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Int. braz. j. urol ; 48(1): 196-197, Jan.-Feb. 2022.
Article in English | LILACS | ID: biblio-1356285


ABSTRACT Background: Inferior vena cava (IVC) invasion from renal cell carcinoma (RCC) occurs at a rate of 4-10% (1). IVC thrombectomy (IVC-TE) can be an open procedure because of the need for handling of the IVC (2). The first reported series of robotic management of IVC-TE started in 2011 for the management of Level I - II thrombi with subsequent case reports in recent years (2-5). Materials and Methods: The following is a patient in his 50's with no significant medical history. Magnetic resonance imaging and IR venogram were performed preoperatively. The tumor was clinical stage T3b with a 4.3cm inferior vena cava thrombus. The patient underwent robotic assisted nephrectomy and IVC-TE. Rummel tourniquets were used for the contralateral kidney and the IVC. The tourniquets were created using vessel loops, a 24 French foley catheter and hem-o-lock clips. Results: The patient tolerated the surgical procedure well with no intraoperative complications. Total surgical time was 274 min with 200 minutes of console time and 22 minutes of IVC occlusion. Total blood loss in the surgery was 850cc. The patient was discharged from the hospital on post-operative day 3 without any complications. The final pathology of the specimen was pT3b clear cell renal cell carcinoma Fuhrman grade 2. The patient followed up post-operatively at both four months and six months without disease recurrence. The patient continues annual follow-up with no recurrence. Conclusions: Surgeon experience is a key factor in radical nephrectomy with thrombectomy as patients have a reported 50-65% survival rate after IVC-TE (4).

Humans , Carcinoma, Renal Cell/surgery , Robotic Surgical Procedures , Kidney Neoplasms/surgery , Tourniquets , Vena Cava, Inferior/surgery , Retrospective Studies , Thrombectomy , Nephrectomy
Medicina (B.Aires) ; 81(3): 454-457, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346484


Resumen La flegmasia cerulea dolens es una complicación rara y poco frecuente de la trombosis venos a profunda. Los principales factores predisponentes son los procesos neoformativos, estados de hiper coagulabilidad, insuficiencia cardíaca congestiva, embarazo, inmovilización prolongada y cirugías. Se caracteriza por edema masivo, dolor intenso y cianosis. Sin tratamiento evoluciona con isquemia, necrosis y amputación del miembro comprometido. No existe consenso en su tratamiento, pero éste debe ser rápido, multidisciplinario y agresivo. La anticoagulación con heparina, la fibrinólisis sistémica, la trombectomía percutánea con fibrinólisis local, la trombectomía quirúrgica, la fasciotomía, la colocación de filtro de vena cava inferior y la amputación son algunos de los tratamientos propuestos.

Abstract Phlegmasia cerulea dolens (FCD) is a rare complication of deep vein thrombosis. Its cause is unknown. The main predisposing factors for the disease are neoformative processes, hypercoagulable states, congestive heart failure, pregnancy, prolonged immobilization, and surgeries on the affected limb. FCD is characterized by massive edema, severe pain, and cyanosis. The diagnosis is clinical. It is associated in most cases with pulmonary embolism and can lead to loss of the compromised limb if not treated in time. So far there is no consensus on its treatment. In clinical practice the use of anticoagulation with heparin, local thrombolysis, systemic fibrinolysis, surgical thrombectomy, fasciotomy, and inferior vena cava filter are described. In irreversible cases amputation is required. We present the case of a patient with FCD, the treatment performed and the evolution.

Humans , Thrombophlebitis/drug therapy , Thrombophlebitis/diagnostic imaging , Venous Thrombosis/drug therapy , Venous Thrombosis/diagnostic imaging , Heparin , Thrombectomy , Fibrinolysis
Rev. cuba. angiol. cir. vasc ; 22(1): e150, ene.-abr. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1251675


Introducción: La insuficiencia renal crónica es una enfermedad frecuente que requiere del uso vital de la hemodiálisis, procedimiento común en los pacientes que la padecen, por lo cual resulta necesario disponer de un acceso vascular adecuado. Objetivo: Caracterizar a los pacientes con fístulas arterio-venosas para hemodiálisis en el Hospital Clínico-Quirúrgico "General Freyre de Andrade". Métodos: Se realizó un estudio descriptivo-retrospectivo en 88 pacientes con fístulas arterio-venosas. Se recogieron las siguientes variables: edad, sexo, tipo de acceso vascular, localización, complicaciones inmediatas y tardías, y procedimiento corrector. El período de estudio abarcó desde enero de 2018 hasta enero de 2019. Resultados: Se les realizaron a los pacientes un total de 88 fístulas arterio-venosas. Predominó el sexo masculino (67 por ciento). Prevaleció el grupo de edades de 50 a 59 años (36,4 por ciento). La fístula arterio-venosa humero-cefálica (48,9 por ciento) resultó el procedimiento más realizado. El hematoma, la trombosis y la infección fueron las complicaciones inmediatas con mayor frecuencia (3,4 por ciento). De las complicaciones tardías, predominó la trombosis (3,4 por ciento), mientras que la trombectomía prevaleció como procedimiento corrector (37,5 por ciento). Conclusiones: Como parte del acceso vascular, la fístula humero-cefálica presentó los mejores resultados en cuanto a permeabilidad y durabilidad. Por otra parte, la fístula humero-humeral constituyó una alternativa cuando no se pudieron usar las venas cefálica y basílica a nivel del pliegue del codo(AU)

Introduction: Chronic kidney disease is a frequent condition that demands the vital use of hemodialysis, a common procedure in patients who suffer from it; therefore, it is necessary to have adequate vascular access. Objective: To characterize patients with arteriovenous fistulas for hemodialysis at General Freyre de Andrade Clinical-Surgical Hospital. Methods: A descriptive-retrospective study was carried out in 88 patients with arteriovenous fistulas. The following variables were selected: age, sex, type of vascular access, location, immediate and late complications, and corrective procedure. The study period covered from January 2018 to January 2019. Results: A total of 88 arteriovenous fistulas were approached among all the patients. The male sex predominated (67 percent). The age group 50-59 years (36.4 percent) prevailed. The procedure for creating a humeral cephalic arteriovenous fistula (48.9 percent) was the most performed. Hematoma, thrombosis and infection were the immediate complications with the highest frequency (3.4 percent). Among late complications, thrombosis prevailed (3.4 percent); while thrombectomy prevailed as a corrective procedure (37.5 percent). Conclusions: As part of vascular access, the procedure for creating humeral cephalic fistula presented the best outcome in terms of patency and durability. On the other hand, the procedure for creating the humeral fistula was an alternative when the cephalic and basilic veins could not be used at the level of the elbow crease(AU)

Humans , Male , Female , Thrombosis , Veins , Renal Dialysis , Thrombectomy , Elbow , Renal Insufficiency, Chronic , Vascular Access Devices , Fistula
Clinics ; 76: e2184, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153968


Non-tumoral portal vein thrombosis (PVT) is associated with higher morbidity and mortality in liver transplantation (LT). In this study, we aimed to evaluate the impact of PVT in LT outcomes and analyze the types of surgical techniques used for dealing with PVT during LT. A systematic review was conducted in Cochrane, MEDLINE, and EMBASE databases, selecting articles from January 1990 to December 2019. The MESH-terms used were ("Portal Vein"[Mesh] AND "Thrombosis"[Mesh] NOT "Neoplasms"[Mesh]) AND ("Liver Transplantation"[Mesh]). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendation was used, and meta-analysis was performed with Review Manager Version 5.3 software. A total of 1,638 articles were initially found: 488 in PubMed, 289 in Cochrane Library, and 861 in EMBASE, from which 27 were eventually selected for the meta-analysis. Surgery time of LT in patients with PVT was longer than in patients without LT (p<0.0001). Intraoperative red blood cell (p<0.00001), fresh frozen plasma (p=0.01), and platelets (p=0.03) transfusions during LT were higher in patients with PVT. One-year (odds ratio [OR] 1.17; p=0.002) and 5-year (OR 1.12; p=0.01) patient survival after LT was worse in the PVT group. Total occlusive PVT presented higher mortality (OR 3.70; p=0.00009) and rethrombosis rates (OR 3.47 [1.18-10.21]; p=0.02). PVT Yerdel III/IV classification exhibited worse 1-year [2.04 (1.21-3.42); p=0.007] and 5-year [0.98 (0.59-1.62); p=0.93] patient survival. Thrombectomy with primary anastomosis was associated with better outcomes. LT in patients with non-tumoral PVT demands more surgical time, needs more intraoperative transfusion, and presents worse 1- and 5-year patient survival. Total occlusive PVT and Yerdel III/IV PVT classification were associated with higher mortality. (PROSPERO, registration number: CRD42020132915).

Humans , Liver Transplantation , Venous Thrombosis , Portal Vein/surgery , Retrospective Studies , Treatment Outcome , Thrombectomy , Liver Cirrhosis
Rev. argent. neurocir ; 34(2): 124-134, jun. 2020. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1123379


Objetivo: Revisar sistemáticamente la evidencia de la terapia endovascular comparado con el manejo estándar. Criterios de inclusión: Ensayos clínicos aleatorizados que incluyan a: pacientes adultos mayores de 18 años, haber sufrido accidente cerebrovascular isquémico manejados con terapia endovascular en comparación con manejo médico. Métodos: Se realizó la búsqueda en las siguientes bases de datos: MEDLINE, the Central Register of Controlled Trials (CENTRAL); PubMed, HINARI, EMBASE; Cochrane Injuries group y lista de referencia de los artículos. Resultados: La trombectomía se asoció con disminución de la mortalidad (OR 0,78, IC del 95%: 0,63-0,95 p= 0,01), aumento de la tasa de revascularización (OR 6,16, IC del 95%: 4,39-8,64 p= <0,0001), mejoría de desenlace funcional (OR 1,78, IC del 95%: 1,52 ­ 2,08 p= <0,0001). No hubo diferencia en cuanto a la recurrencia de isquemia cerebral ni de la aparición de hemorragia intracerebral (OR 0,86, IC del 95%: 0,51 ­ 1,47 p= 0,59; OR 1,13, IC del 95%: 0,79 ­ 1,62 p= 0,5, respectivamente). Conclusiones: La terapia endovascular comparada con la fibrinólisis endovenosa mejora el pronóstico funcional, aunque se necesitan más estudios.

Objective: Systematically review the evidence of endovascular therapy compared with standard management. Inclusion criteria: Randomized clinical trials that include adult patients older than 18 years, have suffered an ischemic stroke managed with endovascular therapy compared to medical management. Methods: The search is performed in the following databases: MEDLINE, the Central Registry of Controlled Trials (CENTRAL); PubMed, HINARI, EMBASE; Cochrane Injury Group and reference list of articles. Results: Thrombectomy was associated with decreased mortality (OR 0.78, 95% CI 0.63-0.95 p = 0.01), increased revascularization rate (OR 6.16, CI 95%: 4.39-8.64 p = <0.0001), improvement in functional outcome (OR 1.78, 95% CI: 1.52 - 2.08 p = <0.0001). There was no difference in the recurrence of cerebral ischemia or the appearance of intracerebral hemorrhage (OR 0.86, 95% CI 0.51 - 1.47 p = 0.59, OR 1.13, 95% CI %: 0.79 - 1.62 p = 0.5, respectively). Conclusions: Endovascular therapy compared with the treatment of fibrinolysis improves functional prognosis

Humans , Stroke , Cerebral Hemorrhage , Brain Ischemia , Mortality , Thrombectomy
Int. braz. j. urol ; 46(1): 92-100, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056355


ABSTRACT Purpose: To evaluate the role of contrast-enhanced ultrasound (CEUS) in differentiating bland thrombus from tumor thrombus of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC). Materials and Methods: We retrospectively investigated 30 consecutive patients who underwent robot-assisted radical nephrectomy with IVC thrombectomy and had pathologically confirmed RCC. All patients underwent US and CEUS examination. Two off-line readers observed and recorded thrombus imaging information and enhancement patterns. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for bland thrombus were assessed. Results: Of the 30 patients, no adverse events occurred during administration of the contrast agent. Early enhancement of the mass within the IVC lumen on CEUS was an indicator of tumor thrombus. Bland thrombus showed no intraluminal flow on CEUS. There were eight (26.7%) patients with bland thrombus, including three level II, two level III, and three level IV. There were three cases with cephalic bland thrombus and five cases with caudal bland thrombus. Three caudal bland thrombi extended to the iliac vein and underwent surgical IVC interruption. Based on no intraluminal flow, for bland thrombus, CEUS had 87.5% sensitivity, 100% specificity, 96.7% accuracy, 100% positive predictive value and 95.6% negative predictive value. Conclusion: Our study demonstrates the potential of CEUS in the differentiation of bland and tumor thrombus of the IVC in patients with RCC. Since CEUS is an effective, inexpensive, and non-invasive method, it could be a reliable tool in the evaluation of IVC thrombus in patients with RCC.

Humans , Male , Female , Adult , Vena Cava, Inferior/diagnostic imaging , Carcinoma, Renal Cell/diagnostic imaging , Ultrasonography, Doppler/methods , Venous Thrombosis , Kidney Neoplasms/diagnostic imaging , Vena Cava, Inferior/surgery , Vena Cava, Inferior/pathology , Magnetic Resonance Imaging , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathology , Reproducibility of Results , Retrospective Studies , Thrombectomy/methods , Contrast Media , Venous Thrombosis/surgery , Venous Thrombosis/pathology , Tumor Burden , Neoplasm Grading , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Middle Aged
Article in Chinese | WPRIM | ID: wpr-828945


Diffusion-weighted imaging (DWI) is currently the most sensitive technique to diagnose early ischemic stroke. DWI signal hyperintensity is usually considered to suggest irreversible infarct core, but recent studies demonstrated that DWI hyperintensity signal could be reversible on small embolic lesions. Herein we present a case in a 63-year-old male patient, who was admitted to the emergency department with altered mental status and complaint of weakness in the left arm and leg 6.8 h prior to the admission. Emergency cranial magnetic resonance imaging (MRI) and angiography (MRA) revealed occlusion of his right middle cerebral artery (MCA) and large lesions on DWI. The patient underwent intra-artery thrombectomy after evaluation in spite of the large volume of the DWI lesions up to 91.5 mL at the baseline. His right MCA was recanalized at 8.5 h from symptom onset. One week after the procedure, the patient showed reduced DWI lesion volume to 11.58 mL. In this case we observed the reversibility of a large lesion of the anterior artery circulation presenting with hyperintensity on DWI, suggesting that the clinical implication of DWI hyperintensity should be interpreted with caution, and a large volume of baseline DWI hyperintensity may not be a contraindication to thrombectomy. This conclusion, however, awaits further validation by future large-scale randomized controlled trials.

Diffusion Magnetic Resonance Imaging , Humans , Infarction, Middle Cerebral Artery , Diagnostic Imaging , Magnetic Resonance Imaging , Male , Middle Aged , Stroke , Thrombectomy
Chonnam Medical Journal ; : 36-43, 2020.
Article in English | WPRIM | ID: wpr-787276


We evaluated whether thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) reduces adverse clinical outcomes within 30-days and 1-year periods. There is no well-designed, Korean data about the clinical impact of intracoronary TA during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI). From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) with pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and December 2015. The patients were divided into two groups: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac event (MACE), defined as the composite of cardiovascular death (CVD), recurrent MI and stroke for 30-days and 1-year. TA did not diminish the risk of MACE, all-cause mortality and CVD in all patients during 30-days or 1-year. After performing the propensity score matching, TA also did not reduce the risk of MACE (Hazard ratio (HR) with 95% Confidence Interval (CI):1.187 [0.863-1.633], p value=0.291), all-cause mortality (HR with 95% CI: 1.130 [0.776-1.647], p value=0.523) and CVD (HR with 95% CI: 1.222 [0.778-1.920], p value=0.384) during the 1-year period. In subgroup analysis, there was no benefit of clinical outcomes favoring PCI with TA. In conclusion, primary PCI with TA did not reduce MACE, all-cause mortality or CVD among the Korean patients with STEMI and pre-procedural TIMI flow 0, 1 during the 30-day and 1-year follow ups.

Coronary Angiography , Follow-Up Studies , Humans , Korea , Mortality , Myocardial Infarction , Percutaneous Coronary Intervention , Propensity Score , Stroke , Thrombectomy , Thrombosis
In. Verga, Federico; Burghi, Gastón. Encares de paciente crítico. Montevideo, Oficina del Libro FEFMUR, 2020. p.15-39, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1342635
Repert. med. cir ; 29(3): 173-178, 2020. tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1255031


Introducción: dada la alta mortalidad asociada con la enfermedad cerebrovascular, es necesario conocer las características clínicas, factores de riesgo, causas del evento, tiempos de atención y tratamiento de los pacientes para implementar medidas que mejoren la detección y su tratamiento. Objetivo: caracterizar a los pacientes adultos hospitalizados con diagnóstico de enfermedad cerebrovascular isquémica atendidos en el Hospital de San José de Bogotá entre el 1 de junio de 2017 y 31 de mayo de 2018. Metodología: estudio descriptivo de corte transversal. Se incluyeron mayores de 18 años con diagnóstico de enfermedad cerebrovascular isquémica. La información se recolectó de las historias clínicas y se empleó estadística descriptiva para analizar los datos. Resultados: se incluyeron 160 pacientes. El tiempo de evolución tuvo una mediana de 9.9 horas, 85% de ellos ingresaron sin alteración de la conciencia y severidad leve. El tiempo puerta a imagen tuvo una mediana de 36 minutos y el de puerta a trombólisis de 72.5 minutos. Se realizaron neuroimágenes en la primera hora de ingreso a 65%, procedimientos de recanalización endovenosa a 13%, de arritmia cardíaca a 96% y de vasos carotídeos a 93%; 82.4% recibió terapia antiagregante y 76% lograron una marcha superior a 10 metros en el momento del egreso. Discusión y conclusiones: se requiere la realización de mejorías en los tiempos de atención para alcanzar las pautas establecidas en las guías internacionales actuales.

Introduction: due to the high mortality rates associated with cerebrovascular disease, knowledge on its clinical characteristics, risk factors, possible causes, time to initial care and treatment is required in order to implement measures to improve detection and treatment. Objective: to characterize adult patients admitted to Hospital de San José of Bogotá diagnosed with ischemic cerebrovascular disease between June 1 2017 and May 31 2018. Methodology: a descriptive cross-sectional study. Patients older than 18 years diagnosed with cerebrovascular disease were included. Relevant data was collected from clinical records and descriptive statistics were used for data analysis. Results: 160 patients were included. The median progression was 9.9 hours, 85% of patients were admitted presenting no alteration of consciousness and mild severity. The median door-to- imaging time was 36 minutes and door-to-thrombolytic therapy 72.5 minutes. Sixty-five percent of patients received neuroimaging within the first hour of admission, endovenous recanalization procedures were conducted in 13%; of cardiac arrhythmias to 96% and of carotid vessels to 93 %; 82.4% received antiplatelet therapy and 76% were able to walk more than 10 meters at dismissal. Discussion and Conclusions: reducing time until initial medical care is required to meet the currently established international guidelines

Humans , Male , Female , Adult , Stroke , Thrombolytic Therapy , Risk Factors , Thrombectomy/rehabilitation
Arq. bras. cardiol ; 113(5): 948-957, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055042


Abstract Backgrund: New-onset atrial fibrillation complicating acute myocardial infarction represents an important challenge, with prognostic significance. Objective: To study the incidence, impact on therapy and mortality, and to identify predictors of development of new-onset atrial fibrillation during hospital stay for ST-segment elevation myocardial infarction. Methods: We studied all patients with ST-elevation myocardial infarction included consecutively, between 2010 and 2017, in a Portuguese national registry and compared two groups: 1 - no atrial fibrillation and 2 - new-onset atrial fibrillation. We adjusted a logistic regression model data analysis to assess the impact of new-onset atrial fibrillation on in-hospital mortality and to identify independent predictors of its development. A p value < 0.05 was considered significant. Results: We studied 6325 patients, and new-onset atrial fibrillation was found in 365 (5.8%). Reperfusion was successfully accomplished in both groups with no difference regarding type of reperfusion. In group 2, therapy with beta-blockers and angiotensin-conversion enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) was less frequent, 20.6% received anticoagulation at discharge and 16.1% were on triple therapy. New-onset atrial fibrillation was associated with more in-hospital complications and mortality. However, it was not found as an independent predictor of in-hospital mortality. We identified age, prior stroke, inferior myocardial infarction and complete atrioventricular block as independent predictors of new-onset atrial fibrillation. Conclusion: New-onset atrial fibrillation remains a frequent complication of myocardial infarction and is associated with higher rate of complications and in-hospital mortality. Age, prior stroke, inferior myocardial infarction and complete atrioventricular block were independent predictors of new onset atrial fibrillation. Only 36.7% of the patients received anticoagulation at discharge.

Resumo Fundamento: A fibrilação auricular de novo no contexto de infarto agudo do miocárdio representa um importante desafio com potencial impacto prognóstico. Objetivo: Determinar a incidência, impacto na terapêutica e mortalidade, e identificar possíveis preditores do aparecimento de fibrilação auricular de novo durante o internamento por infarto agudo do miocárdio com supradesnivelamento do segmento ST. Métodos: Estudamos todos os pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST inseridos consecutivamente de 2010 a 2017 num registro nacional português e comparamos dois grupos: 1 - sem fibrilação auricular; 2- com fibrilação auricular de novo. Efetuamos análise com modelo de regressão logística para avaliar o impacto de fibrilação auricular de novo na mortalidade intra-hospitalar e identificar preditores independentes para o seu aparecimento. Para teste de hipóteses, considerou-se significativo p < 0,05. Resultados: Estudamos 6325 pacientes, dos quais 365 (5.8%) apresentaram fibrilação auricular de novo. Não houve diferença no número de pacientes reperfundidos nem na estratégia de reperfusão. No grupo 2, terapêutica com betabloqueadores e IECA/ARA foi menos frequente, 20.6% tiveram alta sob anticoagulação oral e 16.1% sob terapêutica tripla. A fibrilação auricular de novo associou-se a maior incidência de complicações e mortalidade intra-hospitalar, mas não foi preditor independente de mortalidade intra-hospitalar. Identificamos idade, acidente vascular cerebral prévio, infarto inferior e bloqueio auriculoventricular completo como preditores independentes de fibrilação auricular de novo. Conclusões: A fibrilação auricular de novo continua sendo uma complicação frequente do infarto agudo do miocárdio, estando associada a aumento das complicações e mortalidade intra-hospitalar. Apenas 36.7% desses pacientes teve alta sob anticoagulação.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Stents/statistics & numerical data , ST Elevation Myocardial Infarction/complications , Portugal/epidemiology , Recurrence , Atrial Fibrillation/mortality , Atrial Fibrillation/therapy , Cardiovascular Agents/therapeutic use , Myocardial Reperfusion/mortality , Incidence , Predictive Value of Tests , Retrospective Studies , Age Factors , Hospital Mortality , Coronary Angiography , Thrombectomy/mortality , Stroke/complications , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Heart Failure/complications , Hospitalization/statistics & numerical data , Length of Stay
Rev. bras. cir. cardiovasc ; 34(2): 229-232, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990581


Abstract Advanced renal cell carcinoma accompanied by tumor thrombus in the venous system is present in up to 10% of cases. Extension of tumor thrombus above the diaphragm or into the right atrium represents level IV disease. Level IV tumors are typically treated with sterno-laparotomy approach with or without deep hypothermic circulatory arrest and veno-venous bypass. In this case report, the surgical technique for the resection of advanced RCC were described, with the concomitant use of transesophageal echocardiography for thrombus extraction without the veno-venous or cardiopulmonary bypass.

Humans , Male , Female , Middle Aged , Carcinoma, Renal Cell/surgery , Thrombectomy/methods , Echocardiography, Transesophageal/methods , Venous Thrombosis/surgery , Kidney Neoplasms/surgery , Vena Cava, Inferior/surgery , Carcinoma, Renal Cell/diagnostic imaging , Tomography, X-Ray Computed , Reproducibility of Results , Treatment Outcome , Ultrasonography, Interventional , Venous Thrombosis/pathology , Kidney Neoplasms/diagnostic imaging
Acta méd. colomb ; 44(1): 17-24, ene.-mar. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1019292


Resumen Introducción: en pacientes con tromboembolia pulmonar (TEP) aguda, la fibrinólisis arterial local puede tener una relación muy favorable entre beneficios y riesgos. Objetivo: caracterizar las condiciones epidemiológicas y clínicas de los pacientes con TEP agudo de riesgo intermedio que han recibido terapia fibrinolítica urgente dirigida por catéter. Métodos: estudio descriptivo de una serie de casos de pacientes atendidos en la Fundación Cardiovascular de Colombia (período 2012-2016) con diagnóstico de TEP de riesgo intermedio llevados a terapia fibrinolítica mediante catéter pulmonar. Resultados: se incluyeron 27 casos (26 pacientes, 57±20 años, 52% mujeres). La confirmación de embolia pulmonar aguda se realizó mediante angiotomografía. El 85% de los casos mostró signos ecocardiográficos de disfunción ventricular derecha, 74% elevación de troponinas, y 82% elevación de BNP o pro-BNP. El tiempo puerta-aguja desde el diagnóstico hasta la fibrinólisis fue de 29±31 horas (máx-min, 2-120). El tratamiento endovascular incluyó alteplasa (dosis total, 47±18 mg) y fragmentación-aspiración mecánica mediante catéter pulmonar. El 78% de los pacientes mostró disminuciones en la PAPm >10% del valor inicial [i.e., pacientes respondedores, ΔPAPm=-27±11% (-9±5 mmHg)]. Cinco pacientes fueron clasificados como no-respondedores (ΔPAPm=-2±7%, -1±4 mmHg). La estancia en UCI fue de 7±5 días (1-19), y la hospitalaria 13 días (1-36). No se presentaron complicaciones de sangrado mayor ni de otra índole. La supervivencia a 90 días fue de 100%. Conclusiones: esta serie observa que la fibrinólisis arterial pulmonar induce una mejoría hemodinámica inmediata en una alta proporción de pacientes con TEPa, con un balance beneficio-riesgo favorable en ausencia de complicaciones atribuibles inmediatas o tardías. (Acta Med Colomb 2019; 44: 17-24).

Abstract Introduction: in patients with acute pulmonary embolism (PE), local arterial fibrinolysis can have a very favorable relationship between benefits and risks. Objective: to characterize the epidemiological and clinical conditions of patients with intermediate-risk of acute PE who have received urgent fibrinolytic therapy directed by catheter. Methods: a descriptive study of a series of cases of patients treated at the Cardiovascular Foundation of Colombia (2012-2016 period) with a diagnosis of intermediate-risk PE who received fibrinolytic therapy using a pulmonary catheter. Results: 27 cases were included (26 patients, 57 ± 20 years, 52% women). Confirmation of acute pulmonary embolism was performed by angiotomography. 85% of the cases showed echocardiographic signs of right ventricular dysfunction, 74% elevation of troponins, and 82% elevation of BNP or pro-BNP. The door-needle time from diagnosis to fibrinolysis was 29 ± 31 hours (max-min, 2-120). The endovascular treatment included alteplase (total dose, 47 ± 18 mg) and mechanical fragmentation-aspiration by pulmonary catheter. 78% of the patients showed decreases in PAPm> 10% of the initial value [i.e., responding patients, ΔPAPm = -27 ± 11% (-9 ± 5 mmHg)]. Five patients were classified as non-responders (ΔPAPm = -2 ± 7%, -1 ± 4 mmHg). The stay in the ICU was 7 ± 5 days (1-19), and the hospital stay was 13 days (1-36). There were no complications of major or other bleeding. The 90-day survival was 100%. Conclusions: this series shows that pulmonary arterial fibrinolysis induces an immediate hemodynamic improvement in a high proportion of patients with intermediate-risk PE with a favorable benefit-risk balance in the absence of immediate or delayed attributable complications. (Acta Med Colomb 2019; 44: 17-24).

Humans , Male , Female , Adult , Pulmonary Embolism , Thrombolytic Therapy , Thrombectomy , Fibrinolysis
Neurointervention ; : 99-106, 2019.
Article in English | WPRIM | ID: wpr-760597


PURPOSE: Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. MATERIALS AND METHODS: From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. RESULTS: Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of 2 vs. ≤2. CONCLUSION: A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested.

Angiography , Humans , Logistic Models , Stroke , Thrombectomy
Neurointervention ; : 131-136, 2019.
Article in English | WPRIM | ID: wpr-760593


PURPOSE: Mechanical thrombectomy has become the standard of care for acute stroke caused by large vessel occlusion. As more patients are treated endovascularly, the number of older patients with tortuous vessels has risen. In these patients, catheterizing the internal carotid artery via a transfemoral approach can be very difficult or even impossible. Therefore, in selected patients, alternative strategies to the transfemoral approach have to be applied. MATERIALS AND METHODS: We report a case series of six patients undergoing mechanical thrombectomy via a combined transfemoral and transcarotid approach. Puncture of the carotid artery was conducted using roadmap guidance after an unsuccessful transfemoral attempt. Technical aspects and outcomes with this alternative approach were analyzed. RESULTS: Direct puncture of the carotid artery was achieved in five out of six patients (83%). In three out of six patients (50%), revascularization (modified Thrombolysis in Cerebral Infarction score ≥2b) was restored. No complications related to endovascular therapy were documented. One patient showed good neurological outcome (modified Rankin Scale [mRS] 5 at admission, mRS 1 at discharge). CONCLUSION: A combined transfemoral/transcarotid approach can be an alternative vascular access in patients with problematic vessel anatomy.

Carotid Arteries , Carotid Artery, Internal , Catheters , Cerebral Infarction , Humans , Punctures , Standard of Care , Stroke , Thrombectomy
Neurointervention ; : 137-141, 2019.
Article in English | WPRIM | ID: wpr-760592


Distal intracranial occlusions can sometimes cause significant neurological deficits. Endovascular thrombectomy in these vessels may improve outcome but carry a higher risk of haemorrhagic complications due to the small calibre and tortuosity of the target vessel. We report two cases of isolated M2/3 artery occlusion causing dense hemiplegia that was successfully treated with stent retrieval thrombectomy. A “semi-deployment technique” of a 3 mm stentriever was employed at the M2/3 bifurcation of the middle cerebral artery. Partial stent unsheathing allowed adequate clot engagement while avoiding excessive tension by the stent metal struts along the tortuous course of a distal vessel. Complete revascularization was achieved after first-pass of the stent retriever without complication, resulting in good clinical outcome in both cases. The described semi-deployment technique reduces the radial and tractional force exerted by the stentreiver on small branches, and may reduce the risk of vessel laceration or dissection in distal vessel thrombectomy.

Arteries , Endovascular Procedures , Hemiplegia , Lacerations , Middle Cerebral Artery , Stents , Stroke , Thrombectomy , Traction
Article in English | WPRIM | ID: wpr-741869


Antiphospholipid antibodies may be produced in cases involving autoimmune diseases and can sometimes be caused by infections, such as Mycoplasma pneumoniae infection. However, antiphospholipid antibodies causing thrombosis associated with M. pneumoniae pneumonia in children have rarely been reported. We report a case of an 8-year-old boy with M. pneumoniae pneumonia with antiphospholipid antibodies, complicated by brachial artery thrombosis. He was found to have antiphospholipid antibodies and low protein S levels. The brachial artery thrombus was removed via thrombectomy. The titers of antiphospholipid antibodies turned normal within 5 months. This is a rare case of M. pneumoniae infection with brachial artery thrombosis associated with transient antiphospholipid antibodies.

Antibodies, Antiphospholipid , Autoimmune Diseases , Brachial Artery , Child , Humans , Male , Mycoplasma pneumoniae , Mycoplasma , Pneumonia , Pneumonia, Mycoplasma , Protein S , Thrombectomy , Thrombosis
Article in English | WPRIM | ID: wpr-741458


For recanalization of emergent large vessel occlusions (ELVOs), endovascular therapy (EVT) using newer devices, such as a stent retriever and large-bore catheter, has shown better patient outcomes compared with intravenous recombinant tissue plasminogen activator only. Intracranial atherosclerotic stenosis (ICAS) is a major cause of acute ischemic stroke, the incidence of which is rising worldwide. Thus, it is not rare to encounter underlying ICAS during EVT procedures, particularly in Asian countries. ELVO due to underlying ICAS is often related to EVT procedure failure or complications, which can lead to poor functional recovery. However, information regarding EVT for this type of stroke is lacking because large clinical trials have been largely based on Western populations. In this review, we discuss the unique pathologic basis of ELVO with underlying ICAS, which may complicate EVT procedures. Moreover, we review EVT data for patients with ELVO due to underlying ICAS and suggest an optimal endovascular recanalization strategy based on the existing literature. Finally, we present future perspectives on this subject.

Angioplasty , Asian Continental Ancestry Group , Atherosclerosis , Catheters , Cerebral Infarction , Constriction, Pathologic , Humans , Incidence , Stents , Stroke , Thrombectomy , Tissue Plasminogen Activator