Search Results (32)

Background: Arteriovenous fistula is an abnormal connection between an artery and a vein. Post-traumatic fistulas are uncommon and usually occur after penetrating injuries, including gunshot wounds. Cervical arteriovenous fistulas are particularly rare and may coexist with a pseudoaneurysm, creating diagnostic and therapeutic challenges because of the proximity of major vascular, neurological, and aerodigestive structures. In hemodynamically stable patients, the limited external appearance of the wound may underestimate the extent of internal vascular injury; therefore, imaging is central to diagnosis and treatment planning. Case Presentation: We report the case of a 49-year-old man who presented to the emergency department with a gunshot wound to the left side of the neck. Computed tomography angiography (CTA) demonstrated a vascular injury adjacent to the left common carotid artery (LCCA), and further evaluation revealed an arteriovenous fistula (AVF) between the LCCA and the left internal jugular vein (LIJV), coexisting with a pseudoaneurysm of the LCCA. Doppler ultrasonography (DUS) identified an arterial wall defect and extrinsic compression of the LCCA by the hematoma. Selective digital subtraction angiography (DSA) confirmed an AVF between the LCCA and the LIJV, coexisting with an LCCA pseudoaneurysm. A covered stent-graft was implanted and completion angiography confirmed exclusion of both lesions with preserved patency of the LCCA. Discussion: This case demonstrates the complementary value of CTA, DUS and DSA in penetrating neck trauma. CTA provided rapid cross-sectional assessment of the injury trajectory and associated lesions, DUS added information on the arterial wall and local hemodynamic consequences, and DSA confirmed arteriovenous shunting while enabling immediate endovascular treatment. Conclusions: In hemodynamically stable patients with penetrating neck trauma, CTA should be considered when the wound trajectory approaches major vessels, even in the absence of active external bleeding. DUS and DSA may provide complementary information for lesion characterization and procedural planning. Covered stent-graft implantation may be a feasible reconstructive option in carefully selected patients. Full article

Background and Objectives: Postspinal hypotension (PSH) remains a common complication of cesarean delivery under spinal anesthesia. Simple prespinal predictors may assist in identifying patients at increased risk. This study evaluated the associations of shock index (SI), modified shock index (MSI), diastolic shock index (DSI), and right internal jugular vein collapsibility index (RJV-CI) with postspinal hypotension (PSH). Materials and Methods: This prospective observational study included term parturients undergoing elective cesarean delivery under spinal anesthesia. Prespinal SI, MSI, DSI, and RJV-CI were measured before intrathecal injection. PSH was defined as systolic arterial pressure <90 mmHg or a reduction of ≥30% from baseline within 15 min after intrathecal injection. Receiver operating characteristic (ROC) analyses were performed for individual predictors. Three logistic regression models combining RJV-CI with SI, MSI, or DSI were evaluated using bootstrap internal validation. Results: Of 80 enrolled patients, 76 were included in the final analysis; 36 (47.4%) developed PSH. SI, MSI, DSI, and RJV-CI were significantly higher in the PSH group than in the non-PSH group. The areas under the ROC curve (AUCs) were 0.757 for SI, 0.747 for MSI, 0.693 for DSI, and 0.709 for RJV-CI. In multivariable models, RJV-CI remained significantly associated with PSH after adjustment for the respective shock index. The model combining RJV-CI and SI showed the highest apparent AUC (0.790; 95% confidence interval, 0.688–0.886) and an optimism-corrected AUC of 0.775. The RJV-CI plus MSI model showed an optimism-corrected AUC of 0.774. Conclusions: Prespinal SI, MSI, DSI, and RJV-CI were associated with PSH in this cohort. Models combining RJV-CI with SI or MSI showed numerically higher discrimination than the individual predictors. The derived cutoff values should be considered exploratory and require external validation before routine clinical use. Full article

Background and Objectives: Difficult venous access (DVA) affects 10–26% of hospitalized patients and up to 60% in high-risk populations, leading to increased patient discomfort, delayed diagnosis, and substantial healthcare costs estimated at $4.7 billion annually in the United States. This meta-analysis aimed to systematically evaluate the effectiveness, safety, and implementation considerations of traditional and emerging strategies for obtaining blood samples in patients with DVA. Materials and Methods: We conducted a comprehensive systematic review and meta-analysis following PRISMA guidelines. We searched MEDLINE, Embase, CINAHL, and Cochrane databases from January 2016 to December 2023. Inclusion criteria encompassed randomized controlled trials, systematic reviews, and observational studies examining DVA interventions in adult and pediatric populations. Primary outcomes included first-attempt success rates, overall success rates, and complication rates. Statistical analysis used random-effects models with risk ratios and 95% confidence intervals. Results: Forty-seven studies involving 12,847 patients met the inclusion criteria. Technology-assisted approaches demonstrated superior outcomes compared to traditional techniques. Ultrasound guidance showed the highest effectiveness with a first-attempt success increase of 42% (RR 1.42, 95% CI 1.26–1.58, p < 0.001), followed by near-infrared visualization with a 28% increase (RR 1.28, 95% CI 1.14–1.42, p < 0.001). Population-specific approaches yielded significant benefits, including the use of scalp veins for infants and external jugular approaches for extreme DVA cases. Cost-effectiveness analysis revealed that ultrasound guidance achieved break-even within 8–14 months in high-volume centers. Conclusions: A systematic, stepwise approach integrating appropriate technology and techniques significantly improves success rates while reducing patient discomfort and healthcare costs. Healthcare institutions should implement comprehensive DVA protocols with adequate training, equipment access, and quality monitoring. The proposed algorithm achieved a 93% overall success rate in validation studies, representing a substantial improvement over traditional approaches. Full article

Perinatal asphyxia (PA) remains a common cause of neonatal death and long-term disability, with an incidence of 20 per 1000 live births. Even mild PA, without significant neurological distress at birth, is linked to neurodevelopmental disorders. Premature babies are at high risk for both PA and long-term neurobehavioral deficits. The use of peripherally inserted central venous catheters in neonatal intensive care units has reduced mortality and morbidity in preterms. Given their prevalent use and associated complications, such as thrombosis, the present study aimed to investigate the effects of hypoxia associated with the ligation of the external jugular vein (JH model) in 5-day-old mice, whose central nervous system development shares similarities with that of human preterms. Diffuse white matter (WM) injury is associated with later neurodisabilities following very premature birth before 32 weeks of gestation. The present study aimed to investigate whether the murine JH model replicates a key phenotype of non-cystic WM injury, namely permanent hypomyelination and sensorimotor deficits. The second aim was to determine whether sodium phenylbutyrate (PBA), which is already prescribed in neonates for another indication, could prevent these disabilities. JH induced lasting dysmyelination in males, not prevented by PBA, contrary to the discrete JH-induced neurobehavioral deficits observed in both sexes in the short and long term. Full article

The stylohyoid complex (SHC), comprising the styloid process (SP), stylohyoid ligament, and lesser horn of the hyoid bone, arises from Reichert’s cartilage and plays a central role in head and neck organization. Although anatomically small, it occupies a strategic position in the parapharyngeal space, linking neural, vascular, and visceral compartments. This review integrates embryological, comparative, anatomical, and clinical perspectives to provide an updated synthesis of SHC morphology and significance. Developmental studies highlight the early segmentation of Reichert’s cartilage, its transient relationships with the otic capsule, facial canal, and carotid arteries, and its role in shaping muscular and fascial compartments. Comparative anatomy demonstrates the evolutionary transition from a continuous ossicular chain to a vestigial human structure, reflecting a trade-off between rigidity and vocal tract flexibility. In humans, the SHC exhibits marked variability in length, angulation, segmentation, and ligamentous ossification, which directly influence its spatial relationships with the internal and external carotid arteries, the internal jugular vein, and the lower cranial nerves. These variations underpin the clinical spectrum of Eagle’s syndrome and vascular complications, including carotid artery dissection and jugular compression syndromes. Recognition of these embryological origins, evolutionary trajectories, and anatomical variants is essential for accurate diagnosis, imaging interpretation, and surgical planning. As both an embryological remnant and a clinical landmark, the SHC bridges fundamental anatomy with practical implications for imaging, diagnosis, and surgery. Full article

Current consumer trends for meat production with reduced antibiotic use constitute huge challenges in animal farming. Using indigenous raw materials such as aromatic or medicinal plants or their extracts could positively affect or retain animals’ health. The present study aimed to evaluate the effects of medicinal plant extracts and essential oils on pig performance parameters, health indices and meat quality. A phytobiotic mixture (PM) consisting of oregano (Origanum vulgare subsp. hirtum) essential oil, rock samphire (Crithmum maritimum L.) essential oil, garlic flour (Allium sativum L.) and false flax flour (Camelina sativa L. Crantz) was used in pig diets, containing in the experimental trials two different proportions of the oregano essential oil (200 mL/t of feed vs. 400 mL/t of feed). Three groups of weaned pigs were fed either the control diet (CONT) or one of the enriched diets (PM-A or PM-B, 2 g/kg). After a 43-day feeding period, at 77 days of age, blood was taken from the jugular vein for biochemical and hematological tests, and eight pigs were humanely slaughtered. A microbiological analysis of intestinal digesta from the ileum and caecum was conducted. Additionally, meat tissue cuts (biceps femoris, external abdominal and triceps brachii) were collected for a chemical analysis, fatty acid lipid profile and oxidative stability testing. The statistical analysis revealed no differences (p > 0.05) in the body weights and growth rates among the groups. An increase (p < 0.05) in total aerobic bacteria was detected in the ileum of group PM-A, while Escherichia coli (E. coli) counts were reduced (p < 0.05) in group PM-B. In the caecum, reductions in Enterobacteriaceae and Lactobacillaceae counts were observed in groups PM-A and PM-B. Concentrations of malondialdehyde (MDA) as an indicator of lipid peroxidation were significantly reduced (p < 0.05) in triceps brachii and biceps femoris for both groups PM-A and PM-B (day 0). A reduction (p < 0.05) in MDA was noticed in triceps brachii and external abdominal meat samples (day 7) for groups PM-A and PM-B. In addition, the fatty acid profile of the meat lipids (ΣPUFA, h/H and PUFA/SFA ratios) was positively modified (p < 0.05) in the ham and belly cuts. The addition of the PM significantly (p < 0.05) affected the redness of the ham and shoulder meat (a* value increased), the yellowness of only the ham (b* value decreased) and the lightness of both belly (L* value increased) and ham samples (L* value decreased). The meat proximate analysis, as well as hematological and biochemical parameters, did not identify any differences (p > 0.05) between the groups. In conclusion, the two investigated mixtures could be used in weaned pigs’ diets, with positive results in intestinal microbial modulation, oxidative stability, fatty acid profile and color characteristics of the pork meat produced. Full article

Objectives: The application of fasciocutaneous free flaps for reconstruction of head and neck defects following oncological surgery has increased since the 1970s, coinciding with developments in microvascular techniques. Although reported success rates are between 90% and 99%, flap failure continues to occur, most frequently due to venous congestion. This study examines the rates of re-exploration and flap failure according to the number of venous anastomoses in patients receiving free flap reconstruction after head and neck cancer surgery. Materials and Methods: This retrospective analysis included 163 patients who underwent head and neck reconstruction with free flaps (radial forearm free flap [RFFF] and anterolateral thigh flap [ALTF]) at the University Hospital of Verona between January 2019 and June 2024. Variables examined comprised the type of flap performed, donor and recipient vessels utilized, and number of venous anastomoses, as well as the type (end-to-end [ETE] versus end-to-side [ETS]) and site (internal jugular vein versus external jugular vein) of venous anastomosis. Results: The overall success rate was 93.3%, with no significant difference between single and dual venous anastomosis groups. Prompt re-exploration upon detecting signs of flap failure is critical, as approximately one-third of such failures may be prevented through timely intervention. Conclusions: Single venous end-to-end anastomosis utilizing the internal jugular vein system is typically effective. Further research is warranted to clarify the indications for dual anastomosis involving the external jugular vein system. Full article

Platelet glycoprotein (GP)VI is a transmembrane protein that was originally characterized as a collagen receptor supporting platelet adhesion and activation through its association with the Fc receptor γ-chain (FcRγ). The FcRγ subunit contains immunoreceptor tyrosine-based activation motifs (ITAMs) that recruit and activate Syk (spleen tyrosine kinase), a key player in intracellular signaling pathways. The absence or dysfunction of GPVI produces a mild bleeding defect in humans like the impaired hemostasis reported in the murine knockout. Here, we took an ultrastructure approach to examine the impact of ligand binding to GPVI versus the downstream pharmacologic inhibition of the GPVI-dependent ITAM signaling pathway. Clots were generated for analysis following a puncture wound in the mouse external jugular vein. Images were obtained using mice genetically missing GPVI and mice pretreated with the Syk inhibitor, BI 1002494. Our study was designed to test the hypothesis that the predominant contribution of GPVI to hemostasis is mediated by a Syk-dependent signaling cascade. If true, the clot structure observed with a Syk inhibitor versus the GPVI knockout would be similar. If the extracellular domains of the protein had a Syk-independent platelet adhesion role, then significant comparative differences in the thrombus structure would be expected. Our results clearly indicate an important, Syk-independent role of the GPVI extracellular domain in the adherence of platelets within the intravascular crown of a growing venous clot, a site distant from exposed collagen-rich adventitia. In striking contrast, the adventitial proximal role of GPVI was Syk-dependent, with the GPVI knockout and Syk inhibitor giving the same, limited structural outcome of collagen-proximal platelet cytosol loss and a thinned extravascular cap. Consistent with the lesser role of Syk-dependent processes on the thrombus structure, the Syk inhibitor had no detectable effect on jugular puncture wound bleeding times, while the knockout had a statistically significant, but modest effect on bleeding time. Based on this contrast, we suggest that Syk inhibition may be the more selective approach to modulating the role of GPVI in occlusive clotting. Full article

Background/Objectives: In chronic liver disease, a rebalanced coagulation state often results in an increased risk of thrombosis, particularly in the splanchnic region. While systemic coagulation abnormalities are well documented, alterations in regional (portal) hemostasis remain underexplored. This study aimed to compare systemic and portal hemostasis during liver transplantation and to determine whether systemic parameters can accurately predict regional coagulation status. Methods: Thirty-five liver transplant recipients were included in this study. Systemic blood samples (S1–S5) were collected from the external jugular vein at five surgical time points, while portal blood samples (R3) were obtained immediately before reperfusion simultaneously with S3. All samples were analyzed using ClotPro^® viscoelastic assays, conventional coagulation tests, and blood gas analysis. Results: The EX-test comparison between S3 and R3 samples revealed a discrepancy between systemic and regional hemostasis in 45.7% of patients. Among these, eight regional samples exhibited hypocoagulation characterized by coagulation factor consumption and hyperfibrinolysis. Another eight samples demonstrated hypercoagulation with fibrinolytic shutdown, which was confirmed by a fibrin-rich thrombus identified via scanning electron microscopy. Systemic samples failed to predict these regional variations. Conclusions: Regional (portal) hemostasis significantly differs from systemic coagulation and cannot be accurately predicted using systemic assays alone. These findings suggest that fibrinolytic shutdown in the portal vein may contribute to intraoperative and long-term graft damage, highlighting a potential need for regional coagulation assessment during liver transplantation. Full article

A plethysmograph is a device that quantitatively assesses volumetric variations in an organ or the entire body, typically resulting from fluctuations in blood flow. In this study, a strain-gauge sensor that measures changes in the volume of the neck was used to detect the the cerebral venous outflow in the internal jugular veins. The resulting electronic signal was susceptible to several external factors, complicating the identification of relevant features. A reliable analysis of the waveform, without the need for a manual intervention to analyze the data, is of paramount importance to provide real-time analysis of the vital parameters of the patient. In this work, we demonstrate that specifically designed neural networks can detect artifacts in plethysmographic traces and identify the most important features in the signal with reasonable accuracy, eliminating the need to perform these tasks manually for each patient. Full article

Hemorheological factors may show arterio-venous differences. Alterations in acid-base and metabolic parameters may also influence these factors. However, little is known about changes in micro-rheological parameters during abdominal surgery, influencing splanchnic circulation. In anesthetized pigs, the external jugular vein, femoral artery and vein were cannulated unilaterally, and paramedian laparotomy was performed. In the anastomosis group, after resecting a bowel segment, end-to-end jejuno-jejunostomy was completed. Blood samples (from cannulas and by puncturing the portal vein) were taken before and after the intervention. Hematological, acid-base and blood gas parameters, metabolites, red blood cell (RBC) deformability and aggregation were determined. The highest hematocrit was found in portal blood, increasing further by the end of operation. A significant pH decrease was seen, and portal blood showed the highest lactate and creatinine concentration. The highest RBC aggregation values were found in arterial, the lowest in renal venous blood. The RBC aggregation increased with higher lactate concentration and lower pH. Osmotic gradient deformability declined, with the lowest values in portal and renal venous samples. In conclusion, micro-rheological parameters showed arterio-venous and porto-renal venous differences, influenced by oxygenation level, pH and lactate concentration. The intestinal anastomosis operation caused an immediate micro-rheological deterioration with portal venous dominancy in this experiment. Full article

Background: Autologous vein grafts are widely used for bypass procedures in cardiovascular surgery. However, these grafts are susceptible to failure due to vein graft disease. Our study aimed to evaluate the impact of the latest-generation FRAME external support on vein graft remodeling in a preclinical model. Methods: We performed autologous internal jugular vein interposition grafting in porcine carotid arteries for one month. Four grafts were supported with a FRAME mesh, while seven unsupported grafts served as controls. The conduits were examined through flowmetry, angiography, macroscopy, and microscopy. Results: The one-month patency rate of FRAME-supported grafts was 100% (4/4), whereas that of unsupported controls was 43% (3/7, Log-rank p = 0.071). On explant angiography, FRAME grafts exhibited significantly more areas with no or mild stenosis (9/12) compared to control grafts (3/21, p = 0.0009). Blood flow at explantation was higher in the FRAME grafts (145 ± 51 mL/min) than in the controls (46 ± 85 mL/min, p = 0.066). Area and thickness of neo-intimal hyperplasia (NIH) at proximal anastomoses were similar for the FRAME and the control groups: 5.79 ± 1.38 versus 6.94 ± 1.10 mm², respectively (p = 0.558) and 480 ± 95 vs. 587 ± 52 μm²/μm, respectively (p = 0.401). However, in the midgraft portions, the NIH area and thickness were significantly lower in the FRAME group than in the control group: 3.73 ± 0.64 vs. 6.27 ± 0.64 mm², respectively (p = 0.022) and 258 ± 49 vs. 518 ± 36 μm²/μm, respectively (p = 0.0002). Conclusions: In our porcine model, the external mesh FRAME improved the patency of vein-to-carotid artery grafts and protected them from stenosis, particularly in the mid regions. The midgraft neo-intimal hyperplasia was two-fold thinner in the meshed grafts than in the controls. Full article

Background: Flap perfusion is a prerequisite for microvascular free flap survival and a parameter routinely used for flap monitoring. The aim of this study was to investigate the influence of the anastomosis recipient vessel on flap perfusion. Methods: Flap perfusion was retrospectively analyzed in 338 patients who underwent head and neck reconstruction with microvascular free flaps between 2011 and 2020. The Oxygen-to-see tissue oxygen analysis system measurements for intraoperative and postoperative flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation at 8 and 2 mm tissue depths were compared between arterial anastomosis recipient vessels (external carotid artery [ECA], facial artery [FAA], lingual artery [LIA], and superior thyroid artery [STA]) and venous anastomosis recipient vessels (internal jugular vein [IJV], combination of IJV and IJV branches, IJV branches, and external jugular vein). Results: The postoperative hemoglobin concentration at 2 mm tissue depth differed significantly between arterial anastomosis recipient vessels (ECA, 41.0 arbitrary units [AU]; FAA, 59.0 AU; LIA, 51.5 AU; STA, 59.0 AU; p = 0.029). This difference did not persist in the multivariable testing (p = 0.342). No other differences in flap blood flow, hemoglobin concentration, or hemoglobin oxygen saturation were observed between the arterial and venous anastomosis recipient vessels (p > 0.05 for all). Conclusions: The arterial and venous recipient vessels used for anastomosis did not influence microvascular free flap perfusion. This underlines the capability of the studied recipient vessels to adequately perfuse free flaps, may explain the observed indifferent flap survival rates between commonly used anastomosis recipient vessels, and implies that the recipient vessel is not a confounding variable for flap monitoring with the Oxygen-to-see tissue oxygen analysis system. Further prospective studies are needed to confirm the findings. Full article

In recent years, venovenous extracorporeal membrane oxygenation (VV ECMO) has been used to support patients with severe lung disease. Active use of VV ECMO was also recommended for severe respiratory failure due to COVID-19. However, VV ECMO is also known to cause various complications due to extracorporeal circulation. Although we conducted ECMO research using rats, we have not been able to establish whether double-lumen single-cannulation VV ECMO models in rats have been described previously. The purpose of this study was to establish a simple, stable, and maintainable miniature double-lumen single-canulation VV ECMO model in rats. A double-lumen catheter used as a plain central venous catheter (SMAC plus Seldinger type; Covidien Japan Co., Tokyo, Japan) was passed through the right external jugular vein and advanced into the right atrium as a conduit for venous uptake. The VV ECMO system comprised a roller pump, miniature membrane oxygenator, and polyvinyl chloride tubing line. During VV ECMO, blood pressure and hemodilution rate were maintained at around 80 mmHg and 30%, respectively. Hemoglobin was kept at >9 g/dL, no serious hemolysis was observed, and VV ECMO was maintained without blood transfusion. Oxygenation and removal of carbon dioxide from the blood were confirmed and pH was adequately maintained. This miniature VV ECMO model appears very useful for studying the mechanisms of biological reactions during VV ECMO. Full article

Background: The purpose of this study was to compare the immediate and long-term complications that are associated with the utilized techniques for the insertion of indwelling central venous catheters, that is the open surgical technique, the ultrasound-guided technique, and the transcutaneous technique based on external anatomical landmarks in the right internal jugular vein, to a pediatric population. Methods: This was a prospective randomized trial based on a pediatric patient population under 16 years of age of a tertiary pediatric-oncological hospital. The procedure was performed by a medical team with varying experience regarding the percutaneous and open insertion methods. We studied the outcome of our procedure, based on the immediate and delayed complication rate, as well as the needed time in order to complete the procedure and mean duration of line use. Results: The patients that were inserted in our protocol were divided into three subgroups based on the selected technique for the insertion of the central venous catheter. A total number of 88 insertions (25.4%) (out of 346) were based on the technique that was using external anatomical landmarks, 121 insertions were based on the ultrasound-guided transcutaneous technique (34.9%), whereas in 137 cases (39.5%) the open surgical technique was preferred. All cases that were related to catheter re-insertion were excluded from our study. We performed a statistical analysis regarding the catheter dwell time between the three subgroups of patients and no significant difference was recorded. Moreover, the development of thrombosis was investigated, and we noted that a higher percentage of this complication was related to the transcutaneous external landmark and open surgical technique. Also, the incidence of infection was taken into consideration, which manifested an increased incidence when the transcutaneous technique based on external landmarks was used. Conclusions: Ultrasound-guided percutaneous insertion was considered to be a safe and effective technique for the insertion of central venous catheters. Our study also demonstrated a decrease in operating times when performed by operators with increasing expertise, increased preservation of the diameter of the venous lumen, and no increase in complication rates when the ultrasound-guided technique was selected. Full article