ABSTRACT
We describe a rare case of sacral epidural arteriovenous fistulas (edAVFs) with atypical clinical course of treatment. A 78-year-old man with a history of spinal surgery presented progressive gait disturbance and urinary incontinence. Spinal angiography demonstrated a sacral spinal AVF fed by bilateral lateral sacral arteries, draining to the venous pouch with subdural drainage. The first treatment by direct interruption of a subdural drainer was incompletely finished. Postoperative reassessment by 3D imaging analysis led to the diagnosis of sacral edAVF and 3D understanding of its angioarchitecture. The second treatment by transarterial embolization (TAE) resulted in complete occlusion of a sacral edAVF. However, spinal venous congestion didn’t improve, because the recruitment of occult edAVFs at the multiple lumbar levels and complex-shaped sacral ventral epidural venous plexus (VEP) were involved in the remnant of prior subdural drainage. The third treatment was performed by TAE for three occult edAVFs and the VEP compartment connecting between a patent edAVF and subdural drainage, which resulted in complete disappearance of spinal cord edema. Endovascular embolization of VEP compartment connecting to subdural drainage in addition to fistulous occlusion may be one of the treatment options for several edAVFs at the multiple spinal levels.
ABSTRACT
Introduction: This study examined the association between the use of home nursing care and the consultation time of emergency home visits among patients using home health care. Methods: Participants were recruited from three urban clinics in Japan between September 1 and November 30, 2019. Univariate analysis and multivariate negative binomial regression analysis considering institutional clusters were performed on the relationship between the two. Results: A total of 278 patients were included in the analyses. The use of home nursing care was significantly associated with a decrease in the time spent during emergency home visits in both univariate and multivariate analyses (P < 0.018 and P < 0.001, respectively). The multivariate analysis estimated the mean reduction in consultation time to be 10.3 minutes (95% confidence interval, 9.9-10.8). Conclusion: The use of home nursing care reduced the consultation time in emergency home visits. This study suggested that home nursing care can reduce the burden on physicians providing home visits, but further studies are needed to improve collaboration.