Objective The combination of D-dimer and Wells score can exclude, but not confirm, the diagnosis of deep venous thrombosis (DVT). Since thrombosis and inflammation are interrelated, we evaluated the combination of soluble P-selectin (sPsel) with other inflammatory biomarkers for the diagnosis of DVT. Methods Sixty-two positive and 116 negative DVT patients, by duplex scan, were prospectively evaluated for sPsel, D-dimer, C-reactive protein (CRP), microparticles (total, leukocyte and platelet-derived and tissue factor positive microparticles - MP) and clinical Wells score. Results Biomarkers and clinical scores that differentiated DVT positives from negatives were sPsel (87.3 versus 53.4 ng/ml, p<0.0001), D-dimer (5.8 versus 2.1 mg/L, p<0.0001), CRP (2.1 versus 0.8 μg/ml, p<0.0005) and Wells score (3.2 versus 2.0, p<0.0001). For MP analysis, platelet-derived MP were found to differentiate DVT from negatives. Using multivariable logistic regression, a combination of sPsel and Wells score could establish the diagnosis of DVT (cut-point ≥90 ng/ml + Wells ≥2), with a specificity of 96% and positive predictive value (PPV) of 100%, and could exclude DVT diagnosis (cut-point ≤60 ng/ml and Wells <2) with a sensitivity of 99%, a specificity of 33% and a negative predictive value (NPV) of 96%. Conclusion This study establishes a biomarker and clinical profile combination that can both confirm and exclude the diagnosis of DVT.

Our experience demonstrates the safety and effectiveness of the nitinol vascular plug for hypogastric artery occlusion during EVAR. When compared with coils for hypogastric embolization during EVAR, nitinol vascular plugs are less expensive, produce less technical complications, and are associated with a significantly lower incidence of gluteal claudication.

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Objective Although duplex ultrasound is the standard for the diagnosis of lower extremity deep venous thrombosis (LE-DVT), imaging is not always available. The use of D-dimer can exclude (high-sensitivity), but not rule in (low-specificity) LE-DVT. Previously, we demonstrated that soluble P-selectin (sP-sel) in combination with the Wells score, establishes the diagnosis of LE-DVT with a specificity of 96% and a positive predictive value of 100%. In order to validate our previous results, we applied the model to a separate but similar patient cohort. Additionally, we analyzed the role of biomarkers for diagnosing upper extremity DVT (UE-DVT). Methods Between April 2009 and March 2012, all patients presenting for a duplex ultrasound exam with concern of DVT were screened. Demographics, clinical data, D-dimer, sP-sel, C-reactive protein, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13, and von Willebrand factor levels were prospectively collected in 279 patients (234 LE-DVT, 45 UE-DVT). Continuous and categorical variables among patients with DVT were compared with patients without DVT. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were then calculated using our previously derived cut points to rule in or exclude DVT. Results Among 234 patients evaluated for LE-DVT, 112 (48%) patients had a confirmed LE-DVT with significant differences in all biomarkers. When Wells score ≥2, sP-sel could rule in LE-DVT with a specificity of 97.5% and a positive predictive value of 91%, which was more accurate than Wells score ≥2 and D-dimer (specificity, 65%; positive predictive value, 69%). When Wells score was <2, D-dimer was superior to sP-sel for excluding the diagnosis of LE-DVT (sensitivity, 98%; negative predictive value, 95% vs sensitivity, 91%; negative predictive value, 79%). The use of additional biomarkers did not increase accuracy. Had imaging not been available, we could have correctly ruled in or ruled out LE-DVT in 29% (67/234) of patients. The use of sP-sel in UE-DVT was nondiagnostic. Conclusions We demonstrate that when Wells score ≥2, sP-sel is an excellent biomarker to rule in LE-DVT. Different from our previous study, D-dimer and a Wells score <2 was most sensitive at excluding a diagnosis of LE-DVT. Combined, Wells score, sP-sel, and D-dimer can both rule in and exclude LE-DVT in approximately one-third of patients.

In current practice, inferior vena cava (IVC) filters are commonly used in the prevention of pulmonary embolism. Despite their widespread use, periprocedural as well as late complications do occur. Filter penetration of the IVC wall into surrounding structures, including bowel, is a known although rare complication. This complication may manifest with abdominal pain, gastrointestinal bleeding, duodenocaval fistula, or small bowel obstruction. The authors present a case of abdominal pain from duodenal penetration by a Greenfield IVC filter 13 years after insertion. A detailed operative description and pertinent review of the literature is provided.

Thoracic aortic endovascular repair can be performed safely via a transfemoral approach. Alternative access in patients with high preoperative iliac artery morphology scores and device delivery size requirements over the native iliofemoral size may reduce iliofemoral complications. If early complications occur, prompt repair results in low rates of ischemic limb complications at late follow-up.

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Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular proliferative disorder, which most commonly involves the skin of the head and neck regions. Noncutaneous localization of this pathology is unusual, and its primary localization in large arteries presenting as a pulsatile mass is extremely rare. We report here two cases of ALHE manifested as masses of the occipital and brachial artery. ALHE should be considered in the differential diagnosis of localized peripheral arterial masses in young patients.