Epidemiology and Risk Factors of Portal Venous System Thrombosis in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

BackgroundPatients with inflammatory bowel disease (IBD) may be at risk of developing portal venous system thrombosis (PVST) with worse outcomes. This study aims to explore the prevalence, incidence, and risk factors of PVST among patients with IBD.MethodsPubMed, Embase, and Cochrane Library databases were searched. All the eligible studies were divided according to the history of colorectal surgery. Only the prevalence of PVST in patients with IBD was pooled if the history of colorectal surgery was unclear. The incidence of PVST in patients with IBD after colorectal surgery was pooled if the history of colorectal surgery was clear. Prevalence, incidence, and risk factors of PVST were pooled by only a random-effects model. Subgroup analyses were performed in patients undergoing imaging examinations. Odds ratios (ORs) with 95% CIs were calculated.ResultsA total of 36 studies with 143,659 patients with IBD were included. Among the studies where the history of colorectal surgery was unclear, the prevalence of PVST was 0.99, 1.45, and 0.40% in ulcerative colitis (UC), Crohn's disease (CD), and unclassified IBD, respectively. Among the studies where all the patients underwent colorectal surgery, the incidence of PVST was 6.95, 2.55, and 3.95% in UC, CD, and unclassified IBD after colorectal surgery, respectively. Both the prevalence and incidence of PVST became higher in patients with IBD undergoing imaging examinations. Preoperative corticosteroids therapy (OR = 3.112, 95% CI: 1.017–9.525; p = 0.047) and urgent surgery (OR = 1.799, 95% CI: 1.079–2.998; p = 0.024) are significant risk factors of PVST in patients with IBD after colorectal surgery. The mortality of patients with IBD with PVST after colorectal surgery was 4.31% (34/789).ConclusionPVST is not rare, but potentially lethal in patients with IBD after colorectal surgery. More severe IBD, indicated by preoperative corticosteroids and urgent surgery, is associated with a higher risk of PVST after colorectal surgery. Therefore, screening for PVST by imaging examinations and antithrombotic prophylaxis in high-risk patients should be actively considered.Systematic Review RegistrationRegistered on PROSPERO, Identifier: CRD42020159579.

Features of morphometric parameters of vessels in the human portal venous system identified by multislice computed tomography

The aim of this study was to identify the morphometric features of the human portal venous system by means of multislice computed tomography (MSCT).Materials and methods. A contrast X-ray study of the portal vein was carried out in 53 men who were treated in the surgical departments of the Krasnoyarsk Regional Hospital No. 1. The average age of the patients was 54.9 ± 1.7 years (36–71 years). Measurements were performed on 3D models of the vascular bed in the portal venous system (GE Advantage Workstation and Siemens singo.via workstations). Branching patterns, length, diameter, angle of the portal vein formation relative to the midline of the human body, and angles of formation of the vessels forming the portal vein in the frontal plane were evaluated.Results. Variations in the morphometric parameters of the intrahepatic vessels of the portal vein are obvious, although the branching patterns are not diverse and are reduced to one type – the magistral pattern (according to V.N. Shevkunenko). The veins that form the portal vein are represented by three systems, each of which has a stem and tributaries that differ in branching patterns and other morphological characteristics.Conclusion. The findings of the study made it possible to supplement the scientific materials regarding branching patterns and morphological characteristics of the portal vein and its tributaries as well as to use the morphometric characteristics of the superior and inferior mesenteric and splenic veins to resolve the issues of surgical intervention on the abdominal organs.

Catheter Ablation of Ventricular Arrhythmias Originating From the Region of DGCV-AIV via a Swartz Sheath Support Approach

Aims: This study aimed to investigate an appropriate catheter manipulation approach for ventricular arrhythmias (VAs) originating from the left ventricular epicardium adjacent to the transitional area from the great cardiac vein to the anterior interventricular vein (DGCV-AIV).Methods: A total of 123 patients with DGCV-AIV VAs were retrospectively analyzed. All these patients underwent routine mapping and ablation by conventional approach [Non-Swartz sheath support (NS) approach] firstly. In the situation of the distal portion of the coronary venous system (CVS) not being accessed or a good target site not being obtained, the Swartz sheath support (SS) approach was attempted alternatively. If this still failed, the hydrophilic coated guidewire and left coronary angiographic catheter-guided deep engagement of Swartz sheath in GCV to support ablation catheter was performed.Results: A total of 103 VAs (103/123, 83.74%) were successfully eliminated in DGCV-AIV. By NS approach, the tip of the catheter reached DGCV in 39.84% VAs (49/123), reached target sites in 35.87% VAs (44/123), and achieved successful ablation in 30.89% VAs (38/123), which was significantly lower than by SS approach (88.61% (70/79), 84.81 % (67/79), and 75.95% (60/79), P < 0.05). There were no significant differences in complication occurrence between the NS approach and the SS approach (4/123, 3.25% vs. 7/79, 8.86%, p > 0.05). The angle between DGCV and AIV <83° indicated an inaccessible AIV by catheter tip with a predictive value of 94.5%. Width/height of coronary venous system>0.69 more favored a SS approach with a predictive value of 87%.Conclusion: For radiofrequency catheter ablation (RFCA) of VAs arising from DGCV-AIV, the SS approach facilitates the catheter tip to achieve target sites and contributes to a successful ablation.

Cerebral Venous Thrombosis: A Challenging Diagnosis. A New Nonenhanced Computed Tomography Standardized Semi-Quantitative Method

Cerebral venous sinus thrombosis (CVST) on non-contrast CT (NCCT) is often challenging to detect. We retrospectively selected 41 children and 36 adults with confirmed CVST and two age-matched control groups with comparable initial symptoms. We evaluated NCCT placing four small circular ROIs in standardized regions of the cerebral dural venous system. The mean and maximum HU values were considered from each ROI, and the relative percentage variations were calculated (mean % variation and maximum % variation). We compared the highest measured value to the remaining three HU values through an ad-hoc formula based on the assumption that the thrombosed sinus has higher attenuation compared with the healthy sinuses. Percentage variations were employed to reflect how the attenuation of the thrombosed sinus deviates from the unaffected counterparts. The attenuation of the affected sinus was increased in patients with CVST, and consequently both the mean % and maximum % variations were increased. A mean % variation value of 12.97 and a maximum % variation value of 10.14 were found to be useful to distinguish patients with CVST from healthy subjects, with high sensitivity and specificity. Increased densitometric values were present in the site of venous thrombosis. A systematic, blind evaluation of the brain venous system can assist radiologists in identifying patients who need or do not need further imaging.

SELECTION OF SURGICAL TACTICS FOR TREATMENT OF NON-APHENIC VARICOSIS ON THE RESULTS OF US-DIAGNOSTICS OF THE VENES OF THE LOWER LIMBS

Purpose of research. Determination of variants of the anatomical structure of non-saaphenic veins and pathological anastomoses in varicose enlargement of atypical venous basins with ultrasound Doppler of the veins of the lower extremities, including as sources of pathological venous reflux, as well as the importance of insolvent veins — perforants and non-saaphenic veins — in the formation of venous insufficiency to clarify the treatment protocol. Materials and methods. The venous system was studied in 2348 pa tients, including both patients with various pathologies of the venous system, including those with varicose veins, and those in whom the pathology of the veins was not detected by Doppler ultrasound. Research results and discussion. Surgical treatment for non-safenic varicose veins includes phlebectomy, sclerotherapy and Muller-Vara di minifblektomy, depending on the diameter of the affected nonsafenic vein. Conclusions. The specialists’ understanding of the variants of nonsafenic varicose veins, as well as adherence to the full research protocol for ultrasound Doppler ultrasound of the veins, allows us to provide detailed information in order to determine the most effective treatment tactics and prevention of relapses and complications of the disease.