Myocardial injury after non-cardiac surgery

Perioperative myocardial injury in patients undergoing non-cardiac surgery is a major challenge in the vascular surgical practice. It can be missed if we don’t look for it, but it was found to be associated with early (30-day) and late (1 yr) morbidity and mortality. Puelacher C et al defined Perioperative Myocardial Infarction (PMI) as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. In their large study (2546 surgeries) PMI occurred in 16%, but it was accompanied by chest pain only in 6%, any type of ischemic symptoms in 18%. Crude 30-day mortality was 8.9%  in patients with PMI versus 1.5% in patients without PMI. There is a potential to help many of the 8 million adults globally who have PMI(MINS) to reduce their risk of a major vascular complication. If only we can identify these patients and apply appropriate medications, we can prevent this mortality and morbidity.

Reference

Puelacher C, Lurati Buse G, Seeberger D, Sazgary L, Marbot S, Lampart A, Espinola J, Kindler C, Hammerer A, Seeberger E, Strebel I, Wildi K, Twerenbold R, du Fay de Lavallaz J, Steiner L, Gurke L, Breidthardt T, Rentsch K, Buser A, Gualandro DM, Osswald S, Mueller C; BASEL-PMI Investigators. Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization. Circulation. 2018;137(12):1221-1232. 

Effect of polidocanol foam on pulmonary parenchyma?

Phlebology. 2018 Mar;33(2):122-127. doi: 10.1177/0268355516683922. Epub 2017 Jan 16.

Effect of polidocanol foam administration into rat peripheral veins 

on pulmonary parenchyma.

de Moraes Silva MA¹, Ferreira RG¹, de Jesus-Silva SG¹, Cardoso RS¹, Miranda F Jr.¹

Abstract

Background Sclerotherapy has been gaining increased acceptance and popularity as an effective therapy for the treatment of varicose veins. This attention has fed growing interest into the safety and potential complications of this procedure. There is no evidence of pulmonary complications from foam sclerotherapy in humans; however, animal studies have shown possible damage. The aim of this study is to show the changes in rat pulmonary parenchyma after the injection of 1% polidocanol Tessari foam into the peripheral vein using histological analysis of the inflammatory and fibrosis processes. Methods Twenty-four Wistar rats were divided into the following four groups: 24 h polidocanol, seven-day polidocanol, 28-day polidocanol, and control group. After the foam was injected into the lateral saphenous vein, the lungs of the rats were removed for histological analysis. Results Alveolar edema was observed in only the 24 h group (P < 0.005). Vessel thickening was observed in the seven-and 28-day groups (P < 0.001). Interstitial fibrosis was found in only the 28-day group (P = 0.006). There was no evidence of venous or arterial thrombosis in either group. Conclusion Polidocanol Tessari foam injection into rat peripheral veins causes alveolar edema, vessel thickening, and interstitial fibrosis.

Diosmin along with other active Flavanoids is more effective in treating the venous disease.

Eur J Vasc Endovasc Surg. 2018 Mar 24. pii: S1078-5884(18)30106-0. doi: 10.1016/j.ejvs.2018.02.009. [Epub ahead of print]

Protective Effects of Micronized Purified Flavonoid Fraction (MPFF)

on a Novel Experimental Model of Chronic Venous Hypertension.

das Graças C de Souza M¹, Cyrino FZ², de Carvalho JJ³, Blanc-Guillemaud V⁴, Bouskela E

CONCLUSION:

 MPFF was more effective than diosmin in improving all microvascular

variables. The superiority of MPFF over diosmin alone can be explained by the synergistic

beneficial effects of the association between diosmin and active flavonoids of MPFF.