Vein, Femoral

Eight rats were used for the in vivo experiments, which were performed under deep urethane anesthesia (4 g/kg, i.p.). Each rat was placed on a heating pad to maintain body temperature throughout the experiment. The right femoral vein and artery were cannulated. EBD, which was prepared as a 4% solution in 0.9% saline, was injected as a single bolus dose of 2 ml/kg via the venous cannula. After a 120 min period to enable uniform blood distribution, the EBD-stained blood was collected from the arterial cannula. The blood samples were placed on ice until centrifugation at 10,000 × g to sediment blood cells, and the EBD-stained plasma supernatants were collected in separate tubes. EBD extraction from plasma was accomplished via the addition of 50% TCA at 1:1-1:3 volume–ratios, which resulted in a [TCA_final] of 25.0, 33.3, and 37.5%, respectively. Immediately following blood collection, each rat was thoroughly perfused with 0.9% saline to rid the circulation of remaining dye, and the perfused brain and liver tissues were collected. For extraction, the brain and liver tissues were placed in 1:1–1:5 weight (mg):volume (µl) ratios of 50% TCA, and they were homogenized for 5 min (continuous beating) using a metal-bead homogenizer (BULLET BLENDER® BBX24). The TCA/extracts from the plasma, brain, and liver samples were centrifuged at 10,000 × g for 20 min to remove precipitates, tissue debris, and metal beads, and the supernatants were added to a 96-well plate (30 µl per well, each plate supplemented with 90 µl of 95% ethanol and thoroughly mixed by pipetting) for fluorescence spectroscopy (620 nm/680 nm).

In all experiments, intestinal permeability was induced using FR as previously published (12 (link), 13 (link)). Chickens were randomly assigned to each experimental group and had unrestricted access to feed and water from 1 to 10 days of age. Beginning at 10 days, chickens in control FITC-d groups were allowed to continue with ad libitum access to feed, while chickens in FR FITC-d groups were subjected to 24 h of FR. Concentration of FITC-d was given based on group body weight; therefore, groups were weighed the day before FR began. At 11 days of age, chickens in all groups were given an appropriate dose of FITC-d by oral gavage for each experiment. After 1 h, or 2.5 h respectively, chickens were euthanized with CO₂ asphyxiation. Blood samples were collected from the femoral vein to quantify levels of FITC-d.

A temporary filter was inserted via the nonaffected femoral or jugular vein into the inferior vena cava (IVC) prior to the next procedure for patients with an extensive thrombus in the proximal vein that was evaluated as potentially life-threatening and was retrieved after the proximal DVT was removed and potentially life-threatening conditions were relieved. Consistent with local routines based on published guidelines [9 ], anticoagulant treatment was initiated immediately when DVT was identified with the use of subcutaneous low molecular weight heparin (LMWH) at a bolus dose of 100 units/kg twice daily. PTA and/or stent placement was encouraged for lesions that caused 50% or greater diameter narrowing of the iliac and/or common femoral vein, robust collateral filling, and/or a mean pressure gradient of more than 2 mmHg. At the end of LMWH, oral rivaroxaban was directly commenced at a dosage of 15 mg twice a day over the subsequent 21 days and 20 mg once a day thereafter for at least 6 months. In addition, the use of compression stockings (ankle pressure was approximately 30–40 mmHg) for more than 1 year was recommended.

Technical success was defined as the successful use of AngioJet RT. Thrombus score was calculated through venography imaging by two experienced interventional physicians independently depending on pre-RT, at the completion of RT or post-CDT, by adding the scores of six vein segments (common iliac vein, external iliac vein, common femoral vein, proximal and distal segments of femoral vein, and popliteal vein). Thrombus scores were 0 when the vein was patent and completely free of thrombus, 1 in condition of a partially occluded vein, and 2 in condition of a completely occluded vein (i.e., vein lumen completely occluded with massive thrombus). The score was calculated for each segment, resulting in possible total thrombus scores. The thrombus removal rate was calculated as follows: [total pre-RT scores - total completion of RT (or total post-CDT scores)]/total pre-RT scores × 100%. Thrombus removal grades were evaluated as grade III (100% thrombus removal rate with no residual clots), grade II (50–99% thrombus removal rate), and grade I (< 50% thrombus removal rate). Thrombus removal grades II and III (i.e., ≥50% thrombus removal rate) were considered clinical success [10 (link)], which consisted of primary RT success and adjunctive CDT success. The primary RT (defined as patients who did not require adjunctive CDT treatment) success was classified based on preprocedural and at completion of RT thrombus scores evaluated as grade II and grade III. Adjunctive CDT (defined as patients who required adjunctive CDT treatment) success was classified based on preprocedural thrombus scores and those at the end of adjunctive CDT that were evaluated as grade II and grade III. The requirement of necessary adjunctive PTA and/or stent placement to treat coexisting stenosis to obtain sufficient flow within the same hospital stay was recorded but not considered clinical failure.
The safety outcomes consisted of procedure-related and CDT-related complications. The former included vessel perforation or damage (such as extravasation or retention of contrast agent in the vessel wall), bradycardia, arrhythmias or acute kidney injury (AKI). With adherence to the Society of Interventional Radiology (SIR) [11 (link)], the latter feature was divided into major CDT-related complications, which were defined as intracranial bleeding or bleeding severe enough to result in death, surgery, cessation of therapy, or blood transfusion, and minor complications, which were defined as less severe bleeding manageable with local compression, sheath upsizing, and/or alterations of thrombolytic agent dose and anticoagulant dose [11 (link)]. The SIR classification of complications is listed in the Supplementary Table.