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AJR Am J Roentgenol ; 216(3): 563-569, 2021 03.
Article in English | MEDLINE | ID: covidwho-1133848


Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventionalists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or who are undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement as appropriate. Advanced retrieval techniques increase retrieval rates but require caution. Certain cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.

Device Removal/methods , Prosthesis Implantation/methods , Pulmonary Embolism/prevention & control , Vena Cava Filters , Vena Cava, Inferior , Venous Thrombosis/prevention & control , Antibiotic Prophylaxis , Anticoagulants/administration & dosage , Bariatric Surgery , COVID-19/complications , Device Removal/instrumentation , Endovascular Procedures , Humans , Neoplasms/complications , Physician-Patient Relations , Practice Guidelines as Topic , Prosthesis Design , Recurrence , Risk Assessment , Vena Cava Filters/adverse effects , Venous Thrombosis/etiology , Wounds and Injuries/complications
Multimed Man Cardiothorac Surg ; 20202020 Dec 23.
Article in English | MEDLINE | ID: covidwho-1007098


We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0-5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.

Assisted Circulation , COVID-19 , Heart-Assist Devices , Prosthesis Implantation , ST Elevation Myocardial Infarction , Shock, Cardiogenic , Adult , Assisted Circulation/instrumentation , Assisted Circulation/methods , COVID-19/complications , COVID-19/therapy , Cardiac Catheterization/methods , Humans , Male , Prone Position/physiology , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , SARS-CoV-2/isolation & purification , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/physiopathology , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/surgery , Treatment Outcome
J Otolaryngol Head Neck Surg ; 49(1): 59, 2020 Aug 10.
Article in English | MEDLINE | ID: covidwho-705369


With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center's approach to managing this unique patient population.

Coronavirus Infections/prevention & control , Infection Control/organization & administration , Laryngeal Neoplasms/surgery , Laryngectomy/statistics & numerical data , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Female , Humans , Laryngeal Neoplasms/diagnosis , Laryngectomy/methods , Larynx, Artificial , Male , Ontario , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Prosthesis Implantation/methods , Prosthesis Implantation/statistics & numerical data , Risk Assessment
G Ital Cardiol (Rome) ; 21(5): 336-340, 2020 05.
Article in Italian | MEDLINE | ID: covidwho-456893