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Every year, nearly 60,000 hospitalizations occur in the United States due to chronic pancreatitis (CP). CP can cause severe chronic abdominal pain, pancreatic insufficiency, and increased risk of pancreatic cancer. While venous thrombotic complications are common, arterial thrombotic events are rarely reported in CP. This report describes a case of a 43-year-old female who presented with severe worsening abdominal pain due to CP. Diagnostic imaging disclosed thrombosis of superior mesenteric artery (SMA) and celiac artery (CA) with acute bowel wall changes reflecting ischemic changes, resulting in acute-on-chronic mesenteric ischemia. Endovascular stent placement relieved the ischemia with the resolution of pain. Arterial thrombosis should be considered as a diagnostic possibility when patients with CP present with a significant change in symptoms. Importantly, the case demonstrates that endovascular treatment with stent placement can relieve ischemia and resolve symptoms in patients with CP.

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Resumen A pesar de los avances en la identificación y reco nocimiento de factores de riesgo del accidente cerebro vascular (ACV) isquémico arterial pediátrico hay escasos avances en el tratamiento hiperagudo. Los factores de riesgo más frecuentes son las arteriopatías, cardiopatías y trombofilias. La confirmación temprana con estudios neurorra diológicos es clave para considerar las terapias de re perfusión, que tienen evidencia limitada en pediatría con buen perfil de seguridad. Existe consenso en la utilización de anticoagulación en patología cardioem bólica, enfermedades protrombóticas y antiagregación en arteriopatías. El desafío futuro será lograr una coordinación entre servicios prehospitalarios y centros especializados en ACV, para mejor manejo terapéutico en etapa hiperaguda disminuyendo su morbimortalidad.

Abstract Despite advances in the identification and recogni tion of risk factors for pediatric arterial ischemic stroke, little progress has been made in hyperacute treatment. The most frequent risk factors are arteriopathies, car diopathies, and thrombophilia. Early confirmation with neuroradiological studies is key to consider reperfusion therapies, which have limited evidence in pediatrics but a good safety profile. There is consensus on the use of anticoagulation in cardio-embolic and prothrombotic diseases, and anti platelet therapy in arteriopathies. The future challenge is to improve coordination between prehospital services and specialized stroke centers to improve therapeutic management in the hyperacute stage and reduce morbidity and mortality.

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Despite advances in the identification and recognition of risk factors for pediatric arterial ischemic stroke, little progress has been made in hyperacute treatment. The most frequent risk factors are arteriopathies, cardiopathies, and thrombophilia. Early confirmation with neuroradiological studies is key to consider reperfusion therapies, which have limited evidence in pediatrics but a good safety profile. There is consensus on the use of anticoagulation in cardio-embolic and prothrombotic diseases, and antiplatelet therapy in arteriopathies. The future challenge is to improve coordination between prehospital services and specialized stroke centers to improve therapeutic management in the hyperacute stage and reduce morbidity and mortality.

A pesar de los avances en la identificación y reconocimiento de factores de riesgo del accidente cerebrovascular (ACV) isquémico arterial pediátrico hay escasos avances en el tratamiento hiperagudo. Los factores de riesgo más frecuentes son las arteriopatías, cardiopatías y trombofilias. La confirmación temprana con estudios neurorradiológicos es clave para considerar las terapias de reperfusión, que tienen evidencia limitada en pediatría con buen perfil de seguridad. Existe consenso en la utilización de anticoagulación en patología cardioembólica, enfermedades protrombóticas y antiagregación en arteriopatías. El desafío futuro será lograr una coordinación entre servicios prehospitalarios y centros especializados en ACV, para mejor manejo terapéutico en etapa hiperaguda disminuyendo su morbimortalidad.

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The dysfunction of the blood circulation system typically induces acute or chronic ischemia in limbs and vital organs, with high disability and mortality. While conventional tomographic imaging modalities have shown good performance in the diagnosis of circulatory diseases, multiple limitations remain for real-time and precise hemodynamic evaluation. Recently, fluorescence imaging in the second region of the near-infrared (NIR-II, 1000-1700 nm) has garnered great attention in monitoring and tracing various biological processes in vivo due to its advantages of high spatial-temporal resolution and real-time feature. Herein, we employed NIR-II imaging to carry out a blood circulation assessment by aggregation-induced emission fluorescent aggregates (AIE nano contrast agent, AIE NPs). Thanks to the longer excited wavelength, enhanced absorptivity, higher brightness in the NIR-II region, and broader optimal imaging window of the AIE NPs, we have realized a multidirectional assessment for blood circulation in mice with a single NIR-II imaging modality. Thus, our work provides a fluorescence contrast agent platform for accurate hemodynamic assessment.

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The novel coronavirus disease (COVID-19) pandemic caused by the SARS-CoV-2 virus started in December 2019 in the city of Wuhan, in China's Hubei province. This virus quickly spread worldwide, and on March 11, 2020, it was declared a pandemic. Thrombosis, as a hallmark of severe disease, was recognized early as a cause of death; however, the exact pathophysiological mechanism is still not fully understood. We are reporting the case of a 46-year-old patient who presented with multiple arterial thromboses in the setting of an acute COVID-19 infection requiring systemic thrombolytic therapy and thrombectomy.

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Background: As an early manifestation of diabetic peripheral neuropathy (DPN), sudomotor dysfunction significantly increases the risk of diabetic foot ulcer. The pathogenesis of sudomotor dysfunction is still unclear. Lower limb ischemia may be related to sudomotor dysfunction, but few studies have explored it. The purpose of this study is to explore the relationship between sudomotor function and comprehensive lower limb arterial ischemia including large arteries, small arteries and microvascular in type 2 diabetes mellitus (T2DM). Patients and Methods: 511 T2DM patients were enrolled in this cross-sectional study. Sudomotor function was assessed qualitatively and quantitatively by Neuropad. Lower limb arterial ischemia was defined as any abnormality of the ankle brachial index (ABI), toe brachial index (TBI) or transcutaneous oxygen tension (TcPO2). Results: In this study, 75.1% of patients had sudomotor dysfunction. Compared with normal sudomotor function, patients with sudomotor dysfunction had a higher incidence of lower limb arterial ischemia (51.2% vs 36.2%, p = 0.004). Similarly, compared with the non-arterial ischemia group, the proportion of sudomotor disorders was higher in the arterial ischemia group (p = 0.004). Low TBI and low TcPO2 groups also had a higher proportion of sudomotor disorders (all p < 0.05).Compare with normal groups, low ABI, low TBI, and low TcPO2 groups had lower Slop4 which quantitatively reflecting Neuropad discoloration. Arterial ischemia was an independent risk factor for sudomotor dysfunction [OR = 1.754, p = 0.024]. Low TcPO2 also independently increased the risk of sudomotor disorders [OR = 2.231, p = 0.026]. Conclusion: Lower limb arterial ischemia is an independent risk factor of sudomotor dysfunction. Especially below the ankle (BTA) small arteries and microvascular ischemia may also be involved in the occurrence of sudomotor disorders.

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Introducción: La enfermedad arterial periférica es una de las afecciones más prevalentes. Resulta habitual su coexistencia con la enfermedad vascular en otras localizaciones. El diagnóstico precoz tiene importancia para mejorar la calidad de vida del paciente y reducir el riesgo de eventos secundarios mayores, como el infarto agudo de miocardio o el ictus. Objetivo: Caracterizar el comportamiento de la isquemia arterial aguda trombótica en miembros inferiores en pacientes que ingresaron en el Instituto Nacional de Angiología y Cirugía Vascular. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo, con el fin de determinar factores pronósticos en la evolución final del tratamiento quirúrgico de la isquemia arterial aguda trombótica en miembros inferiores, en pacientes que ingresaron en los servicios de Arteriología y Angiopatía Diabética del Instituto Nacional de Angiología y Cirugía Vascular durante un período de cuatro años. Resultados: El grupo de edades más afectado estuvo entre 40 y 59 años, con un predomino del sexo masculino. El hábito de fumar fue el factor de riesgo vascular más frecuente; y la amputación mayor, el procedimiento quirúrgico más empleado, por lo que el patrón oclusivo femoropoplíteo resultó el más prevalente. Conclusiones: Predominaron el sexo masculino, el hábito de fumar, la amputación mayor y el patrón oclusivo femoropoplíteo(AU)

Introduction: Peripheral arterial disease is one of the most prevalent conditions. Its coexistence with vascular disease in other locations is common. Early diagnosis is important to improve the patient's quality of life and reduce the risk of major secondary events, such as acute myocardial infarction or stroke. Objective: To characterize the behavior of acute thrombotic arterial ischemia in lower limbs in patients admitted to the National Institute of Angiology and Vascular Surgery. Methods: An observational, descriptive and retrospective study was conducted in order to determine prognostic factors in the final evolution of surgical treatment of acute thrombotic arterial ischemia in the lower limbs in patients admitted to the Arteriology and Diabetic Angiopathy services of the National Institute of Angiology and Vascular Surgery for a period of four years. Results: The most affected age group was the one of 40 to 59 years, with a predominance of males. Smoking was the most frequent vascular risk factor; and major amputation, the most used surgical procedure, so the femoropopliteal occlusive pattern was the most prevalent. Conclusions: Male sex, smoking habit, major amputation and femoropopliteal occlusive pattern predominated(AU)

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PURPOSES: We aimed to confirm the risk and risk factor for ischemic stroke after acute retinal arterial ischemia (ARAI). METHODS: A retrospective cohort study of patients with a diagnosis of acute retinal arterial ischemia (ARAI) and completing 2-year follow-up was conducted from January 2015 to December 2021 at a general hospital. RESULTS: A total of 69 patients including 43(62.3%) patients of central retinal artery occlusion (CRAO), 11(15.9%) patients of branch retinal artery occlusion (BRAO) and 15(21.7%) patients of ophthalmic artery occlusion (OAO) were included in the study. Patients age was 58.2 ± 13.0(years), male patients accounting for 51 (73.9%) and 22 (31.9%) patients having at least 70% ipsilateral carotid artery stenosis (ICAS). During the 2-years follow-up period, 11(15.9%) patients of ARAI experienced ischemic stroke. Among them, 3(20%) patients of OAO, 6(14%) patients of CRAO and 2(18.2%) patients of BRAO had ischemic stroke. The cumulative probabilities of ischemic stroke were 13.0% at 12.9 months and 15.9% at 24 months after ARAI. In addition, patients with at least 70% ICAS were more likely than patients without it to have ischemic stroke (p = 0.002). After Cox regression analysis, ICAS (≥ 70%) or occlusion was significantly associated with a high risk of ischemic stroke after ARAI during the 2-years follow-up time (HR,6.769,95%CI [1.792-25.578], p = 0.005). CONCLUSION: Patients have a high risk of ischemic stroke, particularly those with a diagnosis of ICAS (≥ 70%) or occlusion after the onset of ARAI. Clinical management of ARAI should focus on vascular risk factors control and secondary prevention for stroke.

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BACKGROUND: Lower extremity ischemia due to extrinsic arterial compression by venous stent placement is a rare but increasingly recognized occurrence. Given the rise of complex venous interventions, awareness of this entity is becoming increasingly important to avoid serious complications. CASE PRESENTATION: A 26-year-old with progressively enlarging pelvic sarcoma despite chemoradiation developed recurrent symptomatic right lower extremity deep venous thrombosis due to worsening mass effect on a previously placed right common iliac vein stent. This was treated with thrombectomy and stent revision, with extension of the right common iliac vein stent to the external iliac vein. During the immediate post-procedure period the patient developed symptoms of acute right lower extremity arterial ischemia including diminished pulses, pain, and motorsensory loss. Imaging confirmed extrinsic compression of the external iliac artery by the newly placed adjacent venous stent. The patient underwent stenting of the compressed artery with complete resolution of ischemic symptoms. CONCLUSIONS: Awareness and early recognition of arterial ischemia following venous stent placement is important to prevent serious complication. Potential risk factors include patients with active pelvis malignancy, prior radiation, or scarring from surgery or other inflammatory processes. In cases of threatened limb, prompt treatment with arterial stenting is recommended. Further study is warranted to optimize detection and management of this complication.

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Objectives: Pravastatin sodium is reported to have multiple beneficial effects in cerebral atherosclerosis and neuronal injury; however, the preventive effects on cerebral venous ischemia are still unknown. Herein, we aimed to examine the neuroprotective effects of transoral prior administration of pravastatin sodium against cerebral cortical venous ischemia with suppression of apoptosis. Methods: Thirty 8-week-old male Wistar rats were divided equally into two study groups (n = 15 vs. n = 15); the pravastatin group was fed 1% pravastatin sodium with their usual diet for 2 weeks, while the control group only received the usual diet. Two-vein occlusion (2VO) model was applied for this study, and two adjacent cortical veins in each animal were permanently occluded photochemically with rose bengal dye. During photo-thrombosis, regional changes of the cerebral blood flow (CBF) in area of the venous ischemia were recorded. At 48-h after 2VO, animals were euthanized using perfusion fixation, and we histologically measured ratios of infarcted area to contralateral hemisphere, and counted Bax- and Bcl-2-positive cells in the penumbra to investigate the implications for apoptosis. Results: The ratio of infarcted area was significantly decreased in the pravastatin group compared to the control group (P < 0.01). The number of Bax-positive cells also decreased significantly in the pravastatin group (P < 0.01). In contrast, immunolabeling for Bcl-2 was essentially negative in all areas in both groups. There were also no significant differences in regional CBF changes after 2VO between the two groups (P = 0.13). Conclusions: Pre-emptive administration of pravastatin sodium mixed in the food has neuroprotective effects against cerebral cortical venous ischemia with suppression of apoptosis associated with inhibition of Bax expression but has little influence on regional CBF.

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BACKGROUND: Acute peripheral arterial ischemia (APAI) is an acute ischemic condition that develops as a result of embolism or thrombosis, and its morbidity and mortality are still high today. The objective of this study is to determine the effect of preoperative Neutrophil-to-Lymphocyte ratio (NLR) on mortality in patients admitted with the diagnosis of APAI. METHODS: 178 patients who were diagnosed with acute peripheral arterial occlusion and underwent emergency embolectomy were evaluated retrospectively over a 7-year period. Patient demographics, clinical history, risk factors, comorbidity, and hemogram sub-parameters were documented. The endpoint of the patients was determined as death. RESULTS: A total of 178 patients were identified with a mean age 74.29±14.71 (range 28-111) years; among them, 105 (59%) were female. 18% patients (32/178) died within 30 days. Lower extremity involvement was present in 124 (69.7%) of the patients. A statistically significant difference was found between the mortality rates and blood parameters of the patients included in the study in terms of white blood count C-reactive protein (CRP), and age among those with normal distribution. Neutrophil, NLR, procalcitonin, lactate, aspartate aminotransferase, and urea; It was statistically significant in terms of mortality in our patients with APAI. NLR values of the deceased were determined as 7.98 ± 6.85. CONCLUSIONS: APAI patients with high NLRs had significantly higher risks of 30-day mortality. The NLR can be used as a prognostic marker in these patients and warrants further investigation.

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Acute transient or permanent retinal arterial ischemia is ocular and systemic emergency requiring immediate diagnosis and treatment. Transient monocular vision loss is transient retinal arterial ischemia which leaves no permanent deficits. Central retinal arterial occlusion and branch retinal arterial occlusion lead to permanent visual function deficits in the majority of patients. Current treatment include lowering intraocular pressure, dilating blood vessels, hyperbaric oxygen therapy, intravenous or intra-arterial thrombolysis and so on, but there is still no standard treatment procedure. High risk groups should receive primary prevention measures in order to reduce the incidence of the disease. Patients with acute retinal arterial ischemia are at high risk of subsequent stroke and adverse cardiovascular events. Relevant risk factors should be identified in time, the primary disease should be treated actively, and appropriate secondary prevention measures should be taken to improve the prognosis. This review summarizes the recent treatment and prevention procedures of acute retinal arterial ischemia, to provide references for the management of these diseases.

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, whose main expression is an acute respiratory syndrome, is also associated with concurrent multisystemic involvement, coagulation disorders and thrombotic complications, both in patients with prior diseases and those without. We present the case of a patient admitted to our hospital with no prior medical problems who had documented SARS-CoV-2 infection. During hospitalization, the patient developed acute left lower limb pain and absent pedal and posterior tibial pulses, with acute arterial ischemia due to thrombosis confirmed with imaging tests. Other causes of thrombosis such as atheromatosis, embolism and coagulation disorders, among others, were ruled out. He was anticoagulated with low-molecular-weight heparin and cilostazol throughout hospitalization and was discharged on warfarin and cilostazol. SARS-CoV-2-related acute arterial thrombosis should also be considered in our region. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2372).

La infección por síndrome respiratorio agudo severo-coronavirus-2 (SARS-CoV-2), cuya expre sión principal es el síndrome respiratorio agudo también se asocia a compromiso multisistémico y se han detectado coagulopatías y complicaciones trombóticas asociadas durante la infección, tanto en pacientes con patologías previas como sin ellas. Presentamos el caso de un paciente que ingresó a nuestro hospital sin antecedentes patológicos, con infección documentada por SARS-CoV-2. Durante la hospitalización presentó dolor agudo de miembro inferior izquierdo con ausencia de pulsos pedio y tibial posterior, confirmándose por estudios imagenológicos isquemia arterial aguda por trombosis. Se descartaron otras causas de trombosis como ateromatosis, embolia, coagulopatía, entre otros. Recibió anticoagulación con heparinas de bajo peso molecular y cilostazol durante el periodo de hospitalización y egresó con warfarina y cilostazol. La trombosis arterial aguda relacionada con infección por SARS-CoV-2 debe considerarse también en nuestra región. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2372).

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BACKGROUND: This study investigated the long-term effects of arterial ischemia and venous occlusion on lymph node drainage function in a rat model. METHODS: Bilateral groin lymph node flaps of 18 Lewis rats were dissected. The pedicle artery was clamped for 4, 5, and 6 h (A4, A5, and A6 groups), and the vein for 3, 4, and 5 h (V3, V4, and V5 groups) in six flaps. At 4 weeks, the evaluations included gross morphomics, indocyanine green (ICG) lymphography, histological section, immunofluorescence of terminal deoxynucleotidyl transferase assay, and heme oxygenase-1 (HO-1) stain. RESULTS: The lymph node flaps developed shrinkage and partial necrosis in A5, A6, V4, and V5 groups. Hemorrhage in the lymph node cortex and medulla was observed histologically in A5, A6, and V5 groups. ICG lymphography showed loss of lymphatic drainage function in 2 of 6 flaps in A6 and V5 groups. Cell death was shown partly in cortical follicles in A5 and V4 groups and completely in A6 and V5 groups. The HO-1 expression was statistically increased in A5 and V5 groups, respectively (p < 0.05). CONCLUSIONS: The critical arterial ischemia and venous occlusion time were 4 h at 4 weeks of follow-up.

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The clinical spectrum of the disease caused by SARS-CoV-2 (COVID-19) is highly variable. It commonly has a mild or asymptomatic course. Around 15% to 20% of patients have lung involvement, which can progress to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome, with marked alteration of the inflammatory and immune response. In these severe forms, there is an increased prevalence of vascular thrombotic complications which manifest as venous thromboembolism, acute arterial ischemia in the limbs, and, less frequently, myocardial involvement or cerebrovascular accident. The proposed pathogenic mechanisms include diffuse endothelial damage or endotheliitis, microvascular inflammation, cytokine release, hypercoagulability, and hypoxia. Early recognition of these complications is vital for improving the prognosis and survival of these patients.

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La pandemia por COVID-19, ocasionada por el virus SARS-CoV-2, ha producido una alta incidencia de coagulopatía asociada a un aumento en la morbi-mortalidad en los pacientes que la padecen. La coagulopatía resulta principalmente trombótica, determinada por daño endotelial, inflamación, trampas extracelulares de neutrófilos, activación de macrófagos y tormenta de citocinas que mantienen el círculo vicioso de la inflamación y la trombosis. Los eventos trombóticos observados durante la COVID-19 fueron principalmente tromboembólicos venosos e infarto del miocardio; sin embargo, la evidencia mostró el incremento de una complicación vascular que no había sido descrita: la trombosis arterial periférica aguda. El objetivo de este artículo fue exponer la infrecuencia de la isquemia arterial aguda como forma de presentación clínica de la COVID-19. Se presenta un paciente masculino de 54 años, con dolor intenso localizado a nivel de la extremidad inferior derecha, gradiente térmico, palidez, cianosis distal e impotencia funcional, con diagnóstico clínico y ecográfico de isquemia arterial aguda de causa trombótica del sector arterial femoral e ilíaco externo derechos. La evolución del paciente resultó satisfactoria y se mantiene bajo seguimiento médico para evaluar la permeabilidad del sector arterial desobstruido(AU)

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has produced a high incidence of coagulopathy associated with an increase in morbidity and mortality in patients suffering from it. Coagulopathy is mainly thrombotic, determined by endothelial damage, inflammation, extracellular neutrophil traps, macrophage activation and cytokine storm that maintain the vicious cycle of inflammation and thrombosis. The thrombotic events observed during COVID-19 were mainly venous thromboembolic and myocardial infarction; however, the evidence showed an increase in a vascular complication that had not been described: acute peripheral arterial thrombosis. The objective of this article was to expose the infrequency of acute arterial ischemia as a form of clinical presentation of COVID-19. A 54-year-old male patient with severe pain located at the level of the right lower extremity, thermal gradient, pallor, distal cyanosis and functional impotence, with a clinical and ultrasound diagnosis of acute arterial ischemia of thrombotic cause of the right femoral and iliac arterial sector is presented. The evolution of the patient was satisfactory and he is kept under medical follow-up to evaluate the permeability of the unobstructed arterial sector(AU)

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Introducción: Las oclusiones arteriales periféricas agudas de menos de 14 días y de causa embólica y trombótica están asociadas a una alta morbimortalidad. La trombólisis dirigida por catéter representa en la actualidad una modalidad de tratamiento efectivo para la oclusión de vasos distales infrageniculares, que históricamente ha tenido malos resultados mediante embolectomía convencional, debido a la oclusión preexistente de vasos colaterales y al daño mecánico al endotelio, que conlleva esta técnica tradicional. Se decidió presentar este caso por ser la primera vez que se practica esta modalidad de tratamiento en Cuba. Objetivo: Exponer los resultados obtenidos con la aplicación de la trombolisis fibrinolitica mediante catéter en un paciente afectado por trombosis arterial periférica aguda. Presentación del caso: Paciente masculino de 57 años de edad con diagnóstico de trombosis arterial aguda de la arteria poplítea del miembro inferior izquierdo, con más de 24 horas de evolución de la isquemia y del compromiso de la viabilidad de la extremidad. Se utilizó el tratamiento fibrinolítico, mediante infusión de 250 000 unidades de Heberkinasa® en tres horas y se logró la mejoría del nivel de amputación. Conclusiones: El tratamiento fibrinolítico con Heberkinasa® fue útil en el paciente tratado porque redujo el nivel de amputación en el paciente, que presentó isquemia irreversible y criterio inicial de amputación supracondílea alto, en la extremidad comprometida(AU)

Introduction: Acute peripheral arterial occlusions of less than 14 days and of embolic and thrombotic cause are associated with a high morbidity and mortality. Catheter-directed thrombolysis currently represents an effective treatment modality for the occlusion of infragenicular distal vessels, which has historically had poor results by conventional embolectomy, due to the pre-existing occlusion of collateral vessels and the mechanical damage to the endothelium, which this traditional technique entails. It was decided to present this case because it is the first time that this modality of treatment is practiced in Cuba. Objective: Present the results obtained with the application of fibrinolytic thrombolysis by catheter in a patient affected by acute peripheral arterial thrombosis. Case presentation: A 57-year-old male patient diagnosed with acute arterial thrombosis of the popliteal artery of the left lower limb, with more than 24 hours of evolution of ischemia and compromised viability of the limb. Fibrinolytic treatment was used, by infusion of 250,000 units of Heberkinase® in three hours and the improvement of the amputation level was achieved. Conclusions: Fibrinolytic treatment with Heberkinase® was useful in the treated patient because it reduced the level of amputation in the patient, who presented irreversible ischemia and initial criteria of high supracondylar amputation in the compromised limb(AU)

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BACKGROUND: Reported ischemia time of vascularized lymph nodes was 5 hours. This study investigated the effects of arterial ischemia and venous occlusion on vascularized lymph node function in rats. METHODS: Bilateral pedicled groin lymph node flaps were raised in 27 Lewis rats. Femoral artery and vein were separated and clamped for 1, 3, 4, or 5 hour(s). Lymph node flap perfusion and drainage were assessed by laser Doppler flowmetry and indocyanine green lymphography. Histologic changes were assessed using hematoxylin and eosin stain, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL), and glutathione assays. RESULTS: Perfusion units of 2.84 ± 1.41, 2.46 ± 0.64, 2.42 ± 0.37, and 2.01 ± 0.90 were measured in arterial ischemia groups, and 1.71 ± 0.45, 2.20 ± 0.98, 1.49 ± 0.35, and 0.81 ± 0.20 in venous occlusion groups after 1, 3, 4, and 5 hours of clamping, respectively. Lymphatic drainage showed mean latency periods of 5.33 ± 0.88, 9.00 ± 3.21, 10.00 ± 2.08, and 24.50 ± 11.50 seconds in arterial clamping groups, and 25.00 ± 3.61, 26.00 ± 3.06, 23.33 ± 4.41, and 152.00 ± 0 seconds in venous clamping groups, respectively. Severe medullary and cortical congestion and hemorrhage on histology and cell damage by glutathione levels and TUNEL assay were found after 4 hours of venous clamping. CONCLUSIONS: Arterial ischemia and venous occlusion impact the function and viability of vascularized lymph node flaps differently. The critical venous occlusion time was 4 hours.

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Introdução: A utilização de tecido autólogo em reconstruções mamárias tem sido cada vez mais difundida, principalmente devido aos resultados estéticos melhores e mais duradouros; porém fatores de risco como: diabetes, tabagismo e obesidade acabam complicando este tipo de reconstrução. Objetivo: Avaliar a angiogênese tanto no modelo animal de isquemia arterial como no modelo animal de congestão venosa após a utilização de terapia hiperbárica no retalho cutâneo da parede abdominal de ratos. Material: Utilizamos o modelo animal para demonstrar o efeito da terapia hiperbárica na recuperação das áreas de necrose tecidual tanto no modelo de isquemia arterial quanto de congestão venosa. Os ratos foram divididos em 3 grupos e os resultados comparados. Resultados: Ficou demonstrado que a utilização de terapia hiperbárica permite a diminuição da área de necrose tecidual, principalmente no grupo com congestão venosa. Contudo, não está claro qual mecanismo permite que a terapia hiperbárica apresente melhores resultados no grupo com congestão venosa. Conclusão: Há necessidade de pesquisar novos marcadores teciduais para avaliar a resposta tecidual à adaptação ao microambiente com hipoxia e o efeito da terapia hiperbárica nesta situação.(AU)

Introduction: The use of autologous tissue in breast reconstruction has been increasingly widespread, mainly due to better and more durable aesthetic results; but risk factors such as diabetes, smoking and obesity complicate this type of reconstruction. Objective: To evaluate angiogenesis in animal models of arterial ischemia and venous congestion after the use of hyperbaric therapy in the skin flap of the abdominal wall of rats. Material: We used the animal model to demonstrate the effect of hyperbaric therapy on the recovery of areas of tissue necrosis in arterial ischemia and venous congestion. The rats were divided into 3 groups and the results compared. Results: It has been demonstrated that the use of hyperbaric therapy allows the reduction of the area of tissue necrosis, especially in the group with venous congestion. However, it is not clear which mechanism allows hyperbaric therapy to show better results in the group with venous congestion. Discussion: It is not clear which mechanism allows hyperbaric therapy to present better results in the group with venous congestion. Conclusion: There is a need to investigate new tissue markers to evaluate the tissue response to adaptation to the hypoxic microenvironment and the effect of hyperbaric therapy in this situation.(AU)

Introducción: La utilización de tejido autólogo en reconstrucciones de las mamas ha sido cada vez más difundida, principalmente debido a los resultados estéticos mejores y más duraderos; pero factores de riesgo como: diabetes, tabaquismo y obesidad acaban complicando este tipo de reconstrucción. Objetivo: Evaluar la angiogénesis tanto en el modelo animal de isquemia arterial como en el modelo animal de congestión venosa después del uso de terapia hiperbárica en el colgajo de piel de la pared abdominal de ratas. Material: Utilizamos el modelo animal para demostrar el efecto de la terapia hiperbárica en la recuperación de las áreas de necrosis tisular tanto en el modelo de isquemia arterial y de congestión venosa. Los ratones fueron divididos en 3 grupos y los resultados comparados. Resultados: Se ha demostrado que la utilización de terapia hiperbárica permite la disminución del área de necrosis tisular, principalmente en el grupo con congestión venosa. Sin embargo, no está claro qué mecanismo permite que la terapia hiperbárica muestre mejores resultados en el grupo con congestión venosa. Conclusión: Hay necesidad de investigar nuevos marcadores teciduales para evaluar la respuesta tisular a la adaptación al microambiente con hipoxia y el efecto de la terapia hiperbárica en esta situación.(AU)

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INTRODUCTION: Complete proper hepatic arterial [PHA] occlusion due to accidental coil migration during embolization of cystic artery stump pseudoaneurysm resulting from a complex vasculobiliary injurie [CVBI] post laparoscopic cholecystectomy [LC] is an extremely rare complication with less than 15 cases reported. We present a case depicting our strategy to tackle this obstacle in management of CVBI and review the relevant literature. PRESENTATION OF CASE: A 35 year old lady presented on sixth postoperative day with an external biliary fistula following Roux-en-y hepaticojejunostomy [RYHJ] for biliary injury during LC. She developed a leaking cystic artery pseudoaneurysm, during angioembolisation of which, one coil accidentally migrated into left hepatic artery resulting in complete PHA occlusion. Fourteen months later, cholangiogram revealed a worsening RYHJ stricture despite repeated percutaneous balloon dilatations. Multiple collaterals had developed. Revision RYHJ was fashioned to the anterior wall of biliary confluence with an extension into left duct. Minimum hilar dissection ensured preservation of collateral supply to the biliary enteric anastomosis. Postoperative recovery was uneventful. The patient is doing well at 1 year follow up. DISCUSSION: Definitive biliary enteric repair should be delayed till collateral circulation is established within the hilar plate, hepatoduodenal ligament and perihepatic/peribiliary collaterals to provide an adequate arterial blood supply to biliary confluence and extrahepatic portion of the bile duct. CONCLUSION: Assessment of hepatic arteries should be part of investigation of all complex biliary injuries. Delayed definitive biliary enteric repair ensures a well-perfused anastomosis. Minimum hilar dissection is the key to preserve biliary and hepatic neovasculature.