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https://www.readbyqxmd.com/read/28628412/stratification-imaging-and-management-of-acute-massive-and-submassive-pulmonary-embolism
#1
Akhilesh K Sista, William T Kuo, Mark Schiebler, David C Madoff
While pulmonary embolism (PE) causes approximately 100 000-180 000 deaths per year in the United States, mortality is restricted to patients who have massive or submassive PEs. This state of the art review familiarizes the reader with these categories of PE. The review discusses the following topics: pathophysiology, clinical presentation, rationale for stratification, imaging, massive PE management and outcomes, submassive PE management and outcomes, and future directions. It summarizes the most up-to-date literature on imaging, systemic thrombolysis, surgical embolectomy, and catheter-directed therapy for submassive and massive PE and gives representative examples that reflect modern practice...
July 2017: Radiology
https://www.readbyqxmd.com/read/28603724/pulmonary-embolism-in-transit
#2
Anna Koulova, Ramin Malekan, Wilbert S Aronow, Howard A Cooper
A 65-year-old woman with recently diagnosed ovarian cancer presented with near syncope, tachypnea, and hypoxia. Transthoracic echocardiography revealed a dilated and hypokinetic right ventricle and a large, mobile mass in the right atrium prolapsing across the tricuspid valve. She was diagnosed with pulmonary embolism in transit and emergent embolectomy was recommended.
May 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28584461/infective-endocarditis-due-to-abiotrophia-defectiva-and-its-feared-complications-in-an-immunocompetent-person-rare-but-real
#3
Mohan Rudrappa, Laxmi Kokatnur
Abiotrophia defectiva is nutritional deficient streptococci that cannot be cultured on routine culture medias. Even though fastidious in growth requirement, it is a virulent bacterium preferentially affecting endovascular structures and is implicated in many culture-negative endocarditis cases. Unlike other organisms, it is known for heart valve destruction leading to heart failure and excessive embolization rates. It's inherent resistance to routinely used antibiotics also contributed to increased mortality and morbidity in affected individuals and warrants timely diagnosis and prompt treatment...
April 2017: Journal of Global Infectious Diseases
https://www.readbyqxmd.com/read/28578933/extracorporeal-membrane-oxygenation-pulmonary-embolectomy-and-right-ventricular-assist-device-for-massive-pulmonary-embolism
#4
Carly L Lodewyks, Joseph M Bednarczyk, Owen T Mooney, Rakesh C Arora, Rohit K Singal
Consensus regarding the management of massive pulmonary embolism (PE) and persistent shock after thrombolysis is lacking. A 30-year-old man collapsed with massive PE 3 days after an exploratory laparotomy for penetrating trauma, and he remained hypoxic and hypotensive despite thrombolytic therapy. Extracorporeal membrane oxygenation (ECMO) was instituted as a bridge to surgical embolectomy, and placement of a right ventricular assist device (RVAD) was used to facilitate separation from cardiopulmonary bypass...
March 31, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28569123/diffusion-weighted-imaging-or-computerized-tomography-perfusion-assessment-with-clinical-mismatch-in-the-triage-of-wake-up-and-late-presenting-strokes-undergoing-neurointervention-with-trevo-dawn-trial-methods
#5
Tudor G Jovin, Jeffrey L Saver, Marc Ribo, Vitor Pereira, Anthony Furlan, Alain Bonafe, Blaise Baxter, Rishi Gupta, Demetrius Lopes, Olav Jansen, Wade Smith, Daryl Gress, Steven Hetts, Roger J Lewis, Ryan Shields, Scott M Berry, Todd L Graves, Tim Malisch, Ansaar Rai, Kevin N Sheth, David S Liebeskind, Raul G Nogueira
Rationale Efficacy of mechanical thrombectomy for acute stroke due to large vessel occlusion initiated beyond 6 h of time last seen well has not been demonstrated in randomized trials. Aim To establish whether subjects considered to have substantial areas of salvageable brain based on age-adjusted clinical core mismatch who can undergo endovascular treatment within 6-24 h from time last seen (TLSW) well have better outcomes at three months compared to subjects treated with standard medical therapy alone...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28555191/percutaneous-mechanical-thrombectomy-using-rotarex%C3%A2-s-device-in-acute-limb-ischemia-in-infrainguinal-occlusions
#6
Samuel Heller, Jean-Claude Lubanda, Petr Varejka, Miroslav Chochola, Pavel Prochazka, David Rucka, Sylvie Kuchynkova, Johana Horakova, Ales Linhart
PURPOSE: To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. METHODS: In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28515749/thromboembolic-complications-after-an-ankle-joint-open-fracture-in-a-patient-with-a-history-of-deep-vein-thrombosis-in-the-lower-limbs
#7
Tomasz Stankowski, Sleiman Sebastian Aboul-Hassan, Piotr Stępiński, Anna Szymańska, Jakub Marczak, Romuald Cichoń
A 55-year-old patient was admitted to the Department of Orthopedics due to an open fracture in the right ankle joint. On the seventh day of hospitalization the patient experienced a transient ischemic attack. During the next day, dyspnea, chest pain and a 'rider' type pulmonary embolism in the pulmonary trunk occluding both pulmonary arteries and its branches were diagnosed. The patient was transferred to the Department of Cardiac Surgery. He underwent pulmonary embolectomy for massive pulmonary, right and left atrial embolism, and left ventricular embolism...
March 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28502551/variation-in-hospital-costs-and-reimbursement-for-endovascular-aneurysm-repair-a-vascular-quality-initiative-pilot-project
#8
Gary W Lemmon, Dan Neal, Randall R DeMartino, Joseph R Schneider, Tej Singh, Larry Kraiss, Salvatore Scali, Apostolos Tassiopoulos, Andrew Hoel, Jack L Cronenwett
OBJECTIVE: Comparing costs between centers is difficult because of the heterogeneity of vascular procedures contained in broad diagnosis-related group (DRG) billing categories. The purpose of this pilot project was to develop a mechanism to merge Vascular Quality Initiative (VQI) clinical data with hospital billing data to allow more accurate cost and reimbursement comparison for endovascular aneurysm repair (EVAR) procedures across centers. METHODS: Eighteen VQI centers volunteered to submit UB04 billing data for 782 primary, elective infrarenal EVAR procedures performed by 108 surgeons in 2014...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28498107/ultrasound-assisted-thrombolysis-of-an-occluded-transjugular-portosystemic-shunt
#9
Nicholas Hilliard, Teik Choon See, Nadeem Shaida
Transjugular intrahepatic portosystemic shunt (TIPS) insertion is commonly performed for refractory ascites or variceal bleeding. However, TIPS dysfunction can be seen in both early and late settings, with shunt thrombosis a particular problem. Treatment of shunt dysfunction commonly involves angioplasty and re-lining, with or without embolectomy, mechanical thrombectomy, or thrombolysis. Ultrasound-assisted thrombolysis has been shown to be successful for treatment of pulmonary embolism, deep vein thrombosis, and peripheral arterial thromboembolism, but has not been described before for TIPS occlusion...
May 12, 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/28479471/an-original-article-impact-of-ambient-temperature-on-incidence-of-acute-lower-limb-ischemia
#10
Y Law, Y C Chan, S W Cheng
BACKGROUND: This was a retrospective study to explore the possible association between atmospheric temperatures with the occurrence of acute leg ischemia (ALI). METHODS: A linear regression analysis was performed for a period of ten years on the impact of ambient temperature on the incidence of ALI. Mean ambient temperature on a daily basis was retrieved electronically from our Observatory, and the daily incidence of ALI was retrieved from the CDAR (Clinical Data Analysis and Reporting) System...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28473083/acr-appropriateness-criteria-%C3%A2-radiologic-management-of-mesenteric-ischemia
#11
Nicholas Fidelman, Ali F AbuRahma, Brooks D Cash, Baljendra S Kapoor, M-Grace Knuttinen, Jeet Minocha, Paul J Rochon, Colette M Shaw, Charles E Ray, Jonathan M Lorenz
Mesenteric vascular insufficiency is a serious medical condition that may lead to bowel infarction, morbidity, and mortality that may approach 50%. Recommended therapy for acute mesenteric ischemia includes aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting for the treatment of underlying arterial stenosis. Nonocclusive mesenteric ischemia may respond to transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1. Recommended therapy for chronic mesenteric ischemia includes angioplasty with or without stent placement and, if an endovascular approach is not possible, surgical bypass or endarterectomy...
May 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28472317/surgical-embolectomy-for-high-risk-acute-pulmonary-embolism-is-standard-therapy
#12
Daisuke Shiomi, Hiroshi Kiyama, Masatsugu Shimizu, Muneaki Yamada, Naohiro Shimada, Aya Takahashi, Nobuaki Kaki
OBJECTIVES: Acute massive pulmonary embolism (AMPE) is a life-threatening condition that often induces rapid haemodynamic deterioration. The mortality of surgical embolectomy is still poor in patients with preoperative cardiopulmonary arrest (CPA). We analysed the outcome of surgical pulmonary embolectomy for haemodynamically unstable patients. METHODS: Thirty-one patients underwent surgical embolectomy for haemodynamically unstable AMPE. The indications for surgical embolectomy were (i) <7 days from onset, (ii) haemodynamically unstable, (iii) massive clots in bilateral pulmonary arteries or unilateral pulmonary artery occlusion with a floating clot in the main pulmonary artery or right atrium and (iv) right ventricular dilatation in transthoracic echocardiography...
May 2, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28469944/pulmonary-embolism-and-intracardiac-type-a-thrombus-with-an-unexpected-outcome
#13
João Português, Lucy Calvo, Margarida Oliveira, Vítor Hugo Pereira, Joana Guardado, Mário Rui Lourenço, Olga Azevedo, Francisco Ferreira, Filipa Canário-Almeida, António Lourenço
Detection of right heart thrombi (RHT) in the context of pulmonary thromboembolism (PE) is uncommon (4-18%) and increases the risk of mortality beyond the presence of PE alone. Type A thrombi are serpiginous and highly mobile and are thought to be originated from large veins and captured in-transit within the right heart. Optimal management of RHT is still uncertain. A 79-year-old woman, with a history of recent total hysterectomy with adnexectomy and a Wells procedure, presented to the emergency department following an episode of syncope...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28465985/subclavian-artery-pseudoaneurysm-in-an-unusual-case-of-digital-gangrene
#14
Bhuban Majhi, Nandita Pal
A young male patient presented at a tertiary care hospital with cold and bluish left upper limb accompanied with digital gangrene arousing suspicion of peripheral vascular disease. History did not reveal any high-risk behavior. Clinical examination and subsequent investigations lead to the diagnosis of acute infective endocarditis of native aortic valve along with peripheral embolism caused by methicillin-resistant Staphylococcus aureus. Fogarty's balloon embolectomy was done following which patient developed pseudoaneurysm of the left subclavian artery...
January 2017: Journal of Cardiovascular Echography
https://www.readbyqxmd.com/read/28449604/retriever-first-embolectomy-refire-an-alternative-approach-for-challenging-cervical-access
#15
Daniel Behme, Michael Knauth, Marios-Nikos Psychogios
After endovascular treatment became the standard of care procedure for acute ischaemic stroke with large artery occlusion in 2015 the number of performed interventions has increased dramatically. Especially because age is no exclusion criterion for endovascular treatment, a relevant number of patients with difficult to access carotid arteries has to be treated. In these patients a direct puncture of the carotid is a valuable tool but is associated with severe complications and an initial learning curve. We therefore developed the so called retriever first embolectomy (ReFirE) technique in which a stentretriever is deployed over a 5F diagnostic catheter and a microcatheter to establish a stable anchor prior to accessing the internal carotid artery/intracranial vasculature with an 8F guide catheter and a 5F/6F intermediate catheter...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28431732/retrograde-pulmonary-embolectomy-for-acute-pulmonary-embolism-a-simplified-technique
#16
Syed T Hussain, John R Bartholomew, Marzia Leacche, Michael Zhen-Yu Tong
Surgical embolectomy in acute pulmonary embolism is usually reserved for patients with massive pulmonary embolism presenting with cardiogenic shock, or for whom thrombolysis is absolutely contraindicated or has failed. Incomplete removal of thrombotic material lodged in the distal pulmonary arterial bed is considered an important cause of persistent pulmonary hypertension. Retrograde pulmonary embolectomy is an adjunct to conventional pulmonary embolectomy, resulting in more complete embolectomy, specifically of material lodged in the distal pulmonary arterial bed...
May 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28401327/pulmonary-embolism-response-teams
#17
REVIEW
Maya Serhal, Ihab S Haddadin, Gustavo A Heresi, Deborah A Hornacek, Mehdi H Shishehbor, John R Bartholomew
Pulmonary embolism (PE) is a common thrombotic event that is variable in its presentation. Depending on the patients' risk for mortality, guidelines provide several treatment strategies including thrombolysis, catheter-directed therapies, pulmonary embolectomy, anticoagulation, and inferior vena cava filters. However, there is considerable disagreement between guidelines regarding the optimal treatment strategy for patients, particularly for those with intermediate-risk PE. In order to provide rapid and individualized care, PE response teams (PERT) have been developed...
April 11, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28400939/intracardiac-penetrating-injury-with-right-femoral-artery-embolism-due-to-blast-injury
#18
Ahmed Abdulaziz Abuzaid, Thamer Al-Abbasi, Zaid Arekat
Embolization due to blast injury with projectiles entering the bloodstream from the heart is a rare event that is unlikely to be suspected during the initial assessment of trauma patients. We report a case in which a missile penetrating the heart chambers managed to embolize and occlude the right common femoral artery. This was successfully managed by means of a multidisciplinary approach that included exploration, cardiorrhaphy, and embolectomy.
October 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/28400904/extensive-mobile-thrombus-of-the-internal-carotid-discovered-after-intravenous-thrombolysis-what-do-i-do-now
#19
Eugene L Scharf, Jennifer E Fugate, Sara E Hocker
This case report describes a rare presentation of ischemic stroke secondary to an extensive internal carotid artery thrombus, subsequent therapeutic dilemma, and clinical management. A 58-year-old man was administered intravenous (IV) thrombolysis for right middle cerebral artery territory ischemic stroke symptoms. A computed tomography angiogram of the head and neck following thrombolysis showed a longitudinally extensive internal carotid artery thrombus originating at the region of high-grade calcific stenosis...
April 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28385296/17%C3%AE-estradiol-prevents-mesenteric-injury-induced-by-occlusion-of-the-proximal-descending-aorta-in-male-rats
#20
Paulo Thales Rocha de Sousa, Ana Cristina Breithaupt-Faloppa, Cristiano de Jesus Correia, Raif Restivo Simão, Sueli Gomes Ferreira, Alfredo Inácio Fiorelli, Luiz Felipe Pinho Moreira, Paulina Sannomiya
OBJECTIVE: In surgical aortic repair or cardiac surgery with aorta occlusion, the occurrence of mesenteric ischemia and bowel injury has been associated with higher short-term mortality. The vascular protection of estrogens has been investigated and is mainly mediated by increasing the availability of nitric oxide (NO). Therefore, this study investigated the role of 17β-estradiol on visceral ischemia-reperfusion (I/R) injury after descending aorta occlusion in male rats. METHODS: Mesenteric ischemia was induced in male Wistar rats by placing a 2F Fogarty arterial embolectomy catheter (Edwards Lifesciences, Irvine, Calif) in the descending aorta, which remained occluded for 15 minutes, followed by reperfusion for up to 2 hours...
April 3, 2017: Journal of Vascular Surgery
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