ABSTRACT
The AngioVac© system (AngioDynamics, Latham, NY, USA) is a percutaneous catheter-based approach indicated for the removal of unwanted intravascular material from venous circulation and offers a safe alternative to conventional surgical extraction. This series describes various pathologies that were high risk for surgical management in which AngioVac© proved to be a suitable alternative. Learning objectives: Demonstrate the utility of minimally invasive techniques for removal of unwanted venous material using percutaneous endovascular vacuum assisted aspiration. Formulate a new treatment algorithm in the management of unwanted right-sided material.
ABSTRACT
Background: In patients with non-valvular atrial fibrillation, the vast majority of thrombi originate in the left atrial appendage (LAA). Thus, occluding the LAA significantly reduces one's risk for developing an ischaemic stroke. To date, many different surgical methodologies in LAA occlusion (LAAO)/exclusion have been studied and utilized. Unfortunately, patients are often left with incomplete closure of their LAA, leaving behind residual lobes that continue to allow thrombus formations. With the recent rise in percutaneous approaches and devices such as the WATCHMAN FLX, there have been proven success rates in achieving total closure of the LAA. Reports and investigations regarding the utilization of WATCHMAN FLX devices in patients with surgically incomplete LAAO remain limited. Case summary: We present three cases of patients who had previously undergone surgical exclusion of the LAA yet unfortunately were left with residual LAA that continued to place them at high risk for an ischaemic stroke. Percutaneous LAAO with the WATCHMAN FLX was utilized to successfully achieve complete sealing of the residual lobes in failed LAA surgical closures. Discussion: Our multicentre case series elucidates that an increased risk of stroke due to surgical LAAO failure is a real-world possibility that is likely to be encountered in clinical practice. We demonstrate in this series how the WATCHMAN FLX may provide a feasible and safe method to supplement a surgically incomplete LAAO to allow for improved ischaemic stroke and systemic embolization risk reduction.
ABSTRACT
Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. Prompt and aggressive resuscitative strategies are crucial in promoting survivability. We present a case of AFE resulting in cardiopulmonary collapse and subsequent cardiac arrest where we were able to safely deliver the baby and resuscitate the mother with veno-arterial extracorporeal membrane oxygenation and Impella CP-a novel combination known as ECPELLA. We discuss the implications of this approach as a more efficacious strategy in resuscitating AFE-induced cardiogenic shock and arrest.
Subject(s)
Embolism, Amniotic Fluid , Extracorporeal Membrane Oxygenation , Heart Arrest , Heart-Assist Devices , Pregnancy , Female , Humans , Embolism, Amniotic Fluid/diagnosis , Embolism, Amniotic Fluid/therapy , Extracorporeal Membrane Oxygenation/methods , Heart-Assist Devices/adverse effects , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Heart Arrest/etiology , Heart Arrest/therapyABSTRACT
Current methodologies of diagnosing and managing venous thoracic outlet syndrome (vTOS) remain controversial, as pertinent studies using modern advancements in medicine are limited. We present a case in which we innovatively used a modified Wright's test during venography coupled with intravascular ultrasound, which allowed us to definitively determine the etiology of a vTOS. (Level of Difficulty: Intermediate.).
