ABSTRACT
OBJECTIVE: To retrospectively evaluate the frequency and risk factors for developing thrombus in a systemic vein such as the infrarenal inferior vena cava or the iliac vein, in which a balloon-occluded retrograde transvenous obliteration (B-RTO) catheter was indwelled. MATERIALS AND METHODS: Forty-nine patients who underwent B-RTO for gastric varices were included in this study. The B-RTO procedure was performed from the right femoral vein, and the B-RTO catheter was retained overnight in all patients. Pre- and post-procedural CT scans were retrospectively compared in order to evaluate the development of thrombus in the systemic vein in which the catheter was indwelled. Additionally, several variables were analyzed to assess risk factors for thrombus in a systemic vein. RESULTS: In all 49 patients (100%), B-RTO was technically successful, and in 46 patients (94%), complete thrombosis of the gastric varices was achieved. In 6 patients (12%), thrombus developed in the infrarenal inferior vena cava or the right common-external iliac vein. All thrombi lay longitudinally on the right side of the inferior vena cava or the right iliac vein. One of the aforementioned 6 patients required anticoagulation therapy. No symptoms suggestive of pulmonary embolism were observed. Prothrombin time-international normalized ratio and the addition of 5% ethanolamine oleate iopamidol, on the second day, were related to the development of thrombus. CONCLUSION: Development of a thrombus in a systemic vein such as the inferior vena cava or iliac vein, caused by indwelling of the B-RTO catheter, is relatively frequent. Physicians should be aware of the possibility of pulmonary embolism due to iliocaval thrombosis.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Balloon Occlusion/methods , Catheters, Indwelling/adverse effects , Esophageal and Gastric Varices/etiology , Femoral Vein , International Normalized Ratio , Iopamidol/administration & dosage , Oleic Acids/administration & dosage , Prothrombin Time , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Tomography, X-Ray Computed , Treatment Outcome , Venous Thrombosis/drug therapyABSTRACT
Laser-assisted vascular anastomosis (LAVA) of arteries and veins in mongrel dogs was performed using a low-powered carbon dioxide laser. The anastomotic site was irradiated at a point 10mm distal from focus and the beam at this point was 0.8mmφ in diameter. Adequate laser power for anastomosis was 160-200mW for arteries and 120-160mW for veins, and the required duration of radiation was 5-10sec per 1mm anastomotic length for both vessels. In arteries successful anastomosis was achieved by LAVA in 44% of transverse incisions and 65% of longitudinal incisions, compared to 65% and 95% for veins, respectively. LAVA ruptured at a pressure of 102±28mmHg on average in arteries and 77±24mmHg in veins. However, LAVA reinforced with etyl 2-cyanoacrylate were safe at high pressures more than 300mmHg in arteries. Follow up has been achieved in 99 anastomotic sites for 9 months. No stenosis, occlusion, thrombus or infection were found apart from one (1%) pseudoaneurysm formation 4 months after LAVA. Angioscopic views and histological findings of anastomotic tissue welded by mean of LAVA revealed good layer-to-layer continuity of the three-layer structure of arterial wall. LAVA seems to be a useful method for vascular anastomosis.
ABSTRACT
Various types of surgical techniques have been reported for the closure of complicated PDA, since Morrow first described an innovatory operative method. At our institute, extracorporeal circulation has been frequently used as a support measure for these operations to ensure the safety of the operation. Ten patients with complicated PDA were operated under extracorporeal circulation. All patients but one were adults. The reason for use of extracorporeal circulation included age, presence of atherosclerosis or calcification of the ductus, short neck ductus, ductal aneurysms, right sided descending aorta and recanalization after previous ligation. The ductus was approached through the left lateral thoracotomy in 8 patients and median sternotomy in 2. The Morrow procedure was performed in 2 patients. No hospital death occurred, although the mean duration of the hospital stay after the operation was longer in these cases than in cases with simple PDA. We conclude that the use of extracorporeal circulation is safe and effective for the closure of complicated PDA.
ABSTRACT
The patient was a 56-year-old male with an 8-year history of Behcet's syndrome, who presented with chest pain. A saccular aneurysm (4×4cm) of the descending aorta was disclosed by X-ray and CT. Impending rupture of the aneurysm was suspected and emergency surgery was performed under cardiopulmonary bypass. The aneurysm consisted of a large thrombus, and a punched-out lesion on the aorta (φ10mm) was found beneath the thrombus. Closure with a Dacron patch was carried out successfully. Pathologic examination revealed the patient to have vasculo-Behcet's syndrome. Generally this desease has a poor prognosis, especially if an aneurysm is present, since sudden rupture can occur. Thus, prompt surgical treatment of the aneurysm should be considered. The patient was free of recurrence at the time of writing this report.
ABSTRACT
In a 3 year-old girl with acyanotic tetralogy of Fallot, preoperative echocardiography revealed a thick fibrous tissue hanging on the right side of large ventricular septal defect. According to the definition of Kirklin, we diagnosed it as “flap valve ventricular septal defect.” And this diagnosis was supported by the findings of electrocardiogram and cardiac catheterization. At the operation, it was confirmed that the flap was only attached to the posterior margin of ventricular septal defect, and that it hardly played any part in tricuspid valve function. To our knowledge, this is the first case of “tetralogy of Fallot with flap valve ventricular septal defect” reported in Japan.