Background:There are limited data on functional and patient-reported outcomes after acute upper-extremity deep vein thrombosis (UEDVT) caused by compression syndromes. Objectives:This study examined patient-reported functional impairment, quality of life, and treatment satisfaction after UEDVT. Methods:We did a retrospective multicenter cohort study of patients with confirmed UEDVT due to compression syndromes not related to central lines. Patients were included at 5 centers in 4 countries and completed a standardized patient-reported outcome survey. The primary outcome was upper-limb function measured via the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score (range, 0-100; higher scores indicate worse function) during follow-up. Quality of life was assessed using a Visual Analogue Scale. Additional outcomes included persistent symptoms, treatment satisfaction, mental health impact, and perception of unmet needs. Results:We included 82 patients (median age, 38 years; Q1-Q3, 26-48 years); 44% were women. All patients received anticoagulation, and 66% underwent catheter-directed therapy. First-rib resection was performed in 24% of patients. After a median follow-up of 16 months, 63% reported ≥1 persistent symptom, most commonly swelling (30%) and heaviness (29%). The median QuickDASH score was 8 (Q1-Q3, 2-20), indicating mild overall disability. QuickDASH correlated negatively with quality of life (Spearman ρ = -0.82; P < .001) and across QuickDASH items and countries. Symptom persistence emerged as the main predictor of residual functional impairment. Patient-reported priorities included maintaining adequate arm function (78%) and avoiding recurrent UEDVT (73%). Conclusion:UEDVT can have lasting functional and psychosocial effects. Patient-reported outcomes reveal a burden that is not captured by traditional clinical metrics and should be integrated into routine care as well in the setting of interventional trials.

May-Thurner syndrome (MTS), also known as iliac vein entrapment syndrome, is caused by extrinsic compression of the left common iliac vein-most often by the right common iliac artery-leading to venostasis and potential development of deep vein thrombosis (DVT). Though historically underdiagnosed, its recognition has increased with the routine use of cross-sectional imaging and intravascular ultrasound (IVUS), which now serves as the gold standard for diagnosis and procedural guidance. MTS primarily affects young women and often presents with unilateral leg swelling, recurrent DVT, or chronic pelvic symptoms. Diagnosis relies on duplex ultrasound, computed tomography or magnetic resonance venography, venography, and IVUS, which can detect subtle intraluminal abnormalities and guide precise stent placement. Endovascular treatment with dedicated venous stents has largely replaced open surgical options due to superior safety, efficacy, and durability. Proper stent selection and IVUS-guided sizing are essential to avoid complications such as restenosis or migration. Postprocedural management includes anticoagulation and patient-specific follow-up. Ongoing research focuses on novel stent technologies, AI-enhanced imaging, and longterm outcome data from registries like the European Venous Registry. Early identification and intervention improve long-term outcomes and quality of life, underscoring the importance of clinical awareness and multidisciplinary care.

OBJECTIVE:This retrospective, multicentre study aimed to assess the prognostic value of a proposed classification system for chronic venous obstruction (CVO) patients undergoing successful interventional procedures. METHODS:This study analysed data from 13 vascular centres, including 1 033 patients with CVO treated between 2015 - 2019. The patients were classified into five category types: 1 - non-thrombotic iliac vein lesion; 2 - CVO of iliac segment; 3 - CVO of iliofemoral segment above common femoral vein confluence; 4 - CVO of iliofemoral segment extending into the femoral vein (FV) or deep femoral vein (DFV); and 5 - CVO of iliofemoral segment involving both DFV and FV. Stent deployment, complications, and follow ups were evaluated. Uni- and multivariable analyses were performed to identify predictors of primary patency loss. RESULTS:The mean age of the patients was 44.0 ± 14.7 years, with 59.9% being women. A median of two stents was used for unilateral cases and five stents for bilateral cases. At twelve months follow up, primary patency rates for types 1 - 5 were 94.9%, 90.3%, 80.8%, 60.6%, and 39.4%, respectively. These rates were strongly correlated with the extent of CVO and showed significant differences between each type. Univariable analysis identified predictors of primary patency loss as the type of CVO, history of deep vein thrombosis, and the total number of stents. In the multivariable analysis, the significant independent predictors of primary patency loss were the type of CVO and the total number of stents. CONCLUSION:The proposed anatomical classification of iliofemoral CVO will help to predict intervention outcomes and facilitate comparison of stent outcomes in future studies. However, further evaluation and validation in prospective studies are needed to confirm the utility of this classification.

Background Data on availability, affordability, and accessibility is key for the planning of global strategies to reduce the burden of venous thromboembolism (VTE). Objectives A survey was conducted for the 10th anniversary of World Thrombosis Day to assess the availability of VTE therapies worldwide and challenges in uniform implementation. Methods We gathered information on the approval status, availability, utilization, occurrence of shortages, and spread of medical and interventional therapies for VTE. Furthermore, we collected information by accessing or contacting national or continental medicines agencies, manufacturers or distributors, and online drug repositories. Results We obtained data from a total of 69 countries: 33 countries in Europe, 19 in Asia, 7 in the Americas, 9 in Africa, and 1 in Oceania. Unfractionated heparin, low-molecular-weight heparin, and vitamin K antagonists were available in almost all countries, but shortages were recorded in 13%, 19%, and 15% of them, respectively. Direct oral anticoagulants were available in approximately three-quarters of the surveyed countries. At least one parenteral medication for heparin-induced thrombocytopenia was available in 57% of countries and a shortage was reported in 9% of these. Shortage of thrombolytics was recorded in 50% of countries. Overall, at least one type of catheter-directed therapy system was approved for use in 77% of countries and available in 23% of surveyed institutions. Our findings revealed notable geographic disparities in the worldwide availability of VTE therapies, the access to which appeared to be limited by economic and geopolitical factors. Conclusion We anticipate that this comprehensive information will play a pivotal role in highlighting the shortcomings of VTE therapies and the lack of homogeneous availability globally.

More than 10 years ago, an identified need came to life through the dedication of the International Society on Thrombosis and Haemostasis (ISTH) Council. Together, they envisioned a global movement that would shed light on the burden of thrombosis and highlight the significance of awareness, prevention, and treatment. Thus, World Thrombosis Day (WTD) was established on October 13, the birthday of Rudolf Virchow. Led by a Steering Committee of passionate visionaries from 14 countries, the campaign officially launched in 2014 under the guidance of WTD's founding Steering Committee Chair, Gary Raskob, PhD, now Senior Vice President and Provost at the University of Oklahoma in the United States. As the inaugural chair from 2014 to 2019, Raskob worked to ensure that the campaign was founded on published data and knowledge. The committee called attention to the startling statistic that 1 in 4 people globally dies of conditions related to thrombosis each year [[1]Raskob G.E. Angchaisuksiri P. Blanco A.N. Buller H. Gallus A. Hunt B.J. Hylek E.M. Kakkar A. Konstantinides S. McCumber M. Ozaki Y. Wendelboe A. Weitz J.I. Thrombosis: a major contributor to global disease burden.J Thromb Haemost. 2014; 12: 1580-1590Abstract Full Text Full Text PDF PubMed Scopus (308) Google Scholar] and, together with the committee, issued a powerful call to action to "Know Thrombosis" and "Keep Life Flowing." The campaign continued to grow during this time, utilizing social media as an important channel for communication. WTD also incorporated a strong media program, integrating media outreach, journalist meet-and-greets, press releases, video assets, and patient stories, to illustrate the condition, the importance of prevention, and the need for mandated venous thromboembolism risk assessments in hospitals. "WTD has been instrumental in raising awareness about the burden of thrombosis and the importance of prevention and treatment," said Raskob. "We have made great progress over the past 10 years with important research conducted and knowledge contributed, but there is still much work to do to ensure that people are aware and health care professionals know how to diagnose and treat this dangerous condition." WTD published data in 2014 [[1]Raskob G.E. Angchaisuksiri P. Blanco A.N. Buller H. Gallus A. Hunt B.J. Hylek E.M. Kakkar A. Konstantinides S. McCumber M. Ozaki Y. Wendelboe A. Weitz J.I. Thrombosis: a major contributor to global disease burden.J Thromb Haemost. 2014; 12: 1580-1590Abstract Full Text Full Text PDF PubMed Scopus (308) Google Scholar] on the burden of thrombotic disease, in addition to the campaign's first public awareness survey. These projects were significant milestones in the development of the campaign. The article revealed the high prevalence and mortality rates associated with thrombosis, and the survey, conducted in 9 countries, showed significant lack of knowledge of deep vein thrombosis, pulmonary embolism, and venous thromboembolism, supporting the campaign's mandate to address this public health concern. Beverley Hunt, MD, OBE, a distinguished professor at King's College, London, United Kingdom, and former Chair of the WTD Steering Committee (2019-2022), brought her research prowess and advocacy to the campaign. As a renowned hematologist with an impressive publication record, Hunt worked on the frontline during the COVID-19 pandemic. Her work and research resulted in articles on treatment guidelines, best practices, and public health messages to enhance the lives of those affected by thrombosis. During her tenure, the ISTH and WTD campaign collaborated closely with the World Health Organization Patient Safety Group, jointly aiming to increase global awareness and prevention of hospital-associated thrombosis. "Thrombosis can affect anyone, regardless of age or gender, and may go undiagnosed without appropriate attention," Hunt said. "By increasing knowledge and understanding of thrombosis among health care professionals, policymakers, and the general public, we can work together to save lives and improve patient outcomes." Lana Castellucci, MD, MSc, Associate Professor in the Faculty of Medicine at the University of Ottawa, and current WTD Steering Committee Chair, is passionate about her role to inspire new research, empower patients, and encourage the development of new treatment options. Excited to recognize the 10th anniversary of the campaign, Castellucci capitalizes on understanding the signs, symptoms, and risk factors of thrombosis as well as the importance of prevention. Lana shares, "Preventing blood clots is crucial for good health. Maintaining a healthy lifestyle that includes regular exercise, a balanced diet, and avoiding smoking and excessive alcohol consumption can help. Those at higher risk may need medications or devices. These steps reduce the risk of dangerous blood clots and protect overall health." In 2022, WTD achieved remarkable global reach, surpassing 10.5 billion people [[2]International Society on Thrombosis and Haemostasis (2022). World Thrombosis Day.www.worldthrombosisday.org/Date: 2015Date accessed: May 15, 2023Google Scholar]. The impact report reveals the campaign's effectiveness in utilizing social media platforms, generating 540 million impressions, whereas traditional media outreach led to 146 million impressions. Additionally, videos produced by WTD garnered 662 667 views, displaying the power of visual content in raising awareness. WTD also emphasized the importance of patient stories, with over 250 stories of perseverance shared. Despite these accomplishments, the campaign continues to grow and is dedicated to prioritizing efforts for the prevention and treatment of thrombosis. As the WTD campaign celebrates its 10th anniversary, we invite you to join us. We can make a greater impact by celebrating progress, inspiring new ideas, and working toward reducing the incidence, morbidity, and mortality of this life-threatening condition. Together, we can make a positive change and ensure a brighter future for those affected by thrombosis. There are no competing interests to disclose.

Introduction Venous thromboembolism (VTE) is a leading cause of cardiovascular morbidity and mortality. The majority of VTE events are hospital-associated. In 2008, the Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) multinational cross-sectional study reported that only approximately 40% of medical patients at risk of VTE received adequate thromboprophylaxis. Methods In our systematic review and meta-analysis, we aimed at providing updated figures concerning the use of thromboprophylaxis globally. We focused on: (a) the frequency of patients with an indication to thromboprophylaxis according with individual models; (b) the use of adequate thromboprophylaxis; and (c) reported contraindications to thromboprophylaxis. Observational nonrandomized studies or surveys focusing on medically ill patients were considered eligible. Results After screening, we included 27 studies from 20 countries for a total of 137 288 patients. Overall, 50.5% (95% confidence interval [CI]: 41.9-59.1, I-2 99%) of patients had an indication to thromboprophylaxis: of these, 54.5% (95% CI: 46.2-62.6, I-2 99%) received adequate thromboprophylaxis. The use of adequate thromboprophylaxis was 66.8% in Europe (95% CI: 50.7-81.1, I-2 98%), 44.9% in Africa (95% CI: 31.8-58.4, I-2 96%), 37.6% in Asia (95% CI: 25.7-50.3, I-2 97%), 58.3% in South America (95% CI: 31.1-83.1, I-2 99%), and 68.6% in North America (95% CI: 64.9-72.6, I-2 96%). No major differences in adequate thromboprophylaxis use were found across risk assessment models. Bleeding, thrombocytopenia, and renal/hepatic failure were the most frequently reported contraindications to thromboprophylaxis. Conclusions The use of anticoagulants for VTE prevention has been proven effective and safe, but thromboprophylaxis prescriptions are still unsatisfactory among hospitalized medically ill patients around the globe with marked geographical differences.

Background: The optimal treatment of high-risk PE with cardiac arrest is still controversial although various treatment approaches have been developed and improved. Here, we present a serie of patients with high-risk PE showing hemodynamic collapse, who were successfully treated with extracorporeal membrane oxygenation (ECMO) as an adjunct to EKOS™ acoustic pulse thrombolysis. Method: From April 2016 to June 2020, 29 patients with high-risk PE with cardiac arrest were retrospectively included. The mean age was 55.3 ± 9.2 years. Twelve (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in-hospital after the presentation. All patients exhibited acute symptoms, computed tomography (CT) evidence of large thrombus burden, and severe right ventricular dysfunction. Primary outcome was all-cause 30-day mortality. Results: Twenty-two patients survived to hospital discharge, with a mean ICU stay of 9.9 ± 1.6 days (range, 7 to 22 days) and mean length of hospital stay of 23.7 ± 8.5 days (range, 11 to 44 days). Six patients died from refractory shock. Ninety-day mortality was 24.1% (7/29). The Mean ECMO duration was 3.5 ± 1.1 days and the mean RV/LV ratio decreased from 1.31 ± 0.17 to 0.92 ± 0.11 in patients who survived to discharge. The mean tissue plasminogen activator (tPA) dose for survivor patients was 20.5 ± 1.6 mg. Conclusion: Patients with high-risk pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. APT complemented by ECMO could be a successful treatment option for patients who have high-risk PE with circulatory collapse.

Ilio-femoral deep vein thrombosis (DVT) has a high rate of long-term morbidity in the form of the postthrombotic syndrome (PTS). Therefore, management of acute thrombosis should not only focus on the prevention of acute complications such as propagation or embolisation of the initial clot but also on preventing recurrent thrombosis and PTS. Contemporary catheter-based treatments of deep vein thrombosis have proven to be safe and effective in selected patients. Current guidelines recommend medical therapy with anticoagulation alone for all but the most severe, limb-threatening thrombosis. They additionally allow for consideration of endovascular catheter-based treatment in selected patients with acute proximal ilio-femoral DVT and low risk of bleeding complications to prevent PTS. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups with acute iliofemoral DVT.

Currently, the only widely accepted indication for interventional treatment in cases of pulmonary embolism is hemodynamic instability or cardiogenic shock. However, the presence of a right-heart thrombus along with a pulmonary embolism is a poor prognostic indicator, and catheter directed thrombolysis with use of thrombolytic agents should also be considered in this circumstance. Optimal management of right heart thrombus and high-risk pulmonary embolism is still uncertain. Herein, we present the case of an 81-year-old woman who presented at our hospital after progressive dyspnea and a syncopal event. The transthoracic echocardiography showed massive bilateral pulmonary, right ventricular and mobile atrial thrombus and also right-sided enlargement. The patient was successfully treated with acoustic pulse thrombolysis using the EKOS EkoSonic system and echocardiography revealed complete resolution of her right-heart thrombus and her high-risk pulmonary embolism 2 days later.

Risk-benefit balance may depend on illness severity

Objective To examine the efficacy and durability of an interwoven self-expanding nitinol stent for the treatment of superficial femoral and popliteal arteries. Method Consecutive patients with severely diseased superficial femoral and popliteal arteries who received SUPERA (R) stents were retrospectively identified. The patients were followed for 12 months by Doppler ultrasound examinations, stent roentgenograms, and estimation of Rutherford-Becker class and ankle-brachial index. Results From July 2012 to May 2014, 42 limbs in 36 patients (mean age, 61.5 +/- 7.5 years; 75% male) were treated with angioplasty and primary stenting. Total occlusions were present in 14 limbs, and 63.8% had either moderate or severe calcification. The mean (+/- SD) lesion length was 105 mm (+/- 28). Primary patency was 91.4% at 6 months and 85.7% at 12 months. The ankle brachial index increased from 0.57 +/- 0.19 preoperative to 0.91 +/- 0.12 postoperative. There was no procedural or device-related morbidity or mortality after revascularization and only one major amputation was observed on follow-up. Conclusions Our experience shows that, Supera stents are safe and effective in our cohort of patients, with acceptable patency rates. There were no stent fractures so far even with stenting of the femoropopliteal segments. Stent design provides a viable option for high-grade obstructive disease in the femoropopliteal artery.

Journal of Thrombosis and HaemostasisVolume 20, Issue 2 p. 532-535 RESEARCH LETTER Current practices of standardized risk assessment for venous thromboembolism: Results from a global survey from the World Thrombosis Day steering committee Aaron M. Wendelboe, Corresponding Author Aaron M. Wendelboe Aaron-Wendelboe@ouhsc.edu orcid.org/0000-0002-8670-7730 Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA Correspondence Aaron M. Wendelboe, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th St. CHB 301 - 405-271-2229, 73104 Oklahoma City, OK, USA. Email: Aaron-Wendelboe@ouhsc.eduSearch for more papers by this authorHannah Langenfeld, Hannah Langenfeld Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USASearch for more papers by this authorWalter Ageno, Walter Ageno Department of Clinical Medicine, University of Insubria, Varese, ItalySearch for more papers by this authorLana Castellucci, Lana Castellucci Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, CanadaSearch for more papers by this authorGabriela Cesarman-Maus, Gabriela Cesarman-Maus orcid.org/0000-0002-8397-0330 Department of Hematology, Instituto Nacional de Cancerología, Mexico City, MexicoSearch for more papers by this authorHenry Ddungu, Henry Ddungu Uganda Cancer Institute, Kampala, UgandaSearch for more papers by this authorErich Vinicius De Paula, Erich Vinicius De Paula orcid.org/0000-0003-1539-7912 School of Medical Sciences, University of Campinas, Campinas, BrazilSearch for more papers by this authorMert Dumantepe, Mert Dumantepe Department of Cardiovascular Surgery, Uskudar University School of Medicine, Istanbul, TurkeySearch for more papers by this authorGabor Forgo, Gabor Forgo orcid.org/0000-0003-0810-750X Department of Angiology, University Hospital Zurich, Zurich, SwitzerlandSearch for more papers by this authorMaria Cecilia Guillermo Esposito, Maria Cecilia Guillermo Esposito Department of Hematology, Hospital de Clinicas Facultad de Medicina, Universidad de la República Montevideo, Montevideo, UruguaySearch for more papers by this authorClaire McLintock, Claire McLintock orcid.org/0000-0002-4771-8760 National Women’s Health, Auckland City Hospital, Auckland, New ZealandSearch for more papers by this authorFionnuala Ní Áinle, Fionnuala Ní Áinle orcid.org/0000-0003-0163-792X Department of Haematology, Mater Misericordiae University Hospital and Rotunda Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, IrelandSearch for more papers by this authorAlex C. Spyropoulos, Alex C. Spyropoulos orcid.org/0000-0002-3175-461X Institute for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research and the Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, USASearch for more papers by this authorTetsumei Urano, Tetsumei Urano Shizuoka Graduate University of Public Health, Shizuoka, JapanSearch for more papers by this authorStefano Barco, Stefano Barco orcid.org/0000-0002-2618-347X Department of Angiology, University Hospital Zurich, Zurich, Switzerland Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, GermanySearch for more papers by this authorBeverley J. Hunt, Beverley J. Hunt orcid.org/0000-0002-4709-0774 Thrombosis & Haemophilia Centre, Guys & St Thomas’ NHS Foundation Trust, London, UKSearch for more papers by this author Aaron M. Wendelboe, Corresponding Author Aaron M. Wendelboe Aaron-Wendelboe@ouhsc.edu orcid.org/0000-0002-8670-7730 Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA Correspondence Aaron M. Wendelboe, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th St. CHB 301 - 405-271-2229, 73104 Oklahoma City, OK, USA. Email: Aaron-Wendelboe@ouhsc.eduSearch for more papers by this authorHannah Langenfeld, Hannah Langenfeld Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USASearch for more papers by this authorWalter Ageno, Walter Ageno Department of Clinical Medicine, University of Insubria, Varese, ItalySearch for more papers by this authorLana Castellucci, Lana Castellucci Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, CanadaSearch for more papers by this authorGabriela Cesarman-Maus, Gabriela Cesarman-Maus orcid.org/0000-0002-8397-0330 Department of Hematology, Instituto Nacional de Cancerología, Mexico City, MexicoSearch for more papers by this authorHenry Ddungu, Henry Ddungu Uganda Cancer Institute, Kampala, UgandaSearch for more papers by this authorErich Vinicius De Paula, Erich Vinicius De Paula orcid.org/0000-0003-1539-7912 School of Medical Sciences, University of Campinas, Campinas, BrazilSearch for more papers by this authorMert Dumantepe, Mert Dumantepe Department of Cardiovascular Surgery, Uskudar University School of Medicine, Istanbul, TurkeySearch for more papers by this authorGabor Forgo, Gabor Forgo orcid.org/0000-0003-0810-750X Department of Angiology, University Hospital Zurich, Zurich, SwitzerlandSearch for more papers by this authorMaria Cecilia Guillermo Esposito, Maria Cecilia Guillermo Esposito Department of Hematology, Hospital de Clinicas Facultad de Medicina, Universidad de la República Montevideo, Montevideo, UruguaySearch for more papers by this authorClaire McLintock, Claire McLintock orcid.org/0000-0002-4771-8760 National Women’s Health, Auckland City Hospital, Auckland, New ZealandSearch for more papers by this authorFionnuala Ní Áinle, Fionnuala Ní Áinle orcid.org/0000-0003-0163-792X Department of Haematology, Mater Misericordiae University Hospital and Rotunda Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, IrelandSearch for more papers by this authorAlex C. Spyropoulos, Alex C. Spyropoulos orcid.org/0000-0002-3175-461X Institute for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research and the Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, USASearch for more papers by this authorTetsumei Urano, Tetsumei Urano Shizuoka Graduate University of Public Health, Shizuoka, JapanSearch for more papers by this authorStefano Barco, Stefano Barco orcid.org/0000-0002-2618-347X Department of Angiology, University Hospital Zurich, Zurich, Switzerland Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, GermanySearch for more papers by this authorBeverley J. Hunt, Beverley J. Hunt orcid.org/0000-0002-4709-0774 Thrombosis & Haemophilia Centre, Guys & St Thomas’ NHS Foundation Trust, London, UKSearch for more papers by this author First published: 26 November 2021 https://doi.org/10.1111/jth.15608 Manuscript handled by: David Lillicrap Final decision: David Lillicrap, 18 November 2021 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume20, Issue2February 2022Pages 532-535 RelatedInformation

INTRODUCTION:Pulmonary embolism (PE) has not been accounted for as a cause of death contributing to cause-specific mortality in global reports. METHODS:We analyzed global PE-related mortality by focusing on the latest year available for each member state in the World Health Organization (WHO) mortality database, which provides age-sex-specific aggregated mortality data transmitted by national authorities for each underlying cause of death. PE-related deaths were defined by International Classification of Diseases, Tenth Revision codes for acute PE or nonfatal manifestations of venous thromboembolism (VTE). The 2001 WHO standard population served for standardization. RESULTS:We obtained data from 123 countries covering a total population of 2 602 561 422. Overall, 50 (40.6%) were European, 39 (31.7%) American, 13 (10.6%) Eastern Mediterranean, 13 (10.6%) Western Pacific, 3 (2.4%) Southeast Asian, and 2 (1.6%) African. Of 116 countries classifiable according to population income, 57 (49.1%) were high income, 42 (36.2%) upper-middle income, 14 (12.1%) lower-middle income, and 3 (2.6%) low income. A total of 18 726 382 deaths were recorded, of which 86 930 (0.46%) were attributed to PE. PE-related mortality rate increased with age in most countries. The reporting of PE-related deaths was heterogeneous, with an age-standardized mortality rate ranging from 0 to 24 deaths per 100 000 population-years. Income status only partially explained this heterogeneity. CONCLUSIONS:Reporting of PE-related mortality in official national vital registration was characterized by extreme heterogeneity across countries. These findings mandate enhanced efforts toward systematic and uniform coverage of PE-related mortality and provides a case for full recognition of PE and VTE as a primary cause of death.

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Mert Dumantepe1*, Emre Salihlioğlu2, Murat Okten1, Nalan Karadag3, Alper Ozkan3, Yasemin Gundogdu4, Selim Isbir1 and Hasan Karabulut1 1Department of Cardiovascular Surgery, Acibadem Altunizade Hospital, Istanbul, Turkey 2Department of Anesthesiology, Acibadem Altunizade Hospital, Istanbul, Turkey 3Department of Cardiology, Acibadem Altunizade Hospital, Istanbul, Turkey 4Department of Internal Medicine, Acibadem Altunizade Hospital, Istanbul, Turkey

Background The radial artery (RA) is the second most used conduit in coronary artery bypass surgeries. The increased harvest of RA demands new approaches towards the use of this conduit. We aim to compare the efficiency of electrocautery with the vessel sealing system LigaSure™. Materials and Methods This is a randomized trial comparing the use of LigaSure™ vessel sealing system and electrocautery in RA harvesting for coronary artery bypass surgery. Patients were randomly assigned into two groups. Group 1 consists of 27 patients operated with The LigaSure™ small jaw sealer/divider and Group 2 consists of 26 patients operated with electrocautery. Results During the study, 53 patients were operated. 44 of them were men and 9 of them were women. Difference between age and BMI were statistically insignificant. The amount of blood loss from the beginning of harvesting to the end of the closure of the skin of left arm was significantly less in group 1 (p=0,004). The difference in number of hemostatic clips before and after the anastomosis of radial artery to coronary artery are likewise statistically significant and less in group 1 (p<0,001; p<0,001 respectively). The amount of blood loss postoperatively (p>0,6), number of ecchymoses (p>0,1), hematoma (p>0,1) and infection postoperatively (p>0,03) are found to be statistically insignificant. Conclusion The LigaSure™vessel sealing system is found to be a better option of harvesting in patients that are prone to bleed.

Introduction: Post-thrombotic obstruction can be adequately treated by percutaneous transluminal angioplasty and stenting. When post-thrombotic trabeculations extend below the femoral confluence, proper inflow can be facilitated by endophlebectomy, patchplasty and creation of an arteriovenous fistula (AVF). The aim of this study was to investigate whether it is more favorable PTFE graft for the AVF at the endophlebectomy site to prevent early stenosis or occlusion. We carried out a prospective randomized study to compare the patency of standard grafts with heparin-bonded grafts. Methods: A temporary femoral AVF is created using a ring-reinforced 6 mm PTFE graft between June 2016 and January 2018. Patients were randomized to receive either a standard polytetrafluorethylene (PTFE) graft or a heparin-bonded ePTFE graft (Propatenâ, W. L. Gore & Associates). The fistula was given a loop-like shape to simplify later percutaneous plug occlusion. We analyzed the clinical data of all patients who underwent a hybrid procedure in our center. Demographics, interventional details and post-operative imaging were collected Results: In this study, 38 patients were randomized and followed up for 6 months. No patient was lost to follow-up. Primary patency was 45% (10/22) and 31% (7/22) for standard PTFE grafts and 100% (16/16) and 93.7% (15/16) for heparin-bonded Propaten at 3 and 6 months, respectively (P <0.001). There were significantly fewer thromboses in heparin-bonded grafts compared to standard PTFE during the first 6 months (P <0.001). Of 22 standard PTFE grafts, 15 were eventually occluded versus only 1 heparin-bonded ePTFE graft. Logistic regression showed that only reduced femoral inflow (hazard ratio 2.946 (95%CI, 1.148–7.494)) was a significant predictor of early iliac venous stent stenosis and/or occlusion. Furthermore, logistic regression for risk of occlusion showed a significant influence of graft-related complications (hazard ratio 4.377 (95%CI, 1.205–18.260)) and a tendency towards influence of arteriovenous fistula flow and patency in favor of the Heparin bounded Propaten. Bleeding complications, infections rates were similar in both groups. Conclusion: Placement of the temporary arteriovenous fistula of the endophlebectomy site during hybrid recanalization may result in a more favorable outcome. Heparin-bonded ePTFE grafts demonstrated a trend to improved patency, and the difference was statistically significant. Moreover, Propaten grafts had a significantly lower early thrombosis rate that was sustained for 6 months of follow-up for this extremely unique indication.

Introduction: Popliteal artery injury is a potentially-limb threatening complication of traumatic knee dislocation. The purpose of this study was to evaluate the feasibility and effectiveness of endovascular repair of traumatic popliteal a3.102rterial injuries.

Background: Chronic post-thrombotic occlusion of the iliofemoral veins causes significant morbidity, which can be alleviated if venous drainage is restored. We report our technique of surgical endophlebectomy and patchplasty of the common femoral vein (CFV) in conjunction with iliac vein stenting to restore venous flow from the infrainguinal venous system to the vena cava. Methods: There were 157 patients who underwent CFV endophlebectomy combined with iliocaval recanalization. Questionnaires were completed both preoperatively and postoperatively to allow comparison. These included the Clinical, Etiology, Anatomy, and Pathophysiology clinical classification; the Venous Clinical Severity Score; the Villalta scale; the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms; and the 36-Item Short Form Health Survey quality of life questionnaire. Results: Mean follow-up duration was 14.4 +/- 2.9 months (range, 10-29 months). The mean preoperative Venous Clinical Severity Score was 15.3 +/- 2.2, and this fell to 6.1 +/- 1.8 after treatment (P < .001). The mean preoperative Villalta score dropped from 12.7 +/- 2.6 to 6.3 +/- 1.4 (P < .001). The quality of life and symptom severity scores were improved after 3 months by 17.2 points for quality of life (P < .001) and 20.5 points for symptom severity (P < .001). Primary patency was 81% (124/153) and secondary patency was 89.5% (137/153) at 12 months. Wound complications related to groin incision and lymphatic fistulas were observed in 22.8% (35/153) and 28.7% (44/153), respectively. Conclusions: The hybrid operation of CFV endophlebectomy in conjunction with iliac vein recanalization should be considered a safe and effective treatment option in patients with severe post-thrombotic syndrome and iliofemoral veno-occlusive disease.