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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 3 | Issue 4
Page Nos. 99-137

Online since Thursday, December 24, 2020

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EDITORIALS  

What's about pelvic congestion syndrome p. 99
Pier Luigi Antignani
DOI:10.4103/VIT.VIT_25_20  
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Outpatient execution of vascular ultrasound diagnostic tests during the COVID-19 pandemic position paper of the Italian Society for Vascular Investigation p. 102
Giacomo Failla, Leonardo Aluigi, Pier Luigi Antignani, Filippo Magnoni, Tiziana Baroncelli, Domenico Benevento, Sergio De Marchi, Elia Diaco, Dimitrios Kontothanassis, Ferdinando Mannello, Gianfranco Varetto, Luca Costanzo
DOI:10.4103/VIT.VIT_27_20  
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ORIGINAL ARTICLES Top

Prevalence of abdominal aortic aneurysms and iliac aneurysms in the UK population of 50,000 women p. 104
M Chabok, A Nicolaides, M Aslam, M Farahmandfar, K Humphries, NZ Kermani, N Standfield
DOI:10.4103/VIT.VIT_21_20  
BACKGROUND AND AIMS: Screening men aged 65–80 years for abdominal aortic aneurysm (AAA) is considered economically viable when the prevalence of AAA is 1.0% or higher. Currently, women are not included in AAA screening programs because the prevalence of AAA is <1.0%. The aim of the present analysis is to report (a) the prevalence of AAA ≥3.0 cm or isolated iliac aneurysm (IIA) ≥1.8 cm in women screened with ultrasound (b) the risk factors associated with AAA or IIA in this population, and (c) whether high-risk groups can be identified with an AAA or IIA prevalence of >1.0%. MATERIALS AND METHODS: Risk factors were collected from 50,000 females who attended for cardiovascular screening. Ultrasound was used to detect the presence of AAA or IIA, the severity of carotid atherosclerosis, and the measurement of ankle/brachial index (ABI). Electrocardiogram (ECG) was used to detect the presence of atrial fibrillation (AF). RESULTS: Aneurysms were detected in 116 women. Of these aneurysms, 34 (29%) were IIA and 82 were AAA. The presence of AAA or IA below the age of 66 years was rare (10 of 24,499). In the age group of 66–85, there were 102 (0.41%) in 27,170 women, of which 72 were AAA and 30 IIA. By including IIA in the screening protocol for AAA, it became easy to identify subgroups with an aneurysm prevalence >1%. Univariate analysis demonstrated that the presence of any one of the following risk factors, history of myocardial infarction or coronary artery disease, history of stroke/transient ischemic attack (TIA), pack-years ≥10, AF, ABI <0.9, and internal carotid stenosis ≥50% can identify a high-risk group with a prevalence of AAA or IIA >1.0% (range 1.18–2.06). In a multivariable linear logistic regression, age ≥76, hypertension, pack-years, family history of AAA, and history of stroke/TIA were independent predictors for the presence of AAA or IIA. This model had an area under the receiver operator characteristic curve (AUC) of 0.725 (95% confidence interval [CI] 0.673–0.777) and could identify 2947 women who had 41 AAA or IIA present (prevalence 1.39%). By adding ABI and AF, which require a clinical examination and ECG, the receiver operator characteristic (ROC), AUC increased to 0.745 (95% CI 0.693–0.797). This model could identify 3693 women who had 51 AAA or IIA present (prevalence 1.40%). The presence of ≥50% diameter internal carotid stenosis found in 498 women was associated with a prevalence of AAA or IIA of 3.61%, and when added to the model the ROC AUC increased to 0.775 (95% CI 0.724–0.826). This model could identify 3701 women who had 58 AAA or IIA present (prevalence 1.6%). CONCLUSION: The findings of this study have important implications for developing a screening selection plan for women over 65. By including IIA in the screening protocol for AAA, it became easy to identify subgroups with an aneurysm prevalence >1%. The presence of any one or more of the risk factors listed above can be used to develop targeted screening because of increased risk (>1%). However, whether such screening will be associated with benefits can only be determined by randomized controlled trials and cost-benefit studies.
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The beneficial role of intravascular ultrasound in the diagnosis and treatment of nonthrombotic iliac venous obstructions as compared with traditional venography in the Chinese population p. 111
Yong Ding, Min Zhou, Liang Cai, Xu Li, Tianchen Xie, Fen Yu, Daqiao Guo, Zhenyu Shi
DOI:10.4103/VIT.VIT_26_20  
PURPOSE: The efficacy of intravascular ultrasound (IVUS) in diagnosing obstructive venous lesions has been established in the Western countries; however, its beneficial role in the Asian population is seldom reported. Because IVUS is still not widely used in China, we, therefore, investigated whether the salutary effect of IVUS on the diagnosis and treatment of iliac venous outflow obstructions could also be extended to the Chinese population. MATERIALS AND METHODS: This was a prospective single-center study. Patients with nonthrombotic iliac venous obstructions were consecutively enrolled from September 2017 to September 2019. IVUS and venography were performed for every participant. The anatomic characteristics of the venous lesions were measured by these two imaging modalities and then compared with each other. Venous lesions were divided into the collateral and noncollateral group according to the presence of collaterals on venographic images, and comparison was performed between the two groups. The difference of lesion diameter or area at the most compression site was also observed after the endovascular intervention. RESULTS: A total of 50 patients with 59 limbs were eligible (males, 25; females, 25; mean age 63.46 ± 8.07). The clinical-etiology-anatomy-pathophysiology classification was C4: 43 (72.88%), C5: 6 (10.17%), and C6: 10 (16.95%). Compared with IVUS, the diameter and area stenosis calculated by traditional venography were dramatically lower than that measured by IVUS (diameter stenosis, 38.56% ± 17.76% vs. 64.55% ± 15.96%, P < 0.001; area stenosis: 51.14% ± 19.50% vs. 60.11% ± 13.86%, P = 0.003). Based on a previously reported 50% stenosis threshold (significant stenosis), traditional venography displayed a low sensitivity of 23.91% and an acceptable specificity of 84.62% in detecting significant lesions. The overall intermodality agreement was extraordinarily low between venography and IVUS (κ = 0.045). With no major difference in the baseline characteristics, the area stenosis measured by IVUS was not significantly different between the collateral and noncollateral group (61.31% ± 15.29% vs. 57.94% ± 10.79%, P = 0.376). IVUS also confirmed a significant increase of the compressed vein lumen after the endovascular intervention. CONCLUSIONS: Compared with IVUS, traditional venography underestimates the degree of stenosis and misses significant iliac venous obstructive lesions. The collaterals presented by venography is not a reliable indicator in distinguishing significant lesions. IVUS is a valuable and effective imaging modality in the diagnosis and treatment of nonthrombotic iliac venous obstructions in the Chinese population.
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REVIEW ARTICLE Top

The current approaches to the management of coronavirus disease 2019 associated coagulopathy p. 119
Kirill Lobastov, Ilya Schastlivtsev, Olga Porembskaya, Olga Dzhenina, Astanda Bargandzhiya, Sergey Tsaplin
DOI:10.4103/VIT.VIT_19_20  
Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the severe acute respiratory syndrome-CoV-2 virus that appeared in China and has spread globally. Accumulating evidence suggests that the development of specific prothrombotic changes in patients with COVID-19 reflected a high incidence of thrombotic complications. This paper is a narrative review of the diagnostic and management of COVID-19-associated coagulopathy and related venous thromboembolism (VTE). The consecutive search and review of relevant literature were carried out between March 23 and May 22, 2020. Eleven studies assessing the incidence of VTE and eleven guidelines on the management of coagulopathy were identified. The prevalence of VTE in patients with COVID-19 appeared to be unexpectedly high, reaching 8%–13% in the general ward and 9%–18% in the intensive care unit despite pharmacological prophylaxis. The current guidelines suggest prophylactic anticoagulation with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in all inpatients. Intensified anticoagulation in the absence of VTE is not generally recommended but may be considered for patients with obesity, elevated D-dimer, an individually highest risk of VTE, or critical illness. The value of mechanical prophylaxis is underestimated. Extended prophylaxis after discharge may be indicated for patients with increased risk of VTE and low risk of bleeding. Increased D-dimer may be used as an indication for VTE screening by appropriate imaging tests. If VTE is highly suspected according to the clinical signs or D-dimer, then therapeutic anticoagulation may be initiated before VTE confirmation. For putative or confirmed VTE, therapeutic anticoagulation with LMWH or UFH is preferred during inpatient treatment, followed by switching to direct oral anticoagulants after discharge for 3 months. Primary VTE prophylaxis for outpatients is not generally recommended. Most of the guidelines are interim and ambiguous.
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CASE REPORT Top

Vertebral-carotid transposition can treat various diseases p. 132
Yuanrui Gu, Yangxue Sun, Jingjing Ren, Chenxi Ouyang
DOI:10.4103/VIT.VIT_18_20  
Vertebral-carotid transposition (VCT), which is a treatment of vertebral artery stenosis, has excellent long-term efficacy. VCT can also be suitable for various situations where the blood supply of the vertebral artery must be reconstructed. Here, we present an early result of six cases for these anomalies by VCT. Case 1: A 58-year-old male presented with the severe stenosis at the left vertebral V1 segment. Case 2: A 59-year-old female suffered from moderate-to-severe stenosis at the first portion of the left subclavian artery. Case 3: A 55-year-old female experienced severe stenosis at the left vertebral V1 segment, which the wire could not pass through. Case 4: A 53-year-old female presented with the subclavian aneurysm at the origin of the right vertebral artery. Case 5: A 65-year-old male suffered from the long complete occlusion at the origin of the left subclavian artery, a severe stenosis at the origin of the left internal carotid artery, a severe stenosis at the origin of the right internal carotid artery, and a severe stenosis at the right vertebral V1 segment. Case 6: A 56-year-old male experienced the thrombus in the stent of the vertebral artery which had been placed 6 months ago. There are six cases, in which VCT was adapted. VCT is safe and effective for various situations when the blood supply of the vertebral artery must be reconstructed.
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LETTER TO EDITOR Top

Bilateral medulloblastoma p. 136
Varun Aggarwal, Amit Narang, Chandani Maheshwari, Paramdeep Singh
DOI:10.4103/VIT.VIT_23_20  
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