Impaired fibrinolytic system in ApoE gene-deleted mice with hyperlipidemia augments deep vein thrombosis.

Background: Hyperlipidemia increases the level of blood plasminogen activator inhibitor-1 (PAI-1) that is responsible for regulating fibrinolysis by inhibiting both urokinase-type plasminogen activator (u-PA) and tissue-type plasminogen activator (t-PA). While this fibrinolytic pathway is well known, the role of PAI-1 in venous thrombosis (VT) under hyperlipidemic conditions has not been fully established. We sought to determine the effects of PAI-1 in an in vivo hyperlipidemic model of VT.

The effect of increased hip flexion using stirrups on lower-extremity venous flow: a prospective observational study.

Background: Patient positioning during surgeries for colorectal cancer may represent an unrecognized risk factor for deep venous thrombosis.

Methods: Twelve healthy control patients were positioned supine with knee flexion at 90°. Duplex ultrasound examined common femoral vein (CFV) and proximal femoral vein diameter, peak systolic velocity, and volume flow with hip flexion at 0°, 30°, 60°, and 90°.

Evaluation of soluble P-selectin as a marker for the diagnosis of deep venous thrombosis.

Objective: The combination of D-dimer and Wells score can exclude, but not confirm, the diagnosis of deep venous thrombosis (DVT). Since thrombosis and inflammation are interrelated, we evaluated the combination of soluble P-selectin (sPsel) with other inflammatory biomarkers for the diagnosis of DVT.

Methods: Sixty-two positive and one hundred and sixteen patients with negative DVT, by duplex scan, were prospectively evaluated for sPsel, D-dimer, C-reactive protein (CRP), microparticles (MPs; total, leukocyte, and platelet-derived and tissue factor positive microparticles), and clinical Wells score.

Racial disparities in the use of revascularization before leg amputation in Medicare patients.

Objective: Black patients with peripheral arterial disease undergo amputation at two to four times the rate of white patients. In order to determine whether differences in attempts at limb salvage might contribute to this disparity, we studied the limb care received prior to amputation by black patients compared with whites.

Methods: Using inpatient Medicare data for the years 2003 through 2006, we identified a retrospective sample of all beneficiaries who underwent major lower extremity amputation.

Longevity and outcomes of axillary valve transplantation for severe lower extremity chronic venous insufficiency.

Background: To assess the efficacy of axillary vein transplantation in the treatment of severe chronic venous insufficiency (CVI).

Methods: Among 139 complex venous reconstructions performed between 1991 and 2007 for CVI, 18 patients underwent upper extremity to lower extremity venous valve transplantation. An upper extremity valve was transplanted to the popliteal vein in 13 cases, to the common femoral vein in six cases, and to the saphenofemoral junction in two cases for a total of 21 procedures.

An update on etiology, prevention, and therapy of postthrombotic syndrome.

Postthrombotic syndrome is a common sequelae resulting from deep venous thrombosis. The primary interventions are prevention and treatment, both of which many vascular specialists may not always recognize. We review the definition, epidemiology, the basic pathophysiology, and preventative management for postthrombotic syndrome.

Toll-like receptor 9 signaling is critical for early experimental deep vein thrombosis resolution.

Objective: Toll-like receptors (TLR) bridge innate immunity and host responses, including inflammation. Sterile inflammation such as a venous thrombus (Vt) may involve TLR signaling, including TLR9.

Methods And Results: TLR9 signaling on thrombus resolution was investigated using a mouse model of stasis Vt.

Urokinase plasminogen activator independent early experimental thrombus resolution: MMP2 as an alternative mechanism.

Deep-vein thrombosis (DVT) resolution is thought to be primarily a urokinase plasminogen activator (uPA) -dependent mechanism, although observations suggest other non-fibrinolytic mechanisms may exist. We explored the role of matrix metalloproteinase (MMP) -2 and -9 in early DVT resolution in uPA-deficient mice. Male B6/SVEV (WT) and genetically matched uPA -/- mice underwent inferior vena cava (IVC) ligation to create stasis venous thrombi, with IVC and thrombus harvest.

Surgical mentors' and mentees' productivity from 1993 to 2006.

Background: Mentorship in academic surgery is reflected in part by senior surgeon support of younger individuals with their scholarly contributions to the literature. Scholarship is also reflected in the procurement of extramural funding. This study sought to quantify this process in recent years.

Venous thromboembolism risk factor assessment and prophylaxis.

Venous thromboembolism is a common and potentially preventable disease in hospitalized patients. Risk assessment and prophylaxis is also an important quality of care measure. Herein, we discuss the negative impact of VTE on surgical patients, review the risk factors for VTE, the risk assessment tools, available prophylaxis, and then summarize the use of biomarkers for VTE diagnosis.

Postthrombotic vein wall remodeling: preliminary observations.

Background: Postthrombotic syndrome is characterized by a fibrotic vein injury following deep vein thrombosis (DVT). We sought to quantify the change in vein wall thickness in patients who fail to resolve DVT by 6 months and whether there were differences in blood or plasma levels of inflammatory proteins associated with venous remodeling.

Methods: Patients presenting with confirmed lower extremity DVT were prospectively recruited for this study.

A statewide consortium of surgical care: a longitudinal investigation of vascular operative procedures at 16 hospitals.

Background: Regional surgical quality improvement consortiums are becoming more common. Herein we have reported the effectiveness of a statewide consortium focusing on open vascular operative procedures.

Methods: The statewide Michigan Surgical Quality Consortium was established in 2005 with 16 hospitals that report cases of vascular open operative intervention, in a sampling manner consistent with the private sector National Surgical Quality Improvement Program.

Intravascular ultrasound-guided true lumen reentry device for recanalization of unilateral chronic total occlusion of iliac arteries: technique and follow-up.

Background: Endovascular revascularization of chronic total occlusion (CTO) of the iliac arteries is rapidly becoming first-line treatment, with surgical aortofemoral bypass procedures reserved for failure of endovascular treatment. Percutaneous subintimal recanalization is the most common endovascular revascularization technique for CTO of the iliac arteries. The primary reason for failure of the subintimal recanalization technique is failure to reenter the true lumen.

Chronic venous insufficiency: current management of varicose vein disease.

This review encompasses the basic pathophysiology, diagnosis, and current therapies for superficial venous insufficiency.

National trends in venous disease.

Background: The national burden of venous disease and use of ultrasound (US) in the outpatient and emergency department (ED) settings has not been well described. The objective of this study is to describe venous disease in the outpatient and ED settings nationally as well as to characterize the use of US for diagnosis of venous disease, including phlebitis.

Methods: Data from the 1997 to 2006 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were compiled, and complex sampling methods were used to describe the number of outpatient and ED visits for adults given a diagnosis of venous disease or phlebitis by ICD-9 coding.