ABSTRACT
We report a 36-year-old man who presented with unilateral flank pain caused by renal artery occlusion with ischemia and infarction from septic emboli secondary to bacterial endocarditis. We treated the occlusion with a novel rinsing and aspiration device, the Rinspirator Thrombus Removal System (ev3, Plymouth, Minn) and suction thrombectomy, which resulted in significant revascularization of the kidney and relief of symptoms. Postprocedural imaging demonstrated marked improvement in renal vascularization, with only small areas of infarction. This technique may be useful in patients where the embolic material is chronic or thrombolytic agents are contraindicated.
Subject(s)
Embolism/surgery , Endocarditis, Bacterial/complications , Infarction/surgery , Ischemia/surgery , Kidney/blood supply , Renal Artery Obstruction/surgery , Suction , Thrombectomy , Adult , Anti-Bacterial Agents/therapeutic use , Embolism/diagnostic imaging , Embolism/microbiology , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Equipment Design , Flank Pain/etiology , Flank Pain/surgery , Humans , Infarction/diagnostic imaging , Infarction/etiology , Ischemia/diagnostic imaging , Ischemia/etiology , Male , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/microbiology , Streptococcus/isolation & purification , Thrombectomy/instrumentation , Thrombectomy/methods , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Acute cholecystitis is a well known complication in the critically ill patient population. These patients are often at high risk for morbidity and mortality associated with cholecystectomy. Percutaneous cholecystostomy has been shown to be an effective procedure in the treatment of acute cholecystitis in this patient population. Some patients require prolonged catheter drainage before definitive therapy. In four patients with patent cystic ducts, standard drainage catheters were exchanged for 10.2-F Chait pediatric cecostomy catheters. The low profile of the catheter and the "Trapdoor" feature allow maintenance and increased patient satisfaction while maintaining drainage and access.