ABSTRACT
Objective To observe the effect of transcatheter thrombectomy combined with catheter-directed thrombolysis(CDT)for treating acute medium-high and high risk pulmonary thromboembolism(PTE).Methods After placement of inferior vena cava filter,transcatheter thrombectomy combined with CDT were performed in 28 patients with acute medium-high or high risk PTE.After treatment,clinical symptoms improved or not was assessed,and interventional related complications were recorded.The outcomes of arterial blood gas analysis,coagulation function,blood routine test,pulmonary artery pressure(PAP)and right ventricular diameter/left ventricular diameter(RV/LV)were compared before and 72 h after treatment.Regular follow-up was performed,then PAP and the clearance of pulmonary arterial thrombosis were observed 1,3,6 months and 1 year after treatment during follow-up.Results Among 28 cases,significant improvement of clinical symptoms achieved in 26 cases after treatment,while 2 patients died of respiratory failure.Puncture site bleeding occurred in 4 cases and improved after conservative treatment.Compared with those before treatment,among 26 survived patients,blood pH,arterial oxygen pressure,fibrin degradation products and D-dimer increased while the heart rate,N-terminal pro-B-type natriuretic peptide,PAP and RV/LV decreased 72 h after treatment(all P＜0.05).During follow-up,compared with those before treatment,PAP decreased,while the clearance rate of pulmonary thrombosis increased 1,3,6 months and 1 year after treatment(all P＜0.05).No active bleeding nor recurrence of PTE happened.Conclusion Transcatheter thrombectomy combined with CDT was safe and effective for treating acute medium-high and high risk PTE.
ABSTRACT
Objective To explore the feasibility and safety of emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation in the treatment of pelvic fracture combined with hemorrhagic shock.Methods A retrospective analysis of 21 patients with pelvic fractures and hemorrhagic shock who were treated with emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation was performed.The percutaneous minimally invasive screw fixation was performed immediately after embolization.Results There were 18 of 21 cases with obvious arterial bleeding confirmed by femoral artery angiography.And the corresponding interventional embolization was performed.No obvious arterial hemorrhage was found in the other 3 cases who received suspicious hemorrhagic internal iliac arterial prophylactic embolization.The time-consuming of percutaneous minimally invasive screw fixation was no more than 90 min for each patient.There was no servious complication associated with arterial embolization after intervention.Totall 18 cases were improved after discharge.Another 3 cases died,including 2 cases died for postoperative multiple organ failure or disseminated intravascular coagulation,1 case died for hemorrhagic shock caused by still continue bleeding after surgery.The postoperative follow-up was performed during 3-18 months with the average of (10.81 ± 2.62) months.The fractures in all the surviving cases achieved bone healing with good function.Conclusion The emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation is a safe,fast and effective method for the treatment of pelvic fractures and hemorrhagic shock with less complications.
ABSTRACT
Objective To explore the feasibility and safety of emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation in the treatment of pelvic fracture combined with hemorrhagic shock.Methods A retrospective analysis of 21 patients with pelvic fractures and hemorrhagic shock who were treated with emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation was performed.The percutaneous minimally invasive screw fixation was performed immediately after embolization.Results There were 18 of 21 cases with obvious arterial bleeding confirmed by femoral artery angiography.And the corresponding interventional embolization was performed.No obvious arterial hemorrhage was found in the other 3 cases who received suspicious hemorrhagic internal iliac arterial prophylactic embolization.The time-consuming of percutaneous minimally invasive screw fixation was no more than 90 min for each patient.There was no servious complication associated with arterial embolization after intervention.Totall 18 cases were improved after discharge.Another 3 cases died,including 2 cases died for postoperative multiple organ failure or disseminated intravascular coagulation,1 case died for hemorrhagic shock caused by still continue bleeding after surgery.The postoperative follow-up was performed during 3-18 months with the average of (10.81 ± 2.62) months.The fractures in all the surviving cases achieved bone healing with good function.Conclusion The emergency interventional arterial embolization combined with percutaneous minimally invasive screw fixation is a safe,fast and effective method for the treatment of pelvic fractures and hemorrhagic shock with less complications.