ABSTRACT
Deep venous thrombosis (DVT) is a subtype of venous thromboembolism. Lower extremity DVT affects about 1-2% of hospitalized patients. If not managed properly, these thrombi can embolize, causing further complications. Thrombosis risk factors include vascular endothelial injury, venous stasis, and hypercoagulability states. This triad is also known as Virchow's triad. Although clinical features of lower extremity DVT are nonspecific and many patients are asymptomatic, physicians should maintain a high index of suspicion in patients presenting with leg swelling, pain, warmth, and erythema. Several diagnostic approaches for suspected first DVT have been proposed, and management depends on multiple factors such as location, duration of symptoms, cause of the thrombosis, and recurrence rate.
ABSTRACT
Varices secondary to portal hypertension in the setting of liver cirrhosis typically occur in the gastroesophageal region. Management guidelines for bleeding gastroesophageal varices are well established in the literature. Ectopic varices that occur outside of this typical location are an uncommon complication of portal hypertension. Rarely, these varices can result in life-threatening hemorrhage. Management guidelines of ectopic variceal bleeds are not yet standardized as cases are rare and treatment approach in the literature has historically varied. We present an interesting case of a 37-year-old patient with alcoholic liver disease and cirrhosis who developed spontaneous hemorrhage and shock from bleeding ectopic varices. This report exemplifies how coil embolization via a percutaneous transhepatic approach can be used to manage ectopic variceal bleeds in the setting of hemorrhagic shock.
ABSTRACT
Arteriovenous malformations (AVM) are abnormal connections between arteries and veins without a capillary bed, creating high- and low-flow areas that are prone to bleeding. Uterine AVMs can be congenital or acquired with an incidence of 0.1%. Acquired cases are usually caused by uterine instrumentation, trauma, infection, or gestational trophoblastic disease. Patients typically present with sudden onset of heavy vaginal bleeding. Diagnosis is made using angiography, ultrasound, computerized tomography, or magnetic resonance imaging. After patients are stabilized, management depends on their desire for future fertility and may include hysterectomy or endovascular embolization. We present the case of a 16-year-old G1P0010 female with recurrent vaginal bleeding caused by a uterine AVM. To preserve the patient's fertility, a selective embolization approach was employed using microcoils and gel foam. This case highlights a unique treatment option for uterine AVMs in patients who desire fertility preservation. Additionally, we review the diagnostic imaging and treatment options for uterine AVMs.
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 is the virus responsible for the 2019 global pandemic. Pulmonary complications of COVID-19 are well established in the literature. However, the virus causes numerous extrapulmonary manifestations, notably acute aortic occlusion (AAO). COVID-19 creates a hypercoagulable state via the upregulation of numerous procoagulant cytokines in endothelial cells of blood vessels. We present a case of a 63-year-old patient without a previous history of prothrombotic disorders who developed AAO in the distal abdominal aorta and bilateral common iliac arteries after contracting COVID-19. The patient was a poor surgical candidate and was treated with fibrinolytics that were administered via an EkoSonic™ Endovascular System (EKOS) catheter using a bilateral transfemoral approach. This case highlights a unique treatment option for non-surgical candidates with AAO.
