 0.05). There were stent outlet vascular stenosis in most patients with stent thrombosis (88.9%). ConclusionsStent thrombosis after TIPS is common. Dual source computed tomography angiography could evaluate the thrombotic features. Stent outlet vascular stenosis might be associated with thrombosis formation after TIPS.
Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on acute superior mesenteric vein thrombosis. Methods The treatment and therapeutic efficacy of 7 cases of acute superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis under ultrasound guidance from August 2005 to April 2009 were analyzed. Results All the patients succeeded in portal vein catheterization and no bile leakage or abdominal bleeding occurred during the procedure. The clinical symptoms such as abdominal pain, abdominal distension， and passing bloody stool relieved were relieved and liquid diet began at postoperative of day 2-5. Emergency operation was done in one case and there was no intestinal fistula. The angiography after the operation showed that the majority of thrombosis were cleared and the blood of portal vein and superior mesenteric vein flowed smoothly. During the follow-up of 3 months to 3 years, all the patients’ status maintained well and no recurrence occurred. Conclusion Treatment of acute superior mesenteric vein thrombosis by percutaneous transhepatic portal vein thrombolysis is safe and effective.
ObjectiveTo analyze the clinical and immunological characteristics of 26 patients with antiphospholipid syndrome (APS). MethodsThe clinical and immunological features of APS in 26 patients treated between January 2009 and January 2012 were analyzed retrospectively. ResultsThe study consisted of 8 male and 18 female patients with a mean age of 38 years at diagnosis. Seven patients had primary APS. Nineteen patients had APS associated with autoimmune diseases, including 11 cases of systemic lupus erythematosus. Seventy-five percent of the patients had thrombosis, 16 had venous thrombosis, 7 had arterial thrombosis, and 2 had both arterial and venous thrombosis. The deep veins of the lower limbs and the cerebral arterial circulation were the most common sites of venous and arterial thrombosis. Fetal morbidity rate of 16 married women in our study was 43.8%. Thrombocytopenia and anemia were present in 57.7% and 69.2% of the patients respectively. ConclusionAPS is characterized by recurrent thrombosis, pregnancy morbidity and positive antiphospholipid antibodies tests. Early diagnosis and management is essential for APS.
ObjectiveTo explore the value of portable ultrasound in assessing peripheral vein thrombosis of the injured in Lushan earthquake on April 20, 2013. MethodsFrom April 20th to May 5th in 2013, 321 earthquake victims were admitted into our hospital, and 203 fractured patients of them accepted peripheral venous two-dimensional and color doppler ultrasound examination beside the bed every three days. ResultsSixty-three patients (82 locations) suffered from venous thrombosis in the 203 earthquake victims, and the rate was 31.03% (63/203). Among them, one suffered from iliac vein thrombosis; 53 patients (71 limbs) were attacked by lower limb venous thrombosis; 9 patients (10 limbs) suffered from upper limb venous thrombosis. The time was from 2 to 15 days after trauma when the victims were diagnosed to have thrombus at the first time, averaging (6.1±3.8) days. On admission day, 45 victims were diagnosed with peripheral vein thrombosis. Among them, 19 patients increased the scope of thrombus after admission in hospital, while 26 victims reduced the scope. Eighteen victims suffered from newly developed peripheral venous thrombus after admission in hospital. None of the hospitalized patients died of pulmonary embolism. ConclusionsThe victims injured in the earthquake have a high incidence of peripheral vein thrombosis, and the calf is the main site of the disease. After trauma, peripheral venous thrombosis occurs within a short time. Bedside portable ultrasound is the first choice for peripheral vein thrombosis in the earthquake victims.
Objective To optimize the hemodynamics of a disk blood pump in children. Method We used the computational fluid dynamics technology to simulate the flow in a pediatric blood pump numerically, and finally analyzed the results for deep study about the thrombosis and hemolysis produced in it, to improve the design according to the results of the flow field analysis. Results We calculated results between the flow rate and the pressure elevation at different rotational speed: 2 500 rpm, 3 000 rpm, and 4 000 rpm, respectively. Under each rotational speed, it was selected five different discharge outlet boundary conditions. The simulation results conformed to the experimental data. The increased pressure of the blood pump was effective. But the phenomenon of flow separation was increased the at blade surface in the low speed region. The maximum wall shear stress was maintained within 100 Pa. Conclusion The design of disc blood pump has a good fluid dynamic performance. And the flow line is fluent, the probability of thrombosis and hemolysis occurred is in the range of control. But the phenomenon of flow separation is appeared. There is a room to improve.
ObjectiveTo analyze the reason and prevention of late bioprosthetic heart valve thrombosis (LBVT). MethodsBioprosthetic heart valves were implanted in 580 patients between January 2001 and July 2013 in Changhai Hospital, and only found one case of LBVT (0.2%). Reoperation was performed for a 67-year-old male patient 3 years after bioprosthetic aortic valve replacement due to severe aortic valve stenosis. Retrospectively analyzed the clinical data and reviewed the literature between January 1989 and December 2013 in Pubmed. ResultsNo risk factor for thrombosis was revealed in this patient. Pathology revealed valve thrombosis and collagen and elastic fibers fragmentation and disruption in valve leaflets. In literature review, 20 articles and 47 cases were brought in. The morbidity of LBVT was 0.2%-1.0%. At least 18 patients had high risk factors, and 15 of the 18 patients discontinued anticoagulation after 3 months. However, at least 10 patients had no high risk factors. Forty-four of the 47 patients received stented porcine valve replacement, only one patient received stented bovine pericardial valve replacement. ConclusionsLBVT is a rare but serious complication after bioprosthetic valve replacement, the causes of which include the feature of the patients and the bioprosthetic valves. Bovine pericardial valves could be superior to porcine valves in preventing LBVT. Postoperative long-time aspirin therapy is recommended for patients without high risk factors. Patients with any high risk factors should prolong anticoagulation.
ObjectiveTo investigate therapeutic method, curative effect, and prognosis of inferior vena cava (IVC) blocking Budd-Chiari syndrome (BCS) with thrombosis. MethodsClinical data of 128 BCS patients with membranous or short-segment occlusion of IVC as well as IVC thrombosis, who accepted interventional treatment in The Affiliated Hospital of Zhengzhou University from Apr. 2004 to Jun. 2012, were retrospectively analyzed. Comparison of the difference on effect indicators between predilation group and stent filter group was performed. ResultsThereinto, 9 patients with fresh IVC thrombosis were treated with agitation thrombolysis (agitation thrombolysis group), 56 patients were predilated by small balloon (predilation group), for the rest 63 patients, a stent filter was deployed (stent filter group). Besides 1 stent filter fractured during the first removal attempt and had to be extracted surgically in the stent filter group (patients suffered with sent migration), in addition, the surgeries of other patients were technically successful without procedure-related complication. effect indicators were satisfactory in all patients, and there were no statistical differences between predilation group and stent filter group in dosage of urokinase, urokinase thrombolysis time, hospital stay, and incidence of complication (P > 0.05), but the cost of predilation group was lower than that of stent filter group (P < 0.01). All of the 128 patients were followed-up postoperation, and the duration range from 18 to 66 months with an average of 44.2 months. During the follow-up period, reobstruction of the IVC was observed in 13 patients without thrombosis, of which 1 patient in agitation thrombolysis group, 6 patients in predilation group, and 6 patients in stent filter group. There was no significant difference in recurrence rate between predilation group and stent filter group (P > 0.05). Patients with recurrence got re-expansion treatment, and no stenosis or thrombogenesis recurred. ConclusionsAgitation thrombolysis for fresh IVC trombosis in the patients with BCS is safe and effective. Predilation and stent filter techniques are all effective in the treatment of BCS with chronic IVC thrombosis, but the former technique seems to be more economic.
Objective To explore the relationship between the structure and function of galectin-3， lipid metabolism disorders， and investigate the expression of galectin-3 in the occurrence and progress of lower limb arteriosclerosis block disease. Methods Related articles were reviewed. Results Galectin-3 participates in inflammatory reaction and lipid metabolism disorders， regulates the cell growth， differentiation， adhesion， apoptosis， and angiogenesis， and palys a role in the occurrence and progress of arteriosclerosis obliterans. Conclusion Galectin-3 is correlation with the occurrence， progress， and the prognosis of arteriosclerosis obliterans.
Objective To systematically review the correlation of activated partial thromboplastin time (APTT) and prognosis after ECMO treatment. Methods The PubMed, EMbase, MEDLINE, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on the correlation of APTT and prognosis after ECMO treatment from database inception to April 11th, 2022. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 22 studies, involving 2 913 patients were included. The level of APTT in the bleeding group was higher than that in the non-bleeding group during ECMO support treatment (MD=10.34, 95%CI 1.32 to 19.37, P=0.02). The APTT level in the thrombus group was lower than that in the non-thrombus group (MD=?3.58, 95%CI ?5.89 to ?1.27, P=0.002). The level of APTT in the death group was significantly higher than that in the survival group (MD=8.97, 95%CI 5.89 to 12.06, P<0.00001). Conclusion The APTT level of ECMO patients is closely related to the prognosis of bleeding, thrombosis and death. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.
The International Society on Thrombosis and Hemostasis (ISTH) recently released the first ISTH guideline for antithrombotic treatment of COVID-19, which provides recommendations on anticoagulant and antiplatelet agents for patients with COVID-19 in different clinical settings. The target audience includes clinicians in internal medicine, intensive care, infectious diseases, hematology, vascular medicine, residents, family physicians, and other health care providers providing inpatient or outpatient care to COVID-19 patients. This article interprets the important parts of ISTH guideline.