Reference values of normal abdominal aortic areas in Chinese population measured by contrast-enhanced computed tomography.

Objective: To generate reference values of the normal areas of the abdominal aorta at various levels among Chinese people and to explore the factors that may promote the expansion of the abdominal aorta. Methods: The areas of normal abdominal aortas were gauged at various levels based on inner-to-inner measurements in 1,066 Chinese adult patients (>18 years) without the abdominal aortic disease. The areas of subphrenic abdominal, suprarenal abdominal, infrarenal abdominal, and distal abdominal aortas were measured. The demographic and clinical characteristics were collected into a specifically designed electronic database. Multivariable linear regression was used to analyze the potential risk factors promoting the expansion of the abdominal aorta. Results: In males, the median areas of the subphrenic abdominal aorta, suprarenal abdominal aorta, infrarenal abdominal aorta, and distal abdominal aorta were 412.1, 308.0, 242.2, and 202.2 mm2, respectively. In females, the median areas of the subphrenic abdominal aorta, suprarenal abdominal aorta, infrarenal abdominal aorta, and distal abdominal aorta were 327.7, 243.4, 185.4, and 159.6 mm2, respectively. The areas of the abdominal aorta at different levels were larger in males than in females and increased with age. Multiple linear stepwise regression analysis showed that the subphrenic abdominal aortic area was significantly related to age (ß = 0.544, p < 0.001), sex (ß = 0.359, p < 0.001), and hypertension (ß = 0.107, p < 0.001). Suprarenal abdominal aortic area was related to age (ß = 0.398, p < 0.001), sex (ß = 0.383, p < 0.001), history of smoking (ß = 0.074, p = 0.005), and hypertension (ß = 0.111, p < 0.001). The infrarenal abdominal aortic area was correlated with age (ß = 0.420, p < 0.001), sex (ß = 0.407, p < 0.001), and history of smoking (ß = 0.055, p = 0.036). The distal abdominal aortic area was correlated with age (ß = 0.463, p < 0.001), sex (ß = 0.253, p < 0.001), and hypertension (ß = 0.073, p = 0.013). Conclusion: The abdominal aortic areas at different levels were larger in males than in females. Aging, hypertension, and smoking prompt the expansion of abdominal aorta.

Analysis of the Preventive Action of Rivaroxaban against Lower Extremity Deep Venous Thrombosis in Patients after Laparoscopic Radical Gastrectomy.

Background: Gastric carcinoma (GC) is a common lethal cancer in the world. Patients are prone to develop lower extremity deep venous thrombosis (LEDVT) after laparoscopic radical gastrectomy (LRG), which threatens their life and health. Purpose: This research is to clarify the preventive action of rivaroxaban (Riv) against LEDVT in patients undergoing LRG. Methods: A retrospective study was conducted on 70 patients with GC admitted for LRG between January 2019 and January 2022, including 40 patients (observation group) receiving Riv treatment and 30 patients (conventional group) treated with air wave pressure therapy apparatus. Quality of life, coagulation function, LEDVT formation, and complications were compared between groups. Results: The observation group had better recovery of life quality than the control group, along with more effective inhibition of coagulation disorders, less DVT formation, and fewer complications. Conclusions: Compared with air wave pressure therapy apparatus, Riv has better preventive action against LEDVT in GC patients after LRG.

The removal of floating right heart thrombi and pulmonary embolus using AngioJet device and venoarterial extracorporeal membrane oxygenation: a case report.

Background: Floating right heart thrombi (FRHTS), known as thrombi in transit, are usually located in the atrium or ventricle. Generally, it occurs in patients with pulmonary embolism (PE) and dyspnea, chest pain, syncope and palpitations are the most common symptoms on presentation. The mortality of patients with FRHTS is higher than that of those without FRHTS. Current treatment includes anticoagulation, systemic thrombolysis, catheter directed interventions, and surgical embolectomy. However, there is no consensus on the optimal management options. Case Description: Herein, we report the case of a patient who presented with hypotension and tachycardia accompanied by an asymptomatic right leg deep vein thrombosis, right atrial thrombus, and pulmonary embolus. He had a history of radical resection of colon cancer 1 month prior. And he had developed chest tightness accompanied by stabbing pain in the chest area 1 day ago. He experienced an episode of syncope 8.5 hours ago. So he was referred to the local hospital. After the pulmonary computed tomography angiography (CTA) scan, he was diagnosed with pulmonary embolus and administrated with 5,000 u low molecular weight heparin. Then he was transferred to our hospital. On arrival in the emergency department, the bedside transthoracic echocardiography (TTE) revealed there was an enlarged right atrium and right ventricle, with a floating right atrial mass prolapsing through the tricuspid valve during diastole. The patient accepted anticoagulation treatment, but refused to undergo thrombolysis or surgical embolectomy. Eventually, the right heart thrombi (RiHT) floated to the left main branch of pulmonary artery. It was successfully treated by using AngioJet device and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Our case provides clinical evidence supporting the feasibility and efficacy of AngioJet device and VA-ECMO in the treatment of the RiHT and PE. Conclusions: Patients with PE combined with RiHT have higher mortality than those without RiHT, VA-ECMO could be used to maintain the circulation, and the AngioJet device could be used as an alternative treatment for patients who are reluctant to receive thrombolysis or surgical embolectomy.

Systematic review and meta-analysis of the safety and effectiveness of low molecular heparin for severe acute pancreatitis.

BACKGROUND: Because the effect of low molecular heparin (LMH) on acute ulcer and bleeding complications in patients with severe acute pancreatitis (SAP) is unclear, we investigated the safety and efficacy of early intervention with LMH in patients with SAP. METHODS: Using the keywords "heparin", "low molecular weight heparin", "pancreatitis", and "severe acute pancreatitis", we searched PubMed, Medline, CNKI, etc. And select the reference documents of the comparative study of traditional treatment and low molecular weight heparin intervention. RevMan was used for the meta-analysis. RESULTS: A total of 8 references were included in the study, and most of them were low risk bias (medium and high quality). Meta-analysis shows that, The MHS between the two groups is statistically heterogeneous. (Chi2=19.59, I2=95%, P<0.00001), Fixed-effects model (FEM) analysis showed that the MHS of experimental subjects was obviously shorter than that of controls (Z=3.24, P=0.001); The acute physiology and chronic health score (APACHE II) of the two groups were heterogeneous (Chi2=7.24, I2=72%, P=0.03); No heterogeneity was found in the amount of bleeding (Chi2=5.83, I2=31%, P=0.21), FEM analysis showed the number of complications in the experimental group was significantly less than that in the control group (Z=2.70, P=0.007). DISCUSSION: LMH intervention can dramatically reduce the average hospital stay and complications of patients with SAP, improve treatment efficacy, and has high safety.

The short-term outcome of residual thrombus of the lower extremity after pharmacomechanical catheter-directed thrombolysis for deep vein thrombosis.

BACKGROUND: This study aimed to assess the short-term effect of residual thrombus of the lower extremity after pharmacomechanical catheter-directed thrombolysis (PCDT) on the incidence of post-thrombotic syndrome (PTS) and iliofemoral vein patency rate in patients who underwent PCDT. METHODS: There were 94 continuous patients with severe deep vein thrombosis (DVT) of the lower extremities admitted to our hospital between March 2016 and June 2018; 73 cases receiving PCDT and verified with iliac vein compression syndrome (IVCS) were assigned into two groups. Thirty-nine patients without thrombus of the popliteal and infrapopliteal veins were assigned to the proximal DVT group. The remaining 34 cases were placed in the extensive DVT group. The thrombus scores, including venous registry index (VRI) score, Marder score, and Society for Vascular Surgery (SVS) score before and after PCDT, the primary two years' cumulative rate of iliofemoral patency, and the rate of PTS, and complications were analyzed retrospectively. RESULTS: Ultimately, 27 patients in the proximal DVT group and 26 cases in the extensive DVT group completed the study. The two groups had no significant differences in terms of basic characteristics, complication and the rate of PTS (P>0.05). However, there were significant differences in terms of postoperative mean thrombus score and the mean degree of thrombosis removal score by Marder and SVS scores, residual thrombus by lower thrombosis classification (LET) and the two years' cumulative iliofemoral vein patency rate (P<0.05). And the logistic regression analysis demonstrated the residual thrombus of LET class II [odds ratio (OR), 4.619, 95% confidence interval (CI), 1.090-19.567, P=0.038] was an independent risk factor for iliofemoral vein occlusion. CONCLUSIONS: The residual thrombus of LET class II is an independent risk factor for iliofemoral vein occlusion. It is very important to keep the patency of the popliteal vein when deciding to use a stent to maintain iliofemoral vein patency. Furthermore, the anterior tibial vein approach and crisscross technique may be two important alternative methods that can be used to address the thrombus of popliteal vein for patients with extensive DVT.