Experimental venous thrombus resolution is driven by IL-6 mediated monocyte actions.

Deep venous thrombosis and residual thrombus burden correlates with circulating IL-6 levels in humans. To investigate the cellular source and role of IL-6 in thrombus resolution, Wild type C57BL/6J (WT), and IL-6 mice underwent induction of VT via inferior vena cava (IVC) stenosis or stasis. Vein wall (VW) and thrombus were analyzed by western blot, immunohistochemistry, and flow cytometry.

New Trends in Anticoagulation Therapy.

Anticoagulation pharmacy has been dramatically altered with US Food and Drug Administration (FDA) approval of 5 direct oral anticoagulants, 1 novel reversal agent and, a second designated for fast-track approval. Trial data surrounding current trends in anticoagulant choice for VTE, reversal, and bridging are constantly redefining practice. Extended therapy for unprovoked VTE has expanded to include low-dose direct oral anticoagulants, aspirin, and the use of the HERDOO2 system to identify women who can stop anticoagulant therapy without increased risk of recurrent VTE.

Dysfunctional Wound Healing in Diabetic Foot Ulcers: New Crossroads.

Purpose Of Review: Diabetic foot ulcerations (DFU) affect 25% of patients with diabetes mellitus during their lifetime and constitute a major health problem as they are often recalcitrant to healing due to a constellation of both intrinsic and extrinsic factors. The purpose of this review is to (1) detail the current mechanistic understanding of DFU formation and (2) highlight future therapeutic targets.

Recent Findings: From a molecular perspective, DFUs exhibit a chronic inflammatory predisposition.

Endotoxaemia-augmented murine venous thrombosis is dependent on TLR-4 and ICAM-1, and potentiated by neutropenia.

Venous thromboembolism is a major cause of death during and immediately post-sepsis. Venous thrombosis (VT) is mediated by cell adhesion molecules and leukocytes, including neutrophil extracellular traps (NETs). Sepsis, or experimentally, endotoxaemia, shares similar characteristics and is modulated via toll like receptor 4 (TLR4).

Evaluating hospital quality for vascular surgery.

Increasingly, there is a wealth of data available to aid patients in determining where to seek care for quality vascular disease. At times, these data may be difficult for the public to comprehend. Hospital rating organizations, frequently motivated by profit, are marketing directly to consumers with increasingly granular data.

Divergent effects of Tlr9 deletion in experimental late venous thrombosis resolution and vein wall injury.

Deep-vein thrombosis (DVT) resolves via a sterile inflammatory response. Defining the inflammatory response of DVT may allow for new therapies that do not involve anticoagulation. Previously, we have shown that Toll-like receptor 9 (Tlr9) gene deleted mice had impaired venous thrombosis (VT) resolution.

Cigarette smoke-induced MMP2 and MMP9 secretion from aortic vascular smooth cells is mediated via the Jak/Stat pathway.

It is hypothesized that cigarette smoke may increase MMP2 and MMP9 secretion through Jak/Stat pathway in the aorta, thereby facilitating abdominal aortic aneurysm (AAA) formation/progression in smokers. We observed through zymograms that treatment of male rat aortic vascular smooth muscle cells (RASMC) with an aqueous extract of cigarette smoke (CSE) for 24 hours resulted in a significant increase in pro-MMP9 (P = .005) and a modest increase in pro-MMP2 (P = .

Biomarkers for the diagnosis of deep vein thrombosis.

Venous thromboembolic disease (VTE) remains a significant source of morbidity and mortality. As non-specific subjective complaints and a paucity of objective clinical examination findings complicate the diagnosis of both deep venous thrombosis (DVT) and pulmonary embolism, diagnostic modalities remain essential. Compression ultrasound remains the gold standard for DVT diagnosis.

Contemporary outcomes after distal vertebral reconstruction.

Introduction: Flow-limiting lesions or embolic phenomena can produce vertebrobasilar ischemia. This study aims to differentiate the pathophysiology of vertebral ischemia and examine contemporary outcomes after distal vertebral reconstruction.

Methods: Between February 2005 and November 2011, 41 consecutive distal vertebral artery (VA) reconstructions were performed in 34 patients, including bypass to the third portion of the VA (V3) at the C1-2 level (n = 24) or the C0-1 level (n = 7); transposition of the external carotid artery or its occipital branch onto V3 (n = 6); transposition of V3 onto the internal carotid artery (n = 3); and bypass from the ipsilateral subclavian artery to V3 (n = 1).

Surgical treatment of Kommerell's diverticulum and other saccular arch aneurysms.

Background: Saccular aneurysms of the aortic arch are rare, and their surgical repair is challenging with potentially significant morbidity and mortality.

Methods: We examined our experience over a 3-year period with nine consecutive patients that include nine hybrid repairs with initial extra-anatomic carotid and/or subclavian bypass and subsequent endovascular exclusion of the saccular arch aneurysm.

Results: Three patients presented with dysphagia from aberrant right subclavian arteries with aneurysm at the origin of the artery, two had asymptomatic aneurysms at the origin of the left subclavian, and four patients had isolated saccular aneurysms of the arch, three of whom presented with thoracic pain.

Long-segment thoracoabdominal aortic occlusions in childhood.

Developmental coarctation, hypoplasia, and occlusion of the abdominal aorta is a rare disease encompassing many differing etiologies and diverse methods of treatment. Long-segment thoracoabdominal aortic occlusion, an extreme manifestation of this disorder, has not previously been reported in children. Two pediatric patients with this entity, a 5- and 13-year-old with uncontrolled hypertension, underwent extensive arterial reconstructions for this entity and provided the impetus for this report.

Endovascular aortic aneurysm repair with carbon dioxide-guided angiography in patients with renal insufficiency.

Objective: Renal dysfunction following endovascular abdominal aortic aneurysm repair (EVAR) remains a significant source of morbidity and mortality. We studied the use of carbon dioxide (CO(2)) as a non-nephrotoxic contrast agent for EVAR.

Methods: Recorded data from 114 consecutive patients who underwent EVAR with CO(2) as the contrast agent over 44 months were retrospectively analyzed.

Synchronous carotid body and thoracic paraganglioma associated with a germline SDHC mutation.

Paraganglionic tumors are rare. A germline mutation responsible for a familial pattern of paragangliomas (PGLs) has been identified on the genes encoding for the subunits of succinate dehydrogenase (SDH). Manifestations of those with a succinate dehydrogenase subunit C (SDHC) germline mutation have been almost exclusively reported as single head and neck paragangliomas (HNPGLs).

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.

Hybrid repair of aortic aneurysms involving the visceral and renal vessels.

Background: We sought to analyze our experience with hybrid treatment of aortic aneurysms involving the renal and visceral arteries.

Methods: We conducted a retrospective review of 36 consecutive patients who underwent renal/visceral bypasses followed by aortic endografting. Patient demographics, medical history, operations, complications, graft patency, and patient survival were recorded.

Contemporary management of acute limb ischemia: factors associated with amputation and in-hospital mortality.

Contemporary treatment of patients with acute limb ischemia includes both open and endovascular techniques, and advances in technology continue to make interventions easier and safer. However, the greatest gains in improving outcomes in these patients will come from more consistent and prompt recognition of the disease followed by rapid, standardized therapy to minimize the risk of limb loss and subsequent reperfusion-related injury. This article uses case reports to highlight critical issues that may arise during the course of diagnosis and treatment and describes clinical factors associated with morbidity and mortality in these patients.

Metabolic consequences of acute limb ischemia and their clinical implications.

Acute limb ischemia is a common medical condition resulting from arterial embolization, in situ thrombosis, trauma, and other causes. The severity of injury is related to the duration of ischemia and the effects of reperfusion. Metabolic consequences of reperfusion injury can be variable, ranging from transient symptoms in the lower extremity to systemic inflammation with multiple organ dysfunction.

Abdominal aortic coarctation: surgical treatment of 53 patients with a thoracoabdominal bypass, patch aortoplasty, or interposition aortoaortic graft.

Objective: Abdominal aortic coarctation is uncommon and often complicated with coexisting splanchnic and renal artery occlusive disease. This study was undertaken to define the clinical and anatomic characteristics of this entity, as well as the technical issues and outcomes of its operative treatment.

Methods: Fifty-three patients, 34 males and 19 females, underwent surgical treatment of abdominal aortic coarctations from 1963-2008 at the University of Michigan.

Transluminal hypogastric artery occlusion with an Amplatzer vascular plug during endovascular aortic aneurysm repair.

Objective: To evaluate our initial experience with hypogastric artery occlusion using a nitinol vascular plug during endovascular aortic aneurysm repair (EVAR).

Methods: We reviewed the records and images of 23 consecutive patients who underwent transluminal vessel occlusion of the hypogastric artery with a nitinol plug, as well as a cohort of 19 patients who underwent hypogastric artery embolization with coils in conjunction with EVAR.

Results: There were no demographic differences between the two groups of patients.

Angiolymphoid hyperplasia involving large arteries.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular proliferative disorder, which most commonly involves the skin of the head and neck regions. Noncutaneous localization of this pathology is unusual, and its primary localization in large arteries presenting as a pulsatile mass is extremely rare. We report here two cases of ALHE manifested as masses of the occipital and brachial artery.

Current management of infrarenal abdominal aortic aneurysms.

Since the concept of endovascular aneurysm repair (EVAR) was introduced more than 15 years ago, many technological advances and multiple generations of aortic stent-graft devices have been used to manage infrarenal abdominal aortic aneurysms. In this rapidly changing environment, the determination of the optimal management of patients with aneurysmal disease can be difficult. In this article, the current management of infrarenal abdominal aortic aneurysms is outlined.