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Nappi F, Iervolino A, Avtaar Singh SS. Thromboembolic Complications of SARS-CoV-2 and Metabolic Derangements: Suggestions from Clinical Practice Evidence to Causative Agents. Metabolites 2021; 11:341. [PMID: 34070672 PMCID: PMC8229698 DOI: 10.3390/metabo11060341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/08/2023] Open
Abstract
Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2 is a recently identified positive sense single-strand RNA (ssRNA) β-coronavirus. The viral spike proteins infect human hosts by binding to the cellular receptor angiotensin-converting enzyme 2 (ACE2). The infection causes a systemic illness involving cell metabolism. This widespread involvement is implicated in the pathophysiology of the illness which ranges from mild to severe, requiring multi organ support, ranging from oxygen supplementation to full cardiovascular and respiratory support. Patients with multiple co-existing comorbidities are also at a higher risk. The aim of this review is to explore the exact mechanisms by which COVID-19 affects patients systemically with a primary focus on the bleeding and thrombotic complications linked with the disease. Issues surrounding the thrombotic complications following administration of the ChAdOx1 nCoV-19 (Astra-Zeneca-Oxford) vaccine have also been illustrated. Risk stratification and treatment options in these patients should be tailored according to clinical severity with input from a multidisciplinary team.
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Affiliation(s)
- Francesco Nappi
- Centre Cardiologique du Nord de Saint-Denis, Department of Cardiac Surgery, 93200 Saint-Denis, France
| | - Adelaide Iervolino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy;
| | - Sanjeet Singh Avtaar Singh
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank G81 4DY, UK;
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2
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Wang J, Huang W, Zhou Y, Han F, Ke D, Lee C. Hemodynamic Analysis of VenaTech Convertible Vena Cava Filter Using Computational Fluid Dynamics. Front Bioeng Biotechnol 2020; 8:556110. [PMID: 33195121 PMCID: PMC7661937 DOI: 10.3389/fbioe.2020.556110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/21/2020] [Indexed: 01/12/2023] Open
Abstract
The VenaTech convertible filter (VTCF) has been widely used as an inferior vena cava (IVC) filter to prevent fatal pulmonary embolism in patients. However, its hemodynamics that greatly affect the filter efficacy and IVC patency are still unclear. This paper uses computational fluid dynamics with the Carreau model to simulate the non-Newtonian blood flows around the VTCF respectively deployed in the normal, reverse and three converted states in an IVC model. The results show that the prothrombotic stagnation zones are observed downstream from the normal, reverse and small open VTCFs, with the streamwise length is nearly eight times the IVC diameter. The no-slip boundary conditions of the thin-wire VTCF arms lead to the “viscous block” effect. The viscous block accelerates the blood flow by 5–15% inside the IVC and enhances the filter wall shear stress up to nearly 20 times that of the IVC only, which contributes to clot capture and thrombus lysis. The relative flow resistance is defined to evaluate the filter-induced resistance on the IVC blood flow that can be regarded as an index of IVC patency with the filter deployment. The flow resistance of the normal VTCF deployment increases dramatically by more than 60% compared with that of the IVC only and is a little higher (6%) than that of the reverse case. As the VTCF converts to a fully open configuration, the flow resistance gradually decreases to that of no filter. This work shows that even very thin VTCF arms can result in the viscous block effect and may cause significant hemodynamic impacts on clot capture, potential thrombosis and flow impedance inside the IVC. The present study also shows that CFD is a valuable and feasible in silico tool for analyzing the IVC filter hemodynamics to complement in vivo clinical and in vitro experimental studies.
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Affiliation(s)
- Jingying Wang
- School of Energy and Power Engineering, Shandong University, Jinan, China
| | - Wen Huang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Zhou
- School of Aeronautical Science and Engineering, Beihang University, Beijing, China
| | - Fangzhou Han
- School of Energy and Power Engineering, Shandong University, Jinan, China
| | - Dong Ke
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunhian Lee
- School of Energy and Power Engineering, Shandong University, Jinan, China.,School of Aeronautical Science and Engineering, Beihang University, Beijing, China
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López JM, Fortuny G, Puigjaner D, Herrero J, Marimon F. Hemodynamic effects of blood clots trapped by an inferior vena cava filter. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3343. [PMID: 32323487 DOI: 10.1002/cnm.3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
The alteration of blood flow around an OPTEASE inferior vena cava filter with one or two blood clots attached was investigated by means of computational fluid dynamics. We used a patient-specific vein wall geometry, and we generated different clot models with shapes adapted to the filter and vein wall geometries. A total of eight geometries, with one or two clots and a total clot volume of 0.5 or 1 cm3 , were considered. A non-Newtonian model for blood viscosity was adopted and the possible development of turbulence was accounted for by means of a three-equation model. Two blood flow rates were considered for each case, representative for rest and exercise conditions. In exercise conditions, flow unsteadiness and even turbulence was detected in some cases. Pressure and wall shear stress (WSS) distributions were modified in all cases. Clots attached to the filter downstream basket considerably increased averaged WSS values by up to almost 50%. In all the cases a flow recirculation region appeared downstream of the clot. The degree of flow stagnation in these regions, an indicator of propensity to thrombogenesis, was estimated in terms of mean residence times and mean blood viscosity. High levels of flow stagnation were detected in rest conditions in the wake of those clots that were placed upstream from the filter. Our results suggest that one downstream placed big clot, showing a higher tendency to induce flow instabilities and turbulence, might be more harmful than two small clots placed in tandem.
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Affiliation(s)
- Josep M López
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Gerard Fortuny
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Dolors Puigjaner
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Joan Herrero
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Francesc Marimon
- Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, Reus, Catalunya, Spain
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Choi YJ, Kim DH, Kim DI, Kim HY, Lee SS, Jung HJ. Comparison of Treatment Result Between Anticoagulation Alone and Catheter-Directed Thrombolysis Plus Anticoagulation in Acute Lower Extremity Deep Vein Thrombosis. Vasc Specialist Int 2019; 35:28-33. [PMID: 30993105 PMCID: PMC6453597 DOI: 10.5758/vsi.2019.35.1.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Deep vein thrombosis (DVT) is the third most common cause of cardiovascular morbidity and mortality. Anticoagulation has been the primary treatment modality for acute DVT. However, catheter-directed thrombolysis (CDT) has recently become widely accepted as an additional therapy to anticoagulation. We assessed comparative outcomes in patients with acute DVT who underwent anticoagulation therapy alone (ACA) group and those treated with CDT group. Materials and Methods We retrospectively reviewed medical records of 149 patients with DVT from January 2011 to December 2015. We compared patients who received ACA group (n=120) and those who received CDT plus anticoagulation (CDT group, n=29). We analyzed the prevalence of lesions, thrombus removal rate in each lesion, and recurrence-free rate between the two groups. Results We found thrombus involvement in a total of 281 lesions in the ACA group and 85 lesions in the CDT group. For the distribution of lesions in each group, those in the femoral vein accounted for 34.2% of all lesions and those in the popliteal vein accounted for 31.7%. During follow-up, the overall thrombus removal rate was 91.1% in the ACA group and 87.0% in the CDT group (P=0.273). The recurrence-free rate was higher in the CDT group in a log-rank test; however, there was no statistically significant difference between the two groups (P=0.594). Conclusion According to our results, there was no significant difference in thrombus removal and recurrence-free rates between the CDT and ACA groups. ACA still has an important role in the treatment of DVT.
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Affiliation(s)
- Young Jin Choi
- Endovascular and Vascular Division, Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Hyun Kim
- Endovascular and Vascular Division, Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Il Kim
- Endovascular and Vascular Division, Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-Yul Kim
- Endovascular and Vascular Division, Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Su Lee
- Endovascular and Vascular Division, Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyuk Jae Jung
- Endovascular and Vascular Division, Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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López JM, Fortuny G, Puigjaner D, Herrero J, Marimon F. A comparative CFD study of four inferior vena cava filters. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2990. [PMID: 29603681 DOI: 10.1002/cnm.2990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
Computational fluid dynamics was used to simulate the flow of blood within an inferior vena cava (IVC) geometry model that was reconstructed from computed tomography images obtained from a real patient. The main novelty of the present work is that we simulated the implantation of 4 different filter models in this realistic IVC geometry. We considered different blood flow rates in the range between Vin =20 and Vin =80 cm3 /s, and all simulations were performed with both the Newtonian and a non-Newtonian model for the blood viscosity. We compared the hemodynamics performance of the different filter models, and we paid a special attention to the total drag force, Fd , exerted by the blood flow on the filter surface. This force is the sum of 2 contributions: the viscous skin friction force, which was found to be roughly proportional to the filter surface area, and the pressure force, which depended on the particular filter geometry design. The Fd force is relevant because it must be balanced by the total force exerted by the filter hooks/struts on the IVC wall at the attachment locations. For the highest Vin value investigated, the variation in Fd among filters was from 116 to 308 dyne. We also showed how the present results can be extrapolated to obtain good estimates of the drag forces if the blood viscosity levels change, ie, if the patient with a filter implanted is treated with anticoagulant therapy.
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Affiliation(s)
- Josep M López
- Departament d' Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Gerard Fortuny
- Departament d' Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Dolors Puigjaner
- Departament d' Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Joan Herrero
- Departament d' Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | - Francesc Marimon
- Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
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Carlon TA, Sudheendra D. Interventional Therapy for Upper Extremity Deep Vein Thrombosis. Semin Intervent Radiol 2017; 34:54-60. [PMID: 28265130 DOI: 10.1055/s-0036-1597764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Approximately 10% of all deep vein thromboses occur in the upper extremity, and that number is increasing due to the use of peripherally inserted central catheters. Sequelae of upper extremity deep vein thrombosis (UEDVT) are similar to those for lower extremity deep vein thrombosis (LEDVT) and include postthrombotic syndrome and pulmonary embolism. In addition to systemic anticoagulation, there are multiple interventional treatment options for UEDVT with the potential to reduce the incidence of these sequelae. To date, there have been no randomized trials to define the optimal management strategy for patients presenting with UEDVT, so many conclusions are drawn from smaller, single-center studies or from LEDVT research. In this article, the authors describe the evidence for the currently available treatment options and an approach to a patient with acute UEDVT.
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Affiliation(s)
- Timothy A Carlon
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deepak Sudheendra
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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