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Irit Stessman-Lande, Ronza Salem, Chen Rubinstein, Nurith Hiller, Samuel N Heyman, Ronny Alcalai
A patient developed hemopericardium shortly after left brachial arterial embolectomy using an embolectomy catheter. Evaluation disclosed evolving pseudoaneurysm of the right coronary artery that was successfully managed by stenting. Misplacement of the embolectomy catheter within the coronary vessel was facilitated by an anomalous origin of the right coronary artery. This complication highlights the importance of correct insertion of the embolectomy catheter using the markers to avoid maladvancement and damage to central vessels...
March 2018: Journal of Vascular Surgery Cases and Innovative Techniques
Matthew B Bevers, Thomas W K Battey, Ann-Christin Ostwaldt, Reza Jahan, Jeffrey L Saver, W Taylor Kimberly, Chelsea S Kidwell
BACKGROUND: Apparent diffusion coefficient (ADC) imaging is a biomarker of cytotoxic injury that predicts edema formation and outcome after ischemic stroke. It therefore has the potential to serve as a "tissue clock" to describe the extent of ischemic injury and potentially predict response to therapy. The goal of this study was to determine the relationship between baseline ADC signal intensity, revascularization, and edema formation. METHODS: We examined the ADC signal intensity ratio (ADCr) of the stroke lesion (defined as the baseline DWI hyperintense region) compared to the contralateral normal hemisphere in 65 subjects from the Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy trial...
March 13, 2018: Cerebrovascular Diseases
Hassan Saad, Khaled M Krisht, Wei-Hsun Yang, Emad Aboud, Ali F Krisht
BACKGROUND: The vascular closure staple clips have been studied in animal models and shown to have comparable results with sutured repair when it comes to the healing process, degree of vessel narrowing, and risk of thrombosis. However, they are clearly superior when the speed of application is taken into account, and they were clinically used in many vascular repair processes. Nevertheless, their usefulness in intracranial vascular surgery has not been described. OBJECTIVE: To describe the usefulness of hemoclips in fast and efficient repair of medium-sized and large intracranial vessels...
February 26, 2018: Operative Neurosurgery (Hagerstown, Md.)
Rajiv N Srinivasa, Jeffrey Forris Beecham Chick, Joseph J Gemmete, Anthony N Hage, Ravi N Srinivasa
INTRODUCTION: To report the technical and clinical success of performing minimally invasive endolymphatic embolization in neonates presenting with a chylothorax or chylous ascites. MATERIALS AND METHODS: 3 neonates, 2 males and 1 female, with a mean age of 28 days (range: 19-39 days) presented with a chylothorax (2) or chylous ascites (1) which was refractory to conservative management. All 3 patients (1 previously reported) underwent intranodal lymphangiography followed by thoracic duct embolization with 1 patient undergoing additional sclerosis of the retroperitoneal abdominal lymphatics...
March 7, 2018: Annals of Vascular Surgery
Wakako Fukuda, Satoshi Taniguchi, Ikuo Fukuda, Mari Chiyoya, Chikashi Aoki, Norihiro Kondo, Kaoru Hattori, Kazuyuki Daitoku, Ryosuke Kowatari, Masahito Minakawa, Yasuyuki Suzuki
Background : The incidence of pulmonary thromboembolism has been considered rare in Japan. However, its occurrence has been increasing because of westernized lifestyle and diet, increased diagnostic technique, and recognition of this disease. Method : Between January 2003 and September 2014, 179 patients were treated for pulmonary thromboembolism. We classified these patients into 3 groups; Massive (n=35), Sub-massive (n=29) and Nonmassive (n=115) and retrospectively reviewed the treatment options and the outcome...
December 25, 2017: Annals of Vascular Diseases
Takeshi Yamamoto
High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Most deaths in patients with shock occur within the first few hours after presentation, and rapid diagnosis and treatment is therefore essential to save patients' lives. The main manifestations of major PE are acute right ventricular (RV) failure and hypoxia. RV pressure overload is predominantly related to the interaction between the mechanical pulmonary vascular obstruction and the underlying cardiopulmonary status...
2018: Journal of Intensive Care
Hiraku Funakoshi, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
High-risk pulmonary embolism (PE) with hypotension, circulatory failure, or cardiac arrest is a rare, but life-threating condition. Many guidelines recommend that thrombolytic therapy is the first-line therapy for this condition and surgical embolectomy is an alternative treatment. However, nationwide data have been lacking on patient characteristics and practice patterns for high-risk PE in a real-world clinical setting.We defined high-risk PE patients as those who received noradrenaline and underwent surgical embolectomy or thrombolysis within one day after admission...
March 5, 2018: International Heart Journal
Melanie C Bois, Michael D Eckhardt, Vincent M Cracolici, Matthew J Loe, Joseph J Ocel, William D Edwards, Robert D McBane, Thomas C Bower, Joseph J Maleszewski
OBJECTIVE: Arterial neoplastic emboli are uncommon, accounting for <1% of thromboemboli in the current literature. Nonetheless, this event may be associated with significant morbidity and mortality. Herein, we report a series of 11 cases of arterial neoplastic emboli from a single tertiary care center along with a comprehensive review of the literature to date. The aim of this study was to document the incidence, clinical presentations, and complications of arterial neoplastic emboli as well as to highlight the importance of routine histologic examination of thrombectomy specimens...
March 1, 2018: Journal of Vascular Surgery
Michael Jolly, John Phillips
Pulmonary embolism remains a leading cause of death in the United States, with an estimated 180,000 deaths per year. Guideline-based treatment in most cases recommends oral anticoagulation for 3 months. However, in a small subset of patients, the "submassive, high-risk" by current nomenclature, with hemodynamic instability, more advanced therapeutic options are available. Treatment modalities to extract the thromboembolism and reduce pressure overload in the cardiopulmonary system include use of intravenous or catheter-directed thrombolytic agents, catheter-directed mechanical thrombectomy, and surgical embolectomy...
April 2018: Surgical Clinics of North America
Zhaoshun Yuan, Yangzhao Zhou, Xinmin Zhou, Xiaobo Liao
Cement pulmonary embolism (cPE) and inferior vena cava embolism (cIE) are rare but potentially life-threatening complications of percutaneous vertebroplasty (PVP). Most cPE and cIE occur simultaneously. In this case, a 65-year-old woman complained of dyspnea after PVP for 4 days. The patient's symptom and image tests manifested that the cPE was secondary to cIE. Even though the cIE was found on the first day after PVP, local surgeons treated the patient with a regular anticoagulant instead of more effective therapeutic measures...
February 16, 2018: Annals of Vascular Surgery
Chetan Pasrija, Anthony Kronfli, Michael Rouse, Maxwell Raithel, Gregory J Bittle, Sheelagh Pousatis, Mehrdad Ghoreishi, James S Gammie, Bartley P Griffith, Pablo G Sanchez, Zachary N Kon
OBJECTIVES: Ideal treatment strategies for submassive and massive pulmonary embolism remain unclear. Recent reports of surgical pulmonary embolectomy have demonstrated improved outcomes, but surgical technique and postoperative outcomes continue to be refined. The aim of this study is to describe in-hospital survival and right ventricular function after surgical pulmonary embolectomy for submassive and massive pulmonary embolism with excessive predicted mortality (≥5%). METHODS: All patients undergoing surgical pulmonary embolectomy (2011-2015) were retrospectively reviewed...
March 2018: Journal of Thoracic and Cardiovascular Surgery
J X Hing, J K Ch'ng, K H Tay, T T Chong
AIM: The Nellix was introduced to Asia in 2014. Data in Asians have been sparse. Two balloon expandable stents, each surrounded by a polymer-filled endobag are deployed in parallel to obliterate and seal the aneurysm. This paradigm shift to treating abdominal aortic aneurysms confers advantages for certain adverse aneurysm morphology that is outside the IFU for standard EVAR devices. We examine outcomes of fifteen Asian patients with concomitant infrarenal aortic and iliac artery aneurysms treated with the Nellix at our institution...
February 8, 2018: Annals of Vascular Surgery
Zhaoshun Yuan, Yangzhao Zhou, Xinmin Zhou, Xiaobo Liao
Cement pulmonary embolism (cPE) and inferior vena cava embolism (cIE) are rare but potentially life-threatening complications of percutaneous vertebroplasty (PVP). Most cPE and cIE occured simultaneously. In this case, a 65-year-old woman complained of dyspnea after PVP for 4 days. Patient's symptom and image tests manifest that the cPE was secondary to cIE. Even though cIE was found at the first day after PVP, the local surgeons treat the patient with a regular anticoagulant without another more effective therapeutic measure...
February 8, 2018: Annals of Vascular Surgery
Nuria Seguí, Carlos Ruiz-Carmona, Alina Velescu, Eduardo Mateos, Roberto Elosua, Albert Clará
BACKGROUND: The treatment of acute limb ischemia (ALI) has barely changed over the last years. However, the progressive implementation of anticoagulants, antiplatelet agents or statins within the population might have modified the profile and prognosis of patients suffering an ALI. The aim of this study was to evaluate the current results of the management of ALI secondary to a native artery occlusion. METHODS: Retrospective study of 220 consecutive patients (mean age 78 years; 49% male) was conducted between 2007 and 2015...
February 5, 2018: World Journal of Surgery
Khalid Najib, Mark Heckle, Sameh Goubran, Rhadika Mehta, Rohan Goswami, Rami N Khouzam
A paradoxical embolism is defined as a systemic arterial embolus due to passage of a venous thrombus through a right to left shunt. We describe a case of acute cerebral vascular accident (CVA), right subclavian arterial embolus, and pulmonary emboli in the setting of a large patent foramen ovale (PFO). A 74-year-old woman with multiple comorbidities presented to the emergency department with acute onset of shortness of breath, weakness, and right arm pain. She was found to have bilateral pulmonary emboli, left CVA, and a right subclavian arterial embolus on computed tomography (CT)...
January 2018: Annals of Translational Medicine
Reza Hajizadeh, Samad Ghaffari, Afshin Habibzadeh, Naser Safaei, Kamran Mohammadi, Abdolmohammad Ranjbar, Sahar Ghodratizadeh
Introduction: Pulmonary embolism is a challenging critical cardiovascular disease with high morbidity and mortality. Surgical embolectomy has favorable results in patients with massive pulmonary embolism. Aim: To study the outcome of embolectomy in patients with massive pulmonary embolism. Material and methods: In this single-center, retrospective study, 36 patients including 14 male and 22 female patients with a mean age of 50.80 ±18.89 years with acute pulmonary embolism who underwent surgical pulmonary embolectomy from January 2011 to January 2016 were included...
December 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Samad Ghaffari, Nariman Sepehrvand, Leili Pourafkari, Reza Hajizadeh, Elnaz Javanshir, Mehdi Nadiri, Nader D Nader
PURPOSE: We aimed to investigate the factors that are associated with increased cardiac troponin I (cTnI) leakage in the acute pulmonary embolism (PTE) setting and their alignment with patient outcome. METHODS: Adult patients with a diagnosis of PTE were enrolled in this prospective cohort study. The primary endpoint of interest was major adverse cardio-pulmonary events (MACPE), defined as the composite of in-hospital all-cause mortality, need for thrombolysis and mechanical ventilation and surgical embolectomy during index hospitalization...
April 2018: Journal of Critical Care
Antonio Salsano, Elena Sportelli, Guido Maria Olivieri, Nicola Di Lorenzo, Silvia Borile, Francesco Santini
Patients with submassive pulmonary embolism (PE), although normotensive, are characterized by right ventricular (RV) dysfunction and elevated levels of biomarkers of cardiac damage. The best treatment option in these cases is still a subject of debate and the use of thrombolysis in submassive PE remains controversial. A 57-year-old Caucasian male with unprovoked PE, normal blood pressure, and elevated troponin I values was referred to the cardiovascular department. In view of the presence of a right atrium thrombus, the patient underwent surgical embolectomy under extracorporeal circulation, with the extraction of a huge thrombus together with fragmented thrombi from both pulmonary arteries...
December 2017: Journal of Extra-corporeal Technology
Cara M Michelson, Cornelius M Dyke, Douglas J Wick, Rory Guenther, Dylan Dangerfield, Matthew E Wiisanen
The AngioVac suction cannula and circuit were designed for the percutaneous removal of soft thrombus and emboli in procedures requiring extracorporeal circulatory support. We describe a modification of the AngioVac suction catheter and cardiopulmonary bypass (CPB) circuit to effectively remove thrombus while maintaining the ability to rapidly initiate full CPBs during a medical crisis. This article will discuss the design concepts of the modified circuit as well as procedural protocols and considerations. The design modifications of incorporating an oxygenator, reservoir, and bridge allow for an increased flexibility that allows adaption to veno-venous extracorporeal membrane oxygenation or full CPB support when required for oxygenation or hemodynamic support...
December 2017: Journal of Extra-corporeal Technology
Jennifer E Fugate, Waleed Brinjikji, Harry Cloft, David F Kallmes, Alejandro A Rabinstein
BACKGROUND: Five randomized trials proving the efficacy and safety of mechanical embolectomy for ischemic stroke within 8hours used differing radiological methods to select patients. We aimed to evaluate the proportion of patients in clinical practice that would meet radiological criteria for inclusion in these trials. METHODS: Retrospective study of ischemic stroke patients at a large academic medical center who were considered for endovascular stroke therapy based on confirmed intracranial large vessel occlusion from April 2010-November 2014...
December 19, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
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