Flouroscopic versus conventional epidural blood patch in obstetrics: A retrospective cohort study.

BACKGROUND: Epidural blood patch is a common effective treatment for postdural puncture headache after accidental dural puncture during labor and may be done in conventional or fluoroscopy-guided methods. The aim of this study was to compare intensity of headache at the time of discharge from the hospital and to compare blood volumes injected in conventional epidural blood patches versus fluoroscopic-guided blood patches and evaluate the side effects of both method of treatment. METHODS: Between the years 2010 and 2020, 84 patients who were diagnosed with postdural puncture headache received either a conventional epidural blood patch or a fluoroscopic-guided blood patch. Blood volumes were compared and evaluation of side effects was made based on data collected during and after the procedure. RESULTS: Eighty-four patients were included in this study. Fifty-two women in the conventional epidural blood patch group and 32 in the fluoroscopic-guided blood patch group. Women in the conventional epidural blood patch group received statistically significantly higher doses of blood than women in the fluoroscopic-guided blood patch group: conventional method 29 ml IQR [23-36] versus fluoroscopic method 16 ml, IQR [12-18], p < .001 with no difference in headache pain intensity at hospital release. There was no difference between groups in hospital length of stay, or persistent PDPH. There was also no difference chronic headache or backache between the two groups. CONCLUSIONS: Women who received fluoroscopic epidural blood patch required a much lower volume of blood injected while there was no difference between groups in headache pain intensity at discharge.

Long-term outcomes of patients with complex coronary artery disease according to agreement between the SYNTAX score and revascularization procedure in contemporary practice.

AIMS: The SYNTAX score (SS) has been shown to identify subgroups of patients with left main or triple-vessel coronary artery disease (LM/3VCAD) that can be treated with a percutaneous coronary intervention (PCI) with equal clinical outcomes as coronary artery bypass surgery (CABG).We sought to assess the adequacy of referral to PCI/CABG of patients with LM/3VCAD at our institution. PATIENTS AND METHODS: We retrospectively matched all patients with LM/3VCAD referred to CABG (n=145) to patients referred to PCI in our institution during 2009-2010. We calculated the SS and clinical SS (cSS) according to the European Society of Cardiology guidelines and compared the agreement rates between the revascularization modality and the SS as well as clinical outcomes at the 3-year follow-up. RESULTS: The overall agreement rates between the revascularization procedure and the SS was 67%, for example the rate was higher in patients referred to PCI compared with CABG (78 vs. 49%) and patients with 3VCAD compared with patients with LMCAD (68 vs. 51%). Patients without agreement between the revascularization modality and the SS had higher rates of combined adverse cardiac events (42.6 vs. 27% P=0.008). Similar results were observed when using the cSS at different cutoff levels. CONCLUSION: At our institution, there was considerable disagreement between a clinical judgment-based coronary revascularization and the SS/cSS-based allocation process as to the preferred revascularization modality for patients with complex CAD. Our results suggest that integrating the SS/cSS into the decision-making process for assigning patients to revascularization would yield better clinical outcomes.