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  • ISSN: 2378-9344
    Volume 4, Issue 5
    Case Series
    Wolfram Schummer*
    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, i.e., an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality.
    Editorial
    Francis M Chen, Gary Tse, Shuangtao Ma, Nazish Sayed, and Wing Tak Wong*
    Cardiovascular dysfunction has been documented as early as the 1760s when William Heberden remarked on a "…disorder of the breast marked with strong and peculiar symptoms" whose prognosis was "…the patients all suddenly fall down, and perish almost immediately" [1].
    Tigkiropoulos K*
    Thoracic aortic injury among trauma patients is the second leading cause of the death after brain injury [1]. 75% of patients die at the scene whereas 25 % who reach the hospital, half of them will die the next 24 hours [2].
    Case Report
    Konstantinos Tigkiropoulos*, Nikolaos Melas, Dimitrios Kapetanios, Kiriakos Stavridis, Ioannis Lazaridis, and Nikolaos Saratzis
    Purpose: To present a patient with a penetrating left subclavian vascular injury initially treated with a covered stent. Five years post implantation, a late stent-graft restenosis was disclosed, successfully treated by endovascular means.
    Case report: A 26-years old male patient was transferred to our Institution from a regional hospital after a stub wound to the left subclavian region. A thoracostomy tube was already in place since a low resolution CT scan was performed depicting left pneumothorax and subclavicular hematoma. On admission the patient was hemodynamically stable and ct angiography was performed to evaluate the extent of arterial injury, showing extravasation of the contrast agent and arteriovenous fistula. The patient was transferred to the operating theatre, left brachial artery was dissected under local anaesthesia and digital subtraction angiography verified the arteriovenous fistula between distal subclavian - proximal auxiliary artery and adjacent vein which was treated successfully with a Hemobahn stent-graft. On the 5th postoperative day the patient was discharged but he was lost during follow up. Five years later he presented with left arm claudication. A new angiography showed stent-graft stenosis at both ends of the covered stent. The lesion was treated with two balloon expandable (BE) stents.
    Conclusion: Endovascular repair of penetrating subclavian artery injuries could be the treatment of choice in selected patients but close follow up is mandatory for early detection and appropriate treatment of stent-graft related complications especially in young trauma patients.
    Review Article
    Michel JB* and Ho-Tin-Noe B
    In this opinion review, we aim at presenting an integrative picture of human atherothrombosis pathophysiology, taking into consideration its phylogenic determinants and chronological aspects. We first discuss how systemic arterial pressure, inherited from the acquisition of peripheral resistances and conductance artery multi-embranchments throughout evolution, generates outward convection of plasma molecules and particles through the arterial wall and favors collision of circulating cells with the wall. We then present the various responses triggered by the accumulation of cholesterol and blood cells in the arterial wall, with a more particular focus on the role played by vSMCs in triggering those responses in the early stages of the atheromatous disease. The contribution of SMC phenotypic plasticity to the formation of foam cells, intraplaqueefferocytosis, oxidative stress, and angiogenesis is notably outlined. The mechanisms of plaque evolution towards vulnerability, erosion, and rupture are also discussed. Finally, the relationships between local hemodynamics and atheroma evolution towards a given vascular pathology are illustrated by the presentation of vascular territory-specific diseases including coronary and carotid atherosclerosis, peripheral artery disease and abdominal aortic aneurysms.
    Research Article
    Marcel GJ Nederhoff*, Ellen HAM Elsenberg, IE Hofer, Mignon de Goeij, Joyce van Hengstum, Ronald LAW Bleys, and Gerard Pasterkamp
    In biomedical animal research, protocolled vascular interventions such as regular blood sampling or monitoring of organ functions are common practice. Vascular interventions and punctures are applied on large scale with concomitant injury to the arterial wall. In human cardiovascular patients, percutaneous coronary intervention or surgical vascular arteriotomy elicits a rapid decrease of the innate immune response in whole blood samples, shown by a down toning of TNFa expression after incubation with lipopolysaccharides. Significant changes in innate immune responsiveness could influence outcomes in animal experimental research when arterial trauma is part of the study protocol. In the present study, we assessed the effect of vascular trauma that is regularly applied in routine animal experimental studies on the innate immune response. We damaged the rat femoral arterial wall or executed a regularly practiced tail cut for blood withdrawal. Subsequently we examined the responsiveness of whole blood upon stimulation with a TLR4 ligand. Since anaesthetics are known to have an immunosuppressive effect, a volatile and an injectable anaesthetic were also compared.
    We found a strong inhibition of the innate immune response following vascular trauma in the rat. Blood sampling can already provoke a strong down toning of the immune responsiveness, irrespectively of sample volume or duration under anaesthesia. Our results stress that significant inhibition of immune responsiveness should be considered when intravascular interventions or blood punctures are applied in in vivo experimental research. It merits consideration that this effect can have an impact on the outcome of studies in experimental animal models.
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