To date, the relationship between air pollutants and venous thromboembolism (VTE) has not been well established. Our aim is to investigate the association between ambient air pollutants and the incidence of VTE using the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database. From 2003 to 2015, 338,616 subjects from the general population not previously diagnosed with VTE were included. The long-term average concentration of air pollutants before diagnosis for each subject was calculated. During the study period, there were 3196 incident cases of VTE. After adjusting for age, gender, economic status, body mass index, physical activity, smoking, alcohol consumption, comorbid diseases, and meteorological variables, the risk of VTE was observed to increase significantly with the long-term average concentration of particulate matter < 10 μm in diameter: PM₁₀ (hazard ratio (HR) = 1.064 (95% confidence interval [CI] 1.053–1.074) for 1 μg/m³), SO₂ (HR = 1.118 (95% CI 1.079–1.158) 1 ppb), and O₃ (HR = 1.039 (95% CI 1.026–1.053) for 1 ppb), respectively. A difference between the date of the health screening and the date of diagnosis of the disease was observed. Long-term exposure to air pollutants including PM₁₀, SO₂, and O₃ may be an independent risk factor for the development of VTE.

Kim H, et al. Ann Surg Treat Res. 2023 Jul;105(1):37-46. https://doi.org/10.4174/astr.2023.105.1.37

Joon-Young Kim, Sang Ah Lee, Jun Gyo Gwon, Youngjin Han, Yong-Pil Cho, and Tae-Won Kwon. Vasc Specialist Int 2024;40:. https://doi.org/10.5758/vsi.230108

Lee SA, et al. Ann Surg Treat Res. 2023 Jun;104(6):339-347. https://doi.org/10.4174/astr.2023.104.6.339

Kim H, et al. J Korean Med Sci. 2023 Sep;38(39):e321. https://doi.org/10.3346/jkms.2023.38.e321

Renal cell carcinoma (RCC) has a unique feature in which tumor thrombus extends through the vein into the inferior vena cava. RCC with venous tumor thrombus is classified based on the level of thrombus. Standard treatment involves a combination of radical nephrectomy and tumor thrombectomy, despite the technical challenges associated with this approach. We aimed to evaluate the clinical outcomes based on the tumor thrombus level. We conducted a retrospective analysis of patients who underwent tumor resection and thrombectomy for RCC with venous tumor thrombus at a single center between January 2001 and December 2022. Tumor thrombus levels were classified into four levels (I-IV) according to the Mayo Clinic grading system, and patients were grouped based on the hepatic vein level: levels 0, I, and II were categorized as group 1, while levels III and IV were categorized as group 2. Survival outcomes were compared between the two groups using Kaplan-Meier survival analysis. A total of 287 patients with RCC with venous tumor thrombus who underwent tumor resection and thrombectomy were identified. The distribution of patients according to the tumor thrombus level was as follows: 84 patients had level 0 thrombus, 71 had level I, 85 had level II, 19 had level III, and 28 had level IV. This results in 240 patients in group 1 (levels 0, I, and II) and 47 patients in group 2 (levels III and IV). The 5-year survival rates were 46.7% for group 1 and 53.2% for group 2. Kaplan-Meier survival analysis showed no significant difference in 5-year overall survival between the two groups (P = .75). However, patients in group 2 had a significantly longer postoperative hospital stay (21.43 ± 23.09 days) compared with those in group 1 (10.63 ± 6.31 days; P = .004). Tumor thrombus level is not a significant prognostic factor in RCC. Aggressive surgical removal should be considered, even for thrombus extending beyond the hepatic vein, given the acceptable prognosis.