Search Results (846)

Background: Few data are available on the outcomes of patients with venous thromboembolism (VTE) on long-term reduced dose of direct oral anticoagulants (DOACs). We evaluated the effectiveness and safety of reduced dose of DOACs for the extended treatment of VTE. Methods: In this monocenter, ambispective cohort study, 140 patients receiving a reduced dose of DOACs for VTE were included. The primary outcomes were recurrent VTE, major bleeding and clinically relevant non-major bleeding. The secondary outcomes were arterial events and minor bleedings. The incidence of the primary outcomes was calculated. The rate for secondary outcomes was descriptively reported. Results: The mean age of the overall cohort was 72 years. Half of the patients were female, 51.4% had a persistent risk factor, 40.0% an unprovoked VTE, and 8.6% a minor transient risk factor. Most patients had lower extremity deep vein thrombosis with or without pulmonary embolism (55.0%) and received apixaban (73.6%) or rivaroxaban (14.3%) for a mean duration of 2.7 years. Regarding the primary outcomes, there was one recurrent VTE (0.7%), four major bleedings (2.9%) and two clinically relevant non-major bleedings (1.4%). Regarding the secondary outcomes, there were four acute ischemic strokes (2.9%) and two minor bleedings (1.4%). Conclusions: Reduced dose of DOACs was associated with a low rate of recurrent VTE and an acceptably low rate of bleeding complications. The rate of arterial events during follow-up suggests the need for an assessment of cardiovascular risk factors in this study population. Full article

The internal jugular vein (IJV) is of utmost importance during various surgical and endovascular approaches, including central access. It descends through the parapharyngeal space, carotid triangle, and sternocleidomastoid region. The anatomical variables of the IJV are mainly related to its calibre and dominance, number of venous channels (i.e., duplications and fenestrations), and compression sites. Specific compressions of the IJV are not exclusively due to the jugular nutcracker between the styloid process (SP) of the temporal bone and the C1 transverse process, which, in turn, should not be granted the eponym of Eagle. The possible morphologies of the SP and ossified stylohyoid chain are discussed here. Additionally, the digastric and sternocleidomastoid muscles, the hyoid, and the distorted carotid arteries may compress the IJV, thereby raising intracranial pressure. Here, a case is documented with a long inferior petrosal sinus adjacent to the IJV, both compressed into the C1–styloid nutcracker, which is an absolute novelty. Multiple compression sites of the IJV are supported here with original evidence. All anatomical variables of the IJV are relevant, as they may lead to stenoses or interfere with IJV cannulation. In rare cases of IJV agenesis, multiple compression sites on the opposite side may significantly alter bilateral cerebral drainage. Different methods may be used to decompress a stenotic IJV, including styloidectomy. In conclusion, the anatomical variables of the IJV should be acknowledged by practitioners and documented on a case-by-case basis. Full article

Thrombotic complications are a common cause of morbidity and mortality in cancer patients. Factor XI (FXI) appears to play a direct role not only in thrombotic pathogenesis but also in cancer progression. This comprehensive review aims to define the pathophysiological relationships between FXI and cancer and to assess existing therapeutic opportunities targeting this factor. This review highlights how FXI is implicated in tumor growth, tumor cell adhesion and migration, inflammation, and angiogenesis. FXI inhibition has been shown to reduce the risk of thrombosis, with a potentially improved safety profile in terms of bleeding risk. Several molecules, such as asundexian and abelacimab, are in clinical trials for the prevention and treatment of venous thromboembolic events, catheter-related thrombosis, and arterial thromboembolic events in cancer patients. In conclusion, factor XI is closely linked to the pathogenesis of cancer and its thromboembolic complications. The use of FXI inhibitors emerges as a promising therapeutic strategy, offering potentially positive effects in the prevention and treatment of thromboembolic complications without significantly increasing the risk of bleeding, a limitation of conventional anticoagulants. The preliminary evidence is that further clinical trials are required and that the available data is not enough to make firm clinical recommendations. Full article

Background: Propeller perforator flaps (PPFs) have gained increasing popularity in lower limb reconstruction. While their use in elective settings is well described, their role in acute post-traumatic reconstruction remains less defined. Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Cochrane Library were searched on 2 June 2025, for studies reporting on the use of propeller flaps in lower limb reconstruction after trauma. Only studies rated as “good” quality using the NIH quality assessment tool were included. Data on anatomical location, flap survival, complications, reinterventions, and functional and patient-reported outcomes were extracted and analyzed descriptively. Results: Twenty-eight studies published between 2008 and 2024 were included, accounting for 619 propeller flaps in a population of 838 patients. The majority of flaps were fasciocutaneous, with the posterior tibial artery being the most commonly used source vessel. Among the flaps included, 422 (68.2%) achieved complete survival without necrosis, 84 (13.6%) developed partial necrosis, and 23 (3.7%) failed completely. Considering all flaps that remained viable after any required revisions or conservative management, the overall survival rate was 97%. Venous congestion was the leading cause of flap compromise. The overall complication rate was 21.8%, increasing to 35.1% in acute trauma cases. A statistically significant correlation was found between wide rotation angles (≥150°) and higher complication rates (p = 0.015). The mean follow-up duration was 12.5 months. Functional and aesthetic outcomes were poorly reported, but when available, they were generally favorable. Conclusions: PPFs represent a valuable option for lower limb reconstruction, providing reliable coverage while preserving major vascular axes. Their application in acute trauma settings appears promising, although current evidence is limited by small verified cohorts and predominantly retrospective study designs. Despite higher complication rates in acute cases, flap survival remains consistently high, supporting their use in carefully selected patients. Further prospective studies with standardized outcome reporting are needed to clarify long-term functional results and refine selection strategies. Full article

Background and Clinical Significance: Arterial and venous thromboses are typically distinct clinical entities, each governed by unique pathophysiological mechanisms. The concurrent manifestation of both, particularly in the setting of massive pulmonary embolism (PE), is exceptionally rare and poses significant diagnostic and therapeutic challenges. Case Presentation: This report describes a 61-year-old male with well-controlled hypertension and type 2 diabetes who developed extensive thromboses involving deep vein thrombosis (DVT) of the right popliteal vein, arterial thrombosis of the left iliac artery, and massive PE. The patient was initially managed conservatively, in accordance with the European Society of Cardiology (ESC) 2019 Guidelines for Acute PE, using unfractionated heparin (UFH), low-molecular-weight heparin, a direct oral anticoagulant (DOAC), and adjunctive therapy. This approach was chosen due to the absence of hemodynamic instability. However, given failed percutaneous revascularization and persistent arterial occlusion, surgical thromboendarterectomy (TEA) was ultimately required. Post hoc genetic testing was prompted by the complex presentation in the absence of classical provoking factors—such as trauma, surgery, malignancy, or antiphospholipid syndrome—consistent with recommendations for selective thrombophilia testing in atypical or severe cases. The analysis revealed four thrombophilia-associated polymorphisms: heterozygous Factor V Leiden (FVL; R506Q genotype), Plasminogen Activator Inhibitor-1 (PAI-1; 4G/5G genotype), Methylenetetrahydrofolate reductase (MTHFR; c.677C > T genotype), and homozygous Angiotensin-Converting Enzyme Insertion/Deletion (ACE I/D; DD genotype). Conclusions: While each variant has been individually associated with thrombotic risk, their co-occurrence in a single patient with simultaneous arterial and venous thromboses has not, to our knowledge, been previously documented. This case underscores the potential for gene–gene interactions to amplify thrombotic risk, even in the presence of variants traditionally considered to confer only modest to moderate risk. It highlights the need for a multidisciplinary approach and raises questions regarding pharmacogenetics, anticoagulation, and future research into cumulative genetic risk in complex thrombotic phenotypes. Full article

Background/Objectives: Chronic wounds of the lower extremities, particularly arterial and venous ulcers, represent a significant and costly challenge in medical care. To assist in differential diagnosis, we aim to evaluate various advanced deep-learning models for classifying arterial and venous ulcers and visualize their decision-making processes. Methods: A retrospective dataset of 607 images (198 arterial and 409 venous ulcers) was used to train five convolutional neural networks: ResNet50, ResNeXt50, ConvNeXt, EfficientNetB2, and EfficientNetV2. Model performance was assessed using accuracy, precision, recall, F1-score, and ROC-AUC. Grad-CAM was applied to visualize image regions contributing to classification decisions. Results: The models demonstrated high classification performance, with accuracy ranging from 72% (ConvNeXt) to 98% (ResNeXt50). Precision and recall values indicated strong discrimination between arterial and venous ulcers, with EfficientNetV2 achieving the highest precision. Conclusions: AI-assisted classification of venous and arterial ulcers offers a valuable method for enhancing diagnostic efficiency. Full article

An increasing body of evidence suggests the likelihood of a link between arterial atherosclerotic disease (AAD) and venous thromboembolic disease (VTED). Inflammation is accepted as a basic pathogenetic mechanism of both diseases. The involvement of inflammation in the pathogenesis of AAD and VTED is supported by increased levels of circulating inflammatory markers, particularly interleukins, which are involved in the development and progression of atherosclerosis as well as in thrombus formation in arterial and venous beds. A consideration supporting a close link between these diseases is also based on the evidence of common risk factors which promote the development of both diseases through stimulation of systemic inflammation. Further, the relationship between arterial and VTED is supported by findings of the simultaneous appearance of clinical or preclinical AAD and VTED. The aim of this narrative review is to report evidence of the inflammatory basis of arterial and venous diseases, which is important for common therapeutic procedures. Besides classical drugs used in the prevention of arterial and venous diseases with their pleotropic anti-inflammatory activity, new anti-inflammatory drugs provide the possibility for treatment of both AAD and VTED and could represent a unified therapeutic approach to both diseases. Full article

Background/Objectives: In patients with intracranial arteriovenous malformation (AVM), the first diagnostic analysis is often performed in emergency conditions by Computed Tomography (CT) and multiphase CT angiography (CTA). Nevertheless, once ruptured, an AVM might be hardly recognized by an inexperienced neuroradiologist, due to the presence of hematoma or to the destructuring of the lesion. The aim of our study is to outline the utility of color-coded maps derived from multiphase CT angiography in the assessment of cerebral AVMs, evaluating inter-observer agreement between radiologists with different years’ experience and comparing the results with the gold standard, angiography. Methods: The color-coded maps were obtained retrospectively by multiphase CT angiography on a workstation using FastStroke software ColorViz (GE Healthcare, Milwaukee, WI, USA). The color-coded maps were evaluated, independently, by two neuroradiologists, and inter-observer agreement was evaluated. Finally, the AVM’s features (arterial feeders, nidus type, venous drainage type) obtained with color-coded maps were compared with angiographic analysis. The Ethical Committee for Research in Medical Imaging approved this study (Institutional Review Board number 6467). Informed consent was obtained for every patient. Results: A total of 26 patients with intracranial hemorrhage and arteriovenous malformation underwent multiphase CT angiography and were analyzed. Our statistical analysis showed the reproducibility of the color-coded maps and agreement with the angiographic findings, especially in the evaluation of venous drainage type. Conclusions: The ColorViz color-coded maps have proved to be an effective tool in the identification and assessment of AVMs, providing rapid and clear information on intracranial vascular dynamics, even for inexperienced radiologists. Full article

Aim: Both the arterial and venous systems independently predict mortality in septic shock, yet no bedside tools are able to integrate their assessment. Risk stratification becomes challenging when arterial parameters suggest favourable outcomes while venous parameters indicate poor prognosis, or vice versa. To address this gap, we developed the VTI-VeXUS index and conducted this proof-of-concept study to test its association with mortality. Methods: We conducted a prospective cohort study in two ICUs, enrolling adult patients with septic shock. We calculated the VTI-VeXUS index (VTI/[VeXUS+1]) from ultrasound measurements obtained within 24 h of ICU admission and stratified patients as having a high or low VTI-VeXUS index based on a cutoff of 11. We evaluated the primary outcome of mortality at 30 days using survival analysis. Results: We enrolled 62 patients. Patients with a low VTI-VeXUS index had higher rates of left ventricular dysfunction (32.3% vs. 3.2%, p = 0.006), right ventricular dysfunction (35.5% vs. 0.0%, p < 0.001), lower stroke volume (54.0 mL vs. 62.0 mL, p = 0.005), and increased 30-day mortality (adjusted HR: 3.86, 95% CI 1.23 to 12.14). Conclusions: In this exploratory proof-of-concept study, a low VTI-VeXUS index was associated with ventricular dysfunction and increased mortality. While limited by small sample size and univariate analysis, these findings suggest this novel integrated metric warrants validation in larger prospective studies. Full article

The pancreas exhibits a uniquely intricate vascular architecture characterized by frequent and clinically significant morphological variations. These variations—impacting both arterial supply and venous drainage—are critical determinants in surgical planning, radiologic interpretation, and interventional outcomes. This comprehensive review examines the full spectrum of pancreatic vascular anatomy, with particular emphasis on embryological development, imaging manifestations, and surgical relevance. Key arterial structures, including the superior and inferior pancreaticoduodenal arteries (SPDAs and IPDAs) and the dorsal pancreatic artery (DPA)—are explored in detail alongside accessory branches. On the venous side, focus is placed on the gastrocolic trunk (GCT) of Henle, the uncinate and centro-inferior pancreatic veins, and the dorsal pancreatic vein (DPV). The review highlights that arterial aberrations, such as a DPA originating from the superior mesenteric artery (SMA), or duplicated patterns of the IPDA, as well as venous anomalies such as variant drainage of the GCT or the centro-inferior pancreatic vein, have substantial implications during pancreaticoduodenectomy, distal pancreatectomy, and transplantation procedures. With advances in multidetector computed tomography (MDCT), magnetic resonance angiography (MRA), and three-dimensional (3D) modeling, high-risk vascular variants can now be accurately mapped preoperatively, facilitating safer and more effective minimally invasive and robotic-assisted surgeries. In conclusion, the recognition and understanding of pancreatic vascular variations are imperative for optimal surgical and interventional management. This review underscores the importance of multidisciplinary collaboration among surgeons, radiologists, and anatomists, which will allow them to integrate detailed anatomical knowledge into clinical workflows, ultimately improving patient outcomes in pancreatic procedures. Full article

The association between COVID-19 vaccination and thromboembolic events has garnered significant research attention, particularly with the advent of vaccines based on adenoviral vectors, including AstraZeneca’s and Johnson & Johnson’s vaccines. This review underscores the uncommon occurrence of venous thromboembolism (VTE), arterial thromboembolism (ATE), and vaccine-induced thrombotic thrombocytopenia (VITT) following COVID-19 vaccination. Although these complications are extremely rare compared to the heightened risk of thrombosis from COVID-19 infection, elements like age, biological sex, type of vaccine and underlying health conditions may contribute to their development. In addition, rare renal complications such as acute kidney injury and thrombotic microangiopathy have been documented, broadening the spectrum of potential vaccine-associated thrombotic manifestations. Current guidelines emphasize early detection, individualized risk assessment, and use of anticoagulation therapy to mitigate risks. Despite these events, the overwhelming majority of evidence supports the continued use of COVID-19 vaccines, given their proven efficacy in reducing severe illness and mortality. In addition, recent comparative data confirm that mRNA-based vaccines are associated with a significantly lower risk of serious thrombotic events compared to adenoviral vector platforms. Ongoing research is essential to further refine preventive and therapeutic strategies, particularly for at-risk populations. Full article

Background: Diabetes mellitus is associated with worse outcomes after cardiac arrest. Hyperglycemia, diabetes treatments and other long-term sequalae may contribute to this association. We sought to determine the acute effect of diabetes on the return of spontaneous circulation (ROSC) and post-arrest cardiac function in a rat cardiac arrest model. Methods: Eighteen male Wistar rats were utilized, and 12 underwent the induction of type II diabetes for 10 weeks through a high-fat diet and the injection of streptozotocin. The carotid artery flow and femoral arterial pressure were measured. Seven minutes of asphyxial cardiac arrest was induced. An external cardiac compression was performed via an automated piston. Post-ROSC, epinephrine was titrated to a mean arterial pressure (MAP) of 70 mmHg. Data was analyzed using the Mann–Whitney test. The significance was set at p ≤ 0.05. Results: The rate of the ROSC was significantly lower in animals with diabetes, 50% compared to 100% in non-diabetics. Additionally, it took significantly longer to achieve the ROSC in diabetics, p = 0.034. In animals who survived, the cardiac function was reduced, as indicated by an increased epinephrine requirement, p = 0.041, and a decreased cardiac output at the end of the experiment, p = 0.017. The lactate, venous and arterial pressures, heart rate and carotid flow did not differ between groups at 2 h. Conclusions: Diabetes negatively affects the survival from cardiac arrest. Here, the critical difference was the rate of the conversion to a life-sustaining rhythm and the achievement of the ROSC. The post-ROSC cardiac function was depressed in diabetic animals. Interventions targeted at improving defibrillation success may be important in diabetics. Full article

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by venous and arterial thrombosis and obstetric complications, driven by antiphospholipid antibodies (APLAs). This review synthesizes the latest advancements and current understanding, diagnosis, and treatment of APS. APLAs, including lupus anticoagulant (LAC), anticardiolipin (aCL), and anti-β2-glycoprotein I (aβ2-GPI), interfere with coagulation and endothelial function, as well as with placental health. APS can be primary or secondary; it is often associated with systemic autoimmune diseases like lupus. The pathogenesis of APS remains only partially understood. APLAs promote thrombosis through endothelial damage, platelet activation, and inflammatory signaling pathways. Laboratory diagnosis relies on persistent positivity for APLAs and LAC through tests like ELISA and clotting assays, following a three-step confirmation process. New integrated test systems have been introduced to improve standardization. Classification criteria have evolved, with the 2023 EULAR-ACR criteria providing a weighted, domain-based scoring system, enhancing diagnostic precision. Catastrophic APS (CAPS) is a severe, rare manifestation of APS, characterized by multi-organ failure due to rapid, widespread microthrombosis and systemic inflammation, which requires urgent anticoagulation. Seronegative APS is proposed for patients with clinical features of APS but negative standard antibody tests, possibly due to non-criteria antibodies or transient immunosuppression. Treatment primarily involves long-term anticoagulation with vitamin K antagonists; direct oral anticoagulants are generally not recommended. APS diagnosis and management remain complex due to clinical heterogeneity and laboratory challenges. Continued refinement of diagnostic tools and criteria is essential for improving outcomes in this life-threatening condition. Full article

Background: Peripheral endovascular intervention (PEVI) is routinely performed using standard-dose radiation (SDR), which is associated with elevated levels of radiation. No study has evaluated the outcomes of minimal-dose radiation (MDR) in PEVI. Methods: We performed a prospective observational study of 184 patients (65 ± 12 years) at an academic medical center from January 2019 to March 2020 (mean follow-up of 3.9 ± 3.6 months) and compared the outcomes of MDR (n = 24, 13.0%) and SDR (n = 160, 87.0%) in PEVI. Primary endpoints included air kerma, dose area product (DAP), fluoroscopy time, and contrast use. Secondary endpoints included all-cause mortality, cardiac mortality, acute myocardial infarction, acute kidney injury, stroke, repeat revascularization, vessel dissection/perforation, major adverse limb event, access site complications, and composite of complications. Results: For MDR (68 ± 10 years, mean follow-up of 4.3 ± 5.2 months), the primary endpoints were significantly less than SDR (65 ± 12 years, mean follow-up of 3.8 ± 3.2 months; p < 0.001). Regarding the secondary endpoints, one vessel dissection occurred using MDR, while 36 total complications occurred with SDR (p = 0.037). Conclusions: PEVI using MDR was safe and efficacious. MDR showed a significant decrement in radiation parameters and fluoroscopy time. Therefore, MDR can serve as an effective alternative for PEVI in acute or critical limb ischemia. Full article

Background: Chronic wounds represent a persistent clinical challenge and impose a considerable burden on healthcare systems. These lesions often require multidisciplinary management due to underlying factors such as microbial colonization, impaired immunity, and vascular insufficiencies. Regenerative therapies, particularly autologous approaches, have emerged as promising strategies to enhance wound healing. Adipose tissue-derived stem cells (ADSCs) and platelet-rich plasma (PRP) may improve outcomes through paracrine effects and growth factor release. Methods: A prospective observational study was conducted on 31 patients with chronic wounds that were unresponsive to conservative treatment for over six weeks. Clinical and photographic evaluations were employed to monitor healing. All patients underwent surgical debridement, with adjunctive interventions—negative pressure wound therapy, grafting, or flaps—applied as needed. PRP infiltration and/or autologous adipose tissue transfer were administered based on wound characteristics. Wound area reduction was the primary outcome measure. Results: The cohort included 17 males and 14 females (mean age: 59 years). Etiologies included venous insufficiency (39%), diabetes mellitus (25%), arterial insufficiency (16%), and trauma (16%). Most lesions (84%) were located on the lower limbs. All patients received PRP therapy; five underwent combined PRP and fat grafting. Over the study period, 64% of the patients exhibited >80% wound area reduction, with complete healing in 48.3% and a mean healing time of 49 days. Conclusions: PRP therapy proved to be a safe, effective, and adaptable treatment, promoting substantial healing in chronic wounds. Autologous adipose tissue transfer did not confer additional benefit. PRP may warrant inclusion in national treatment protocols. Full article