ABSTRACT
Thrombolytic therapy is an effective method for reopening an occluded venous segment, but little is known about the long-term results of thrombolysis via direct intravenous route for axillary subclavian vein thrombosis (ASVT). Our experience with 13 cases of primary ASVT illustrates the possible advantages of a protocol consisting of lytic therapy, surgical decompression and percutaneous balloon angioplasty if a high-grade stenosis persists. If accompanied by adjunctive therapy to correct the underlying cause, thrombolytic therapy for ASVT results in acceptable long-term symptom relief and vein patency.
Subject(s)
Angioplasty, Balloon/methods , Axilla/blood supply , Streptokinase/therapeutic use , Subclavian Vein , Thrombectomy/methods , Thrombolytic Therapy/methods , Thrombosis/therapy , Urokinase-Type Plasminogen Activator/therapeutic use , Adult , Aged , Anticoagulants/therapeutic use , Causality , Clinical Protocols , Combined Modality Therapy , Female , Follow-Up Studies , Hot Temperature/therapeutic use , Humans , Infusions, Intravenous , Male , Middle Aged , Phlebography , Thrombosis/classification , Thrombosis/diagnostic imaging , Thrombosis/epidemiology , Treatment Outcome , Vascular Patency , Veins/transplantationABSTRACT
We reviewed the courses of 40 patients with variceal bleeding treated with a standardized protocol, including intravenous (IV) vasopressin (Pitressin) and transhepatic embolization. Twelve of the 32 patients with acute episodes of massive variceal bleeding responded to the administration of IV vasopressin alone. Of the 20 patients who did not respond to vasopressin therapy, emergency transhepatic portography with embolization produced cessation of bleeding in ten (50%). The remaining ten patients who failed to respond to either IV vasopressin therapy or transhepatic embolization died, regardless of whether they were treated with aggressive medical therapy or emergency portosystemic shunt. Transhepatic embolization in both the emergent and elective situation demonstrated a thrombotic complication rate of 20%, which limited or precluded eventual therapy with elective portosystemic shunt. Because of this relatively high incidence of occult portal thromboses after transhepatic embolization, transhepatic portography should be obtained routinely prior to elective portosystemic shunts in those patients who have a history of transhepatic embolization.
Subject(s)
Embolization, Therapeutic/methods , Esophageal and Gastric Varices/therapy , Adult , Aged , Embolization, Therapeutic/adverse effects , Esophageal and Gastric Varices/drug therapy , Female , Gastrointestinal Hemorrhage/drug therapy , Gastrointestinal Hemorrhage/therapy , Hemoperitoneum/etiology , Humans , Infusions, Parenteral , Male , Middle Aged , Portal System/diagnostic imaging , Radiography , Thrombosis/etiology , Vasopressins/therapeutic useABSTRACT
Aortofemoral (AF) and axillofemoral bypass grafts (AXFG) are alleged to have similar patency rates, but little is known of their comparative functional results. In 91 limbs clinically selected for AXFG or AF, pulse volume recording amplitude (PVR) and Dopper systolic ankle/brachial artery pressure ratio (DSP A/B) were measured before and 6 months after surgery. Preoperatively, the limbs were classified by angiography into aortoiliac disease alone (AI) or AI and femoropopliteal disease (AIFP), and were further classified by PVR and DSP A/B into claudication and limb salvage groups. Six months after surgery, the degree of hemodynamic improvement was comparable for AF and AXFG for limbs with AI. After AXFG in AIFP, however, the claudication group showed less of an improvement in DSP A/B ratio and PVR than with AF. There was no functional improvement after AXFG in the limb salvage group. AF appears to be associated with better functional results than AXFG in AIFP.
