Abstract
The impact of COVID-19 disease on platelets and coagulation
GD Wool, JL Miller. Pathobiology 2021; 88: 15–27. doi: 10.1159/000512007.
The authors reviewed the impact of COVID-19 infection on platelets and coagulation. They reported that localized pulmonary platelet consumption, low grade disseminated intravascular coagulation (DIC), and thrombotic microangiopathy play a role in coagulopathy in infected patients. Sick patients are thrombocytopenic, however this is not a predictor of mortality. Patients are found to have elevated immature platelet fraction (IDF) together with increased activated platelets. This is associated with endothelial damage along with activation of the coagulation cascade as seen in COVID-19 pneumonia. Elevated von Willebrand Factor (vWF), group A blood type, elevated fibrinogen and D-dimer levels are associated with COVID-19 infected patients with activated and/or damaged endothelium.
The authors conclude that more data will be needed to better understand the best treatment options for these patients.
Central venous catheters are an important factor in paediatric thrombosis
M Biswas, PM Ryan, R Nakrani, M Bhatt, AKC Chan, T Mondal. Acta Paediatr 2021; 110: 1001–1008. doi: 10.1111/apa.15543.
The authors retrospectively reviewed patients aged 18 and under who were treated in a Canadian tertiary care center for arterial and venous thrombosis. They found the incidence of thrombosis was 52.2 per 10,000 admissions. Provoked thrombosis was found in 88.9%, unprovoked was 2.9%, and idiopathic was found in 4%. Fifty one percent were found in children under 2 years old. Risk factors include central venous catheterization (56.2%), trauma, oral contraceptives, infection, surgery, and malignancy. Acute arterial stroke was diagnosed in 11.1% and pulmonary embolism was found in 3 percent of patients. Low molecular weight heparin was the first line of therapy in 47.8%.
The authors concluded that central venous access increases the thrombosis risk in infants and children.
A postdischarge venous thromboembolism risk calculator for inflammatory bowel disease surgery
CJR Schlick, TK Yuce, AD Yang, MF McGee, DJ Bentrem, KY Bilimoria, RP Merkow. Surgery 2021; 169: 240–247. doi: 10.1016/j.surg.2020.09.006.
The authors studied patients who developed post discharge venous thromboembolism (VTE) within 30 days of surgery for inflammatory bowel disease. The following preoperative factors were found to be associated with VTE: body mass index >35, steroid use, and the diagnosis of ulcerative colitis. Minimally invasive surgery, anastomotic leak, and ileus were also associated with VTE post operatively.
The authors developed a postdischarge VTE risk calculator which allows for tailored extended chemoprophylaxis depending on individual risk.
Body dysmorphic disorder in patients with telangiectasias
JA Bravo, S Cifuentes, JH Ulloa, L Kabnick, A Pedazzoli, C Simkin, J Javier, F Santiago. Int Angiol 2021; 40: 19–22.
The authors, in a multicentric study, examined 223 Chronic Venous Disease (CVD) patients with telangiectasias seeking treatment. Some CVD patients have a minimal degree of telangiectasias and in spite of successful treatment of them, the patients may insist on continuing treatment, focusing excessive attention on what they perceive to be persistent telangiectasias that, in their opinion, must be removed. The Body Dysmorphic Disorder (BDD) Questionnaire was answered and then evaluated according to the Diagnostic Statistical Manual of Mental Disorders criteria for BDD. The authors found the prevalence of BDD in patients with telangiectasias to be 17%.
The authors conclude that these telangiectasias can be a stress that triggers the way patients perceive their appearance. Furthermore, the authors suggest that referral to a psychiatrist for assessment should be done prior to initiating any treatment.
The symptoms-varices-pathophysiology (SVP) classification of pelvic venous disorders a report of the American vein and lymphatic society international working group on pelvic venous disorders
MH Meissner, NM Khilnani, N Labropoulos, AP Gasparis, K Gibson, M Greiner, LA Learman, D Atashroo, F Lurie, MA Passman, A Basile, Z Lazarshvilli, J Lohr, MD Kim, PH Nicolini, WM Pabon-Ramos, M Rosenblatt. J Vasc Surg Venous Lymphat Disord 2021 Jan 30; S2213-333X(21)00071-8.
The American Vein and Lymphatic Society selected a multidisciplinary group charged with the development of a discriminative classification instrument for pelvic venous disease (PeVD). Misleading historical nomenclature, such as the “May-Thurner,” “pelvic congestion,” and “nutcracker” syndromes, often fails to recognize the interrelationship of many pelvic symptoms and their underlying pathophysiology This instrument, the “SVP” classification, includes 3 domains - Symptoms (S), Varices (V), and Pathophysiology (P), with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H), and Etiologic (E) features of the patient's disease to create a reliable classification instrument; an individual patient's classification is designated as SVPA, H, E. For patients with pelvic origin lower extremity signs or symptoms, the SVP instrument is complementary to and should be used in conjunction with CEAP.
The authors believe and concluded that the SVP instrument accurately defines the diverse patient populations with PeVD, and is an important step in improving clinical decision making, developing disease-specific outcome measures, and identifying homogenous patient populations for clinical trials.
Non-invasive capillary blood pressure measurement enabling early detection and classification of venous congestion
J Liu, B Yan, SC Chen, Y Zhang, C Sodini, N Zhao. IEEE J Biomed Health Inform 2021. Epub ahead of print, doi: 10.1109/JBHI.2021.3055760.
Capillary blood pressure (CBP) is the primary driving force for fluid exchange across microvessels. Subclinical systemic venous congestion prior to overt peripheral edema can directly result in elevated peripheral CBP. Therefore, CBP measurements can enable timely edema control in a variety of clinical cases including venous insufficiency, heart failure, and so on. Currently, CBP measurements can be only done invasively and with a complicated experimental setup. In this work, the authors proposed an opto-mechanical system to achieve non-invasive and automatic CBP measurements through modifying the widely implemented oscillometric technique in home-use arterial blood pressure monitors. The proposed CBP system is featured with a blue light photoplethysmography sensor embedded in finger/toe cuffs to probe skin capillary pulsations. The experimental results demonstrated the proposed CBP system can track local CBP changes induced by different levels of venous congestion. Leveraging the decision tree technique, the authors demonstrate the use of a multi-site CBP measurement at fingertips and toes to classify four categories of subjects (total N = 40) including patients with peripheral arterial disease, varicose veins, and heart failure.
The authors conclude that their work demonstrates the promising non-invasive CBP measurement as well as its great potential in realizing point-of-care systems for the management of cardiovascular diseases.
Duplex ultrasound investigation for the detection of obstructed iliocaval venous stents
T Sebastian, S Barco, RP Engelberger, D Spirk, M Schindewolf, F Baumann, I Baumgartner, N Kucher. Eur J Vasc Endovasc Surg 2020; 60: 443–450.
The authors aimed to develop criteria for routine surveillance of iliocaval vein stents, as duplex ultrasound (DUS) visualization is often tricky and criteria for detecting venous stent obstruction (VSO) have not been clearly defined to date. A nested case control study of 120 patients (42 ± 17 years, 53% women, mean 2.7 ± 1.8 stents) was performed, and the performance of various duplex parameters for detecting VSO (defined as >50% lumen diameter reduction or occlusion) was tested, confirmed by biplane venography or intravascular ultrasound (IVUS). 40 patients with VSO (25 with stent occlusion, 15 with >50% in stent stenosis) were matched to 80 control patients by age, gender, and index diagnosis who fulfilled the following criteria: (1) ongoing symptom control (Villalta score <5), (2) good image quality of entire stent segment, (3) spontaneous color Doppler signal >50% of lumen in entire stent segment, (4) at least 2 DUS where the baseline DUS was obtained within 24 h after successful venous intervention. The superior test was the combination of peak flow velocity and flow pattern analysis at the stent inlet. A peak flow velocity >10 cm/s and a flow pattern spontaneously modulated by respiration ruled out VSO with a specificity of 93.7% (95% CI 86.0%–97.3%). A peak flow velocity ≤10 cm/s or any Doppler flow pattern other than spontaneously modulated by respiration was 92.1% (95% CI 79.2%–97.3%) sensitive to detect VSO.
The authors concluded that the combination of peak flow velocity and analysis of Doppler flow pattern at the stent inlet is accurate to diagnose or rule out stent occlusion; however, indirect criteria should always be coupled with direct visualization of iliocaval stents since those may be less sensitive for detecting stent stenosis.
Influence of body mass index (BMI), age and gender on stages of varicose vein in newly diagnosed cases following screening Doppler in outpatient clinic
B Shrestha, RM Karmacharya. Kathmandu Univ Med J (KUMJ) 2020; 18: 28–31.
In a one-year, 108 patient (135 lower extremity) cross sectional hospital-based study, the authors conducted a limited registry review to understand how Body Mass Index, Age, and Gender influence staging of varicose veins. Patients with signs and symptoms of varicose veins were included. Male:Female ratio was 1.4:1. Mean age of patients was 44.47 ± 12.65 (17–81) years. Significant correlation was found between increasing age and progression in Clinical staging of varicose veins according to Clinical classification (p < 0.05). Mean Great Saphenous Vein diameter at the knee was found significantly higher in patients with more than five years of symptoms. Mean Body Mass Index was not different in different Clinical stages of varicose veins.
The authors concluded that this study showed that the Clinical Staging (CEAP) of varicose veins is significantly related to age. The mean diameter of Great Saphenous Vein at the level of knee is significantly related to the duration of symptoms. However, the influence of Body Mass Index and gender on stages of varicose veins could not be established.