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A Systematic Review Supporting the Society for Vascular Surgery, the American Venous Forum and the American Vein and Lymphatic Society Guidelines on the Management of Varicose Veins.

J Vasc Surg Venous Lymphat Disord 2021 Aug 24. Epub 2021 Aug 24.

Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. Electronic address:

Background: Several diagnostic tests and treatment options for patients with lower extremities varicose veins have existed for decades. The purpose of this systematic review was to summarize the latest evidence of the diagnostic and treatments options to support the forthcoming updates of the clinical practice guidelines on the management of varicose veins for the Society for Vascular Surgery (SVS), the American Venous Forum (AVF) and the American Vein and Lymphatic Society (AVLS).

Methods: We searched multiple databases for studies that addressed four clinical questions identified by the AVF and the SVS guideline committee about evaluating and treating patients with varicose veins. Read More

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Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia.

J Vasc Surg Venous Lymphat Disord 2021 Aug 24. Epub 2021 Aug 24.

Department of Phlebology, Skin and Vein Clinic Oosterwal, Alkmaar, the Netherlands.

Objective: The long-term results of saphenofemoral ligation and stripping (SFL/S) were compared with 980-nm bare fiber endovenous laser ablation (EVLA) for the treatment of great saphenous vein (GSV) incompetence.

Methods: This was a single-center, randomized, controlled trial with a follow-up time of 10 years. Patients with GSV incompetence were randomised to undergo SFL/S or EVLA under tumescent anesthesia. Read More

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Superficial Venous Reflux Intervention Guided by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging: Different QFlow Pattern from Health Controls.

J Pers Med 2021 Jul 30;11(8). Epub 2021 Jul 30.

Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan.

(1) Background: To assess the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in superficial venous reflux and its difference from health controls. (2) Methods: Thirty patients underwent TRANCE MRI before surgical intervention of their superficial venous reflux of the legs. Ten healthy volunteers were included as a control. Read More

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Cerebral Autoregulation during Postural Change in Patients with Cervical Spinal Cord Injury-A Carotid Duplex Ultrasonography Study.

Diagnostics (Basel) 2021 Jul 23;11(8). Epub 2021 Jul 23.

Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.

Patients with a spinal cord injury (SCI) frequently experience sudden falls in blood pressure during postural change. Few studies have investigated whether the measurement of blood flow velocity within vessels can reflect brain perfusion during postural change. By performing carotid duplex ultrasonography (CDU), we investigated changes in cerebral blood flow (CBF) during postural changes in patients with a cervical SCI, determined the correlation of CBF change with presyncopal symptoms, and investigated factors affecting cerebral autoregulation. Read More

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A multicenter randomized controlled trial of cyanoacrylate closure and surgical stripping for incompetent great saphenous veins.

J Vasc Surg Venous Lymphat Disord 2021 Aug 23. Epub 2021 Aug 23.

Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Korea. Electronic address:

Objective: Treatment of varicose veins has been shifted from conventional surgical stripping (SS) to minimally invasive endovenous modalities. Cyanoacrylate closure (CAC) with the Venaseal system has gained popularity owing to its non-thermal and non-tumescent technique. The purpose of this study was to compare the clinical outcomes of CAC with SS for the treatment of incompetent great saphenous veins. Read More

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Common iliac vein stenting for May-Thurner syndrome and subsequent pregnancy.

J Vasc Surg Venous Lymphat Disord 2021 Aug 23. Epub 2021 Aug 23.

Division of Vascular Surgery, New York University Langone Health, New York, NY. Electronic address:

Background: For women with left common iliac vein compression (ie, May-Thurner syndrome) who undergo venous stenting and subsequently become pregnant, concerns have been raised regarding a possible compromise of stent patency due to compression from the gravid uterus and the hypercoagulability induced by pregnancy. Only a small body of literature exists on this subject, and limited management guidelines are available. The present study was designed to evaluate the safety of iliac vein stenting for May-Thurner syndrome (MTS) with subsequent pregnancy. Read More

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Changes of stump length depending on starting position of glue injection related to venous diameter during cyanoacrylate closure for incompetent saphenous veins.

J Vasc Surg Venous Lymphat Disord 2021 Aug 23. Epub 2021 Aug 23.

Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea. Electronic address:

Objectives: A common pattern of recurrence after cyanoacrylate treatment of incompetent saphenous veins has been associated with reflux from the residual stump. The purpose of this study was to analyze the starting point of cyanoacrylate glue injection from the junction to decrease stump length.

Methods: A retrospective review was performed using prospectively collected data of patients with cyanoacrylate closure (CAC). Read More

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Left Atrial Thrombus Mimicking Myxoma Secondary to Rebound Hypercoagulable State.

J Med Cases 2021 Jun 24;12(6):243-247. Epub 2021 Mar 24.

Department of Cardiology, Staten Island University Hospital/Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA.

Novel oral anticoagulants (NOACs) have made the use of anticoagulation in patients with atrial fibrillation (AFib) much more convenient and predictable. It is a very common practice to hold anticoagulation either in anticipation of surgical procedures (to prevent excessive bleeding) or in case of acute bleeding episodes. This abrupt withdrawal of anticoagulation tilts the balance in favor of pro-thrombotic state in the body. Read More

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Surgical Outcome of Large Solid Posterior Fossa Hemangioblastoma without Preoperative Embolization.

J Neurol Surg A Cent Eur Neurosurg 2021 Aug 25. Epub 2021 Aug 25.

Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India.

Background:  Large solid hemangioblastoma in the posterior fossa has an abundant blood supply as an arteriovenous malformation. The presence of adjacent vital neurovascular structures makes them vulnerable and difficult to operate. Complete surgical resection is always a challenge to the neurosurgeon. Read More

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The quick carotid scan for prevention of strokes due to carotid artery disease.

Ann Transl Med 2021 Jul;9(14):1202

Department of Surgery, Uniformed Services University, Bethesda, MD, USA.

There are approximately 800,000 strokes in the United States (U.S.) annually. Read More

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Intraoperative completion studies in carotid endarterectomy: systematic review and meta-analysis of techniques and outcomes.

Ann Transl Med 2021 Jul;9(14):1201

Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.

Background: Declining perioperative stroke and death rates over the past 3 decades have been paralleled by an increasing use of intraoperative completion studies (ICS) following carotid endarterectomy (CEA). Techniques applied include angiography, intraoperative duplex ultrasound (IDUS), flowmetry, and angioscopy. This systematic review and meta-analysis is aiming on providing an overview of techniques and corresponding outcomes. Read More

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Potential benefits of functional magnetic resonance urography (fMRU) over MAG3 renal scan in children with obstructive uropathy.

J Pediatr Urol 2021 Jul 10. Epub 2021 Jul 10.

Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Introduction: Functional renal imaging, most commonly with MAG3 nuclear medicine renal scan, is recommended in the evaluation of children with urinary tract dilation (UTD) suspected of obstructive uropathy. Alternatively, renal function can be evaluated with functional Magnetic Resonance Urography (fMRU), which has superior anatomic detail. However, there are not enough data comparing both methods' equivalency. Read More

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A systematic review of the treatment of residual below the knee venous reflux after endovenous thermal ablation of the great saphenous vein.

J Vasc Surg Venous Lymphat Disord 2021 Aug 21. Epub 2021 Aug 21.

Division of Vascular Surgery, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla.

Background: Great saphenous vein (GSV) antireflux procedures have evolved during the past few decades to reduce elevated venous pressure. Untreated reflux in the below knee (BK) GSV (BK-GSV) can lead to persistent venous hypertension and deterioration of the venous circulation. The purpose of the present systematic review was to study the influence of BK-GSV intervention on venous disease progression. Read More

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Renal cell carcinoma in a duplex kidney in pediatric.

Urol Ann 2021 Jul-Sep;13(3):320-322. Epub 2021 Jul 14.

Department of Urology, Division of Pediatric Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Renal cell carcinoma (RCC) in children is relatively uncommon, especially in the absence of syndromes or hereditary diseases. Duplex kidney - as a common congenital anomalies in children - is usually insignificant with no serious impact or known risk of tumor association. Herein, we report a 5-year-old girl who presented with gross hematuria and a right renal mass in duplex system identified on computed tomography. Read More

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ARTERIOVENOUS FISTULA MATURATION: PHYSICAL EXAM vs FLOW STUDY.

Ann Vasc Surg 2021 Aug 17. Epub 2021 Aug 17.

Division of Vascular Surgery, Loma Linda University, Veterans Administration Hospital, Loma Linda, CA. Electronic address:

Purpose: The purpose of this study was to determine the utility of routine duplex flow study 4-6 weeks after primary AVF creation and to compare physical exam against a duplex flow study in predicting fistula maturation. A surveillance algorithm was established to evaluate the naïve fistula after primary creation.

Methods: This was a single institution retrospective review of 155 veterans with primary autogenous AVF creation from 2016-2018. Read More

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European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack.

Eur Stroke J 2021 Jun 18;6(2). Epub 2021 Jun 18.

Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomedica de Lleida (IRBLleida), Universitat de Lleida (UdL), Lleida, Spain.

The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. Read More

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European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack.

Eur Stroke J 2021 Jun 16;6(2):CLXIII-CLXXXVI. Epub 2021 Mar 16.

Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomedica de Lleida (IRBLleida), Universitat de Lleida (UdL), Lleida, Spain.

The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. Read More

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Multiple schwannomas of the facial nerve mimicking cervical lymphoma: a case report.

J Med Case Rep 2021 Aug 20;15(1):436. Epub 2021 Aug 20.

Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Kirrbergerstr. 100, building 6, 66421, Homburg, Germany.

Background: In this report, we describe the first case in literature of a patient with multiple schwannomas of the marginal mandibular branch of the facial nerve.

Case Presentation: A Caucasian patient presented with a sudden onset of left lower facial nerve palsy House-Brackmann score III for 1 month. Computed tomography imaging was performed to exclude a cerebral event and revealed multiple tumors within the left parotid gland. Read More

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[Venous blood flow in ocular vessels of patients with active retinopathy of prematurity].

Vestn Oftalmol 2021 ;137(4):65-71

Kaluga Branch of the S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Kaluga, Russia.

Purpose: To study the characteristics of venous circulation in the eyes with retinopathy of prematurity (ROP) observed in examination of blood flow in the central retinal vein and superior orbital vein in patients with different forms, stages and state of the disease.

Material And Methods: Color duplex scanning of the central retinal vein and superior orbital vein was performed using color Doppler imaging and pulsed Doppler sonography in 55 premature babies (55 eyes) with active ROP and 8 premature babies (8 eyes) with no signs of ROP. All babies included in the study were born at 25-32 weeks of gestation, their birth weight was 680-1760 g. Read More

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Use of the Descending Branch of the Lateral Circumflex Femoral Artery as an Arterial Graft in Living Donor Liver Transplant.

Transplant Proc 2021 Aug 14. Epub 2021 Aug 14.

Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore. Electronic address:

Background: Reconstructing the hepatic artery in living donor liver transplantation presents the challenges of a short and small donor vessel stump, which is compounded by poor surgical access for microsurgical anastomosis. Arterial interpositional grafts (eg, the radial artery) have been used to overcome these problems. The purpose of this presentation is to describe the use of the descending branch of the lateral circumflex femoral artery (DLCFA) as an alternative when the patient has had an abnormal Allen's test precluding the use of the radial artery or if a Y-graft is needed. Read More

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Carotid Web Diagnosed by Ultrasound Carotid Duplex in a Patient With Ischemic Stroke.

Cureus 2021 Jul 12;13(7):e16330. Epub 2021 Jul 12.

Neurovascular Diseases, National Institute of Neurological Sciences, Lima, PER.

Carotid web (CW) is an atypical form of intimal fibromuscular dysplasia that occurs at the level of the carotid bulb. It is associated with ischemic strokes. The first report of this association was in 1967 and it is currently known to represent a significant percentage of cryptogenic stroke. Read More

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1-Year Results From a Prospective Experience on CAS Using the CGuard Stent System: The IRONGUARD 2 Study.

JACC Cardiovasc Interv 2021 Sep 11;14(17):1917-1923. Epub 2021 Aug 11.

Vascular and Endovascular Surgery Unit, Department of Surgery, "Sapienza" University of Rome, Rome, Italy.

Objectives: The aim of this study was to evaluate the 1-year safety and efficacy of a dual-layered stent (DLS) for carotid artery stenting (CAS) in a multicenter registry.

Background: DLS have been proved to be safe and efficient during short-term follow-up. Recent data have raised the concern that the benefit of CAS performed with using a DLS may be hampered by a higher restenosis rate at 1 year. Read More

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September 2021

Venous thromboembolism in lung transplant recipients real world experience from a high volume center.

J Heart Lung Transplant 2021 Jul 22. Epub 2021 Jul 22.

Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania.

Background: Venous thromboembolism (VTE) post lung transplantation is common and has been associated with worse post transplant survival. We report a comprehensive single center review of VTE incidence in the first post transplant year, investigate modifiable risk factors and assess impact on short term outcomes.

Methods: Retrospective review of all lung transplant recipients between August 2016 to 2018 at Temple University Hospital. Read More

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Is there a link between lung parenchyma lesions , BMI , CRP , D-dimer and acute pulmonary embolism in patients infected with COVID-19 ?

Cardiovasc Hematol Disord Drug Targets 2021 Aug 11. Epub 2021 Aug 11.

Service de Médecine Vasculaire , GHRMSA, Hôpital Emile Muller , Mulhouse. France.

Introduction: Since the outbreak of the COVID-19 pandemic , increasing suggests that infected patients present a high incidence of venous thromboembolic events (VTE). The main objective of this retrospective study was to evaluate the prevalence of acute pulmonary embolism (PE) on pulmonary computer tomography angiograms (CTPA) in patients classified as COVID-19 infection. The second objective was to determine if there is a link between D-dimer levels, serum C-reactive protein (CRP ), body mass index (BMI) , the lung parenchyma lesions (LPL) and acute pulmonary embolism (PE) in these patients. Read More

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Spatially distinct reprogramming of the tumor microenvironment based on tumor invasion in diffuse-type gastric cancers.

Clin Cancer Res 2021 Aug 12. Epub 2021 Aug 12.

Department of Surgery, Ajou University School of Medicine

Purpose: Histological features of diffuse-type gastric cancer (GC) indicate that the tumor microenvironment (TME) may substantially impact tumor invasiveness. However, cellular components and molecular features associated with cancer invasiveness in the TME of diffuse-type GCs are poorly understood.

Experimental Design: We performed single-cell RNA-sequencing (scRNA-seq) using tissue samples from superficial and deep invasive layers of cancerous and paired normal tissues freshly harvested from five patients with diffuse-type GC. Read More

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Safety and Efficacy of 2 Intracavernous Injections of Allogeneic Wharton's Jelly-Derived Mesenchymal Stem Cells in Diabetic Patients with Erectile Dysfunction: Phase 1/2 Clinical Trial.

Urol Int 2021 Aug 12:1-9. Epub 2021 Aug 12.

Cell Therapy Center, The University of Jordan, Amman, Jordan.

Background And Objectives: Stem cell therapy is a novel treatment with regenerative ability that can treat erectile dysfunction (ED). This phase 1/2 clinical trial (NCT02945449) using 2 consecutive intracavernous (IC) injections of allogeneic Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) was studied for the first time in the treatment of diabetic patients with ED. The primary outcome was to assess the safety and tolerability, and the secondary outcome was to assess the efficacy of 2 consecutive IC injections of allogeneic WJ-MSCs in diabetic ED. Read More

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Simultaneous Bilateral Primary Occlusion of the Ophthalmic Artery due to Florid Giant Cell Arteritis.

Klin Monbl Augenheilkd 2021 Aug 11. Epub 2021 Aug 11.

Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany.

Purpose: To report a case of simultaneous bilateral ophthalmic artery occlusion in diagnosed giant cell arteritis (GCA).

Observations: A 77-year-old male patient presented to the emergency department with simultaneous vision loss in both eyes for 3 hours. Headache at both temples and jaw claudication had been present for 3 weeks. Read More

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Macrocalcification of intracranial vertebral artery may be related to in-stent restenosis: lessons learned from optical coherence tomography.

J Neurointerv Surg 2021 Aug 10. Epub 2021 Aug 10.

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China

Background: Calcification has been proven to be a marker of atherosclerosis and is related to an increased risk of ischemic stroke. Additionally, calcification was reported to be prevalent in patients with stenotic lesions of the intracranial vertebral artery. Thus, reliable imaging facilities for evaluating plaque calcification have remarkable significance in guiding stenting and predicting patient outcomes. Read More

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Complete study for erectile dysfunction (CompED) improving diagnosis and treatment decision-making.

Andrologia 2021 Aug 9:e14212. Epub 2021 Aug 9.

Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia.

Erectile dysfunction is a condition associated with increasing age. Patient evaluation and management should follow a comprehensive, stepwise approach. The aim of this article was to report our experience with the complete study for erectile dysfunction, including intracavernous injection rigidity test, biothesiometry and colour duplex Doppler ultrasound. Read More

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Precision of Low-Cost Augmented Reality in Prefabricated Cutting Guide for Fibular Free Flap Surgery.

J Craniofac Surg 2021 Aug 6. Epub 2021 Aug 6.

Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine Siriraj hospital, Mahidol University Technology Department, Meticuly Co Ltd Faculty of Information and Communication Technology, Mahidol University, Bangkok, Thailand.

Background: Augmented reality (AR) is an imaging technology encompassing an interactive experience of a real-world environment enhanced by computer-generated perceptual information. It has been introduced to current medical practice to help the preoperative planning in many surgical fields.

Methods: The authors applied AR to the computed tomography angiography of 8 patient's legs. Read More

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