Diosmin Alleviates Venous Injury and Muscle Damage in a Mouse Model of Iliac Vein Stenosis

Chronic venous disease (CVD) is a progressive inflammatory disease that increases in prevalence with age. Elucidating the underlying molecular mechanism of CVD development is essential for disease prevention and treatment. This study constructed a mouse model of iliac vein stenosis to explore the mechanism of the CVD disease progression, and diosmin was administered as a positive control (as recommended by clinical practice). The mouse model was established successfully with iliac vein stenosis, leading to the expansion of the intercellular space and venous leakage. Conversely, micronized diosmin showed a dose-dependent therapeutic effect for these manifestations. Concerning the mechanism, iliac vein stenosis caused an inflammatory response in veins, while diosmin suppressed this increase. Furthermore, RNA sequencing analysis indicated that diosmin significantly improved muscle function through actin filament organization and muscle contraction. These results indicated that the mouse model of iliac vein stenosis is a reliable model to study venous diseases. Furthermore, the dose-dependent therapeutic effect of diosmin on stenosis (without toxic side-effects) suggests greater protection against venous diseases at higher doses of diosmin.

Prevalence and outcome of abdominal vascular injury in severe trauma patients based on a TraumaRegister DGU international registry analysis

This study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma based on a large registry of trauma patients. The impact of arterial, venous and mixed vascular injuries on patients’ outcome was of interest, as in particular the relevance of venous vessel injury may be underestimated and not adequately assessed in literature so far. All patients of TraumaRegister DGU with the following criteria were included: online documentation of european trauma centers, age 16–85 years, presence of abdominal vascular injury and Abbreviated Injury Scale (AIS) ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries. Reporting in this study adheres to the STROBE criteria. A total of 2949 patients were included. All types of abdominal vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n = 606, 33%) and venous injury alone (n = 95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10–1.98, p = 0.010). Abdominal arterial and venous injury in patients suffering from severe trauma were associated with a comparable rate of hemodynamic instability at the time of admission. 24 h as well as in-hospital mortality rate were similar in in patients with venous injury and arterial injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible subtle venous injury.

Neutrophil Enzyme Myeloperoxidase Modulates Neuronal Response in a Model of Subarachnoid Hemorrhage by Venous Injury

Background and Purpose: Aneurysmal subarachnoid hemorrhage (SAH) is associated with the development of delayed cognitive deficits. Neutrophil infiltration into the central nervous system is linked to the development of these deficits after SAH. It is however unclear how neutrophil activity influences central nervous system function in SAH. The present project aims to elucidate which neutrophil factors mediate central nervous system injury and cognitive deficits after SAH. Methods: Using a murine model of SAH and mice deficient in neutrophil effector functions, we determined which neutrophil effector function is critical to the development of deficits after SAH. In vivo and in vitro techniques were used to investigate possible pathways of neutrophils effect after SAH. Results: Our results show that mice lacking functional MPO (myeloperoxidase), a neutrophil enzyme, lack both the meningeal neutrophil infiltration (wild type, sham 872 cells/meninges versus SAH 3047, P =0.023; myeloperoxidase knockout [MPOKO], sham 1677 versus SAH 1636, P =NS) and erase the cognitive deficits on Barnes maze associated with SAH (MPOKO sham versus SAH, P =NS). The reintroduction of biologically active MPO, and its substrate hydrogen peroxide (H 2 O 2 ), to the cerebrospinal fluid of MPOKO mice at the time of hemorrhage restores the spatial memory deficit observed after SAH (time to goal box MPOKO sham versus MPOKO+MPO/H 2 O 2 , P =0.001). We find evidence of changes in neurons, astrocytes, and microglia with MPO/H 2 O 2 suggesting the effect of MPO may have complex interactions with many cell types. Neurons exposed to MPO/H 2 O 2 show decreased calcium activity at baseline and after stimulation with potassium chloride. Although astrocytes and microglia are affected, changes seen in astrocytes are most consistent with inflammatory changes that likely affect neurons. Conclusions: These results implicate MPO as a mediator of neuronal dysfunction in SAH through its effect on both neurons and glia. These results show that, in SAH, the activity of innate immune cells in the meninges modulates the activity and function of the underlying brain tissue.

TP5.2.10 Ligation Versus Repair of Isolated Traumatic Peripheral Deep Venous Injury: A Systematic Review And Meta-analysis

Optimal management of isolated peripheral deep venous injuries remain controversial with no clear evidence based guidelines on repair vs ligation. We aimed to compare the morbidity and mortality after venous reconstruction versus ligation of isolated peripheral venous injuries in patients with trauma. Methods We conducted systematic review and meta-analysis of all literature reported on management of isolated vascular injuries in adult trauma patients excluding case reports from 1950 to 2020. Primary outcomes of interest were mortality and amputation while secondary outcomes of interest were compartment syndrome, chronic venous hypertension, deep venous thrombosis and pulmonary embolism. Pubmed, Google Scholar, Cochrane database and Web of Science were searched for relevant literature. Study selection and sysnthesis was done following PRSMA Guidelines. Protocol was registered with PRSPERO (Registration Number: CRD42019143136). Results A total of 25 studies met our selection criteria and reported at least one of outcomes of interest. All the data is from observational studies with mostly retrospective data collection. Results of our meta-analysis show that ligation is significantly associated with higher rate of amputations [OR: 1.73 (1.20 – 2.48), p = 0.003] and mortality [OR: 1.5 (1.09 – 2.06), p = 0.01] whereas there is no significant difference in rate of chronic venous insufficiency, deep venous thrombosis and pulmonary embolism. There is not sufficient data to analyze various types of repair. Also data is lacking to account for clinical severity at time of presentation. Conclusion Our results favor repair over ligation of isolated peripheral deep venous injury.

Case study on Deep Vein Thrombosis with its Systemic management

Deep vein thrombosis commonly known as DVT has globally about 1–2 per 1000 population cases. The rate of Mortality is high; About 6% death cases occurs within primary 30 days of DVT by the primarily through pulmonary embolism, and also about 13% of patients with the pulmonary embolism. Among treated patients, about 20–50% develop post-thrombotic syndrome (PTS) after DVT, and 3% develop chronic thromboembolic pulmonary hypertension after pulmonary embolism.3,4 After 3–6 months of anticoagulation, VTE recurs in up to 40% of patients within 10 years. The risk of recurrence is two- to threefold higher after unprovoked than provoked VTE. Deep Vein thrombosis (DVT) is a life-threatening condition which may lead to sudden death as an immediate complication due to formation of thrombo-embolism. DVT is associated with various risk factors such as prolonged immobilization, inflammation, and/or coagulation disorders including muscular or venous injury. Deep venous thrombosis (DVT) frequently occurs in the lower limb. Successful treatment of DVT exclusively by the use of the different remedies has rarely been recorded in peer-reviewed journals. The present case report intends to record yet another case of DVT in a patient cured exclusively Since this report is based on a single case of recovery, results of more such cases are warranted to strengthen the outcome of the present study.

Endovascular treatment of traumatic azygous vein injuries: a case report

Background Management of thoracic vascular injury predominantly focuses on the aorta and its tributaries while reports of venous injury are less frequent. Although rare, traumatic azygous vein injuries are associated with high mortality. Prompt treatment is required and has traditionally been open surgery. We present a case of an endovascular repair of an azygous vein injury. Case presentation A female patient presented to our trauma center following ejection after a motor vehicle collision (MVC). CT imaging workup revealed mediastinal and periaortic hematoma with active contrast extravasation adjacent to the azygos vein. She was referred to interventional radiology for vascular evaluation and potential endovascular intervention. The patient met criteria for class III hypovolemic shock upon arrival in the endovascular suite. Aortography demonstrated no arterial injury. Venography revealed a pseudoaneurysm on the superior aspect of the azygos arch and contrast extravasation from the inferior margin of the azygous arch. A stent-graft was deployed and post-deployment venogram showed no extravasation and successful exclusion of the injuries. The patient did not have further signs of bleeding. She left the interventional suite with improved vital signs, yet her condition remained guarded. Follow-up CT chest confirmed continued patency of the stent-graft at 8 days and 2 years post-procedure. Conclusion Historically, azygos vein injuries are a rare occurrence and managed with open surgery. Swift management is necessary to prevent the increased morbidity and mortality associated with azygous vein injury, particularly in polytrauma patients such as the one presented here. We believe endovascular stent-graft treatment offers an innovative alternative to the current standard of operative management of azygos vein injury.

Prevalence and Outcome of Abdominal Vascular Injury in Severe Trauma Patients – An International Registry Analysis

BackgroundThis study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma.Patients and methodsAll patients of TraumaRegister DGU® with following criteria were included: online documentation of European trauma centers, age 16-85 years, presence of abdominal vascular injury, and AIS ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries.ResultsA total of 2949 patients were included. All types of vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n= 606, 33%) and venous injury alone (n=95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10-1.98, p=0.010).ConclusionAbdominal arterial injury and venous injury were equally responsible for the rate of hemodynamic instability at the time of admission. However, the proportion of adverse outcome during hospital stay was significantly higher in patients with venous injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible retroperitoneal hematoma caused by subtle venous injury.

Prevalence and Outcome of Abdominal Vascular Injury in Severe Trauma Patients – An International Registry Analysis

BackgroundAbdominal vascular injuries and the resulting hemorrhagic shock are still one of the main causes of death in trauma patients. This study details the etiology, frequency and effect of major vessel lesions of the abdomen in patients after polytrauma.Patients and methodsAll patients of TraumaRegister DGU® who met the following criteria were included: online documentation of European trauma centers, age 16-85 years, presence of abdominal vascular injury, and AIS ≥ 3. Patients were divided in three groups based on the type of vessel injuries: arterial injury only, venous injury only, mixed arterial and venous injuries.ResultsA total of 2949 patients met the inclusion criteria. A blunt mechanism of abdominal vascular injuries was more frequent in all three groups. All types of vessel injuries were more prevalent in patients with relevant abdominal trauma followed by relevant thoracic trauma. On admission to hospital the rate of patients with shock were the same in patients with arterial injury alone (n= 606, 33%) and venous injury alone (n=95, 32%). Patients with venous injury alone or together with arterial injuries had higher early (within first 24h) mortality rates (isolated arterial injury OR: 1.31; 95%, CI 1.14-1.50, p<0.001; isolated venous injury OR: 1.48; 95%, CI 1.10-1.98, p=0.010) and also in-hospital mortality.ConclusionAbdominal arterial injury and venous injury were equally responsible for the rate of hemodynamic instability at the time of admission. However, the proportion of adverse outcome during hospital stay was significantly higher in patients with venous injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible retroperitoneal hematoma caused by subtle venous injury.