[Applications of the inferior vena cava filter for the prevention of the risk for pulmonary emboli]. / Pulmoner emboli riskini önlemede inferior vena kava filtresi uygulamalarimiz.

The most serious and fatal complication of deep venous thrombosis (DVT) is still accepted as pulmonary embolism (PE). One of the methods used for PE prophylaxis is inferior vena cava filter(VCF). Between 1999 and 2000, VCF is used in 12 patients (8 male, 4 female) who were hospitalized in Trauma and Surgical Emergency Service of Istanbul Medical Faculty. 10 of the VCF used were permanent and 2 of them were temporary filters. 8 permanent filter were applied to patients with life-long paraplegia or quadriplegia due to spinal cord injury. Two patients to whom permanent filters were applied had malignancy. Patient who had the diagnosis of late stage cervical carcinoma, had DVT. In this patient, because of the high bleeding risk, we applied permanent filter. In the other patient, who had the diagnosis bladder carcinoma, had DVT despite the usage of low molecular weight heparin. In two patients who needed short term PE prophylaxis, had temporary VCF. In one of these patients, primary diagnosis was subarachnoidal hemorrhage due to head trauma. In the 8th day of hospitalization, DVT occurred. Because of high risk of intracranial bleeding, VCF was performed. The second patient had the diagnosis of subdural hematoma and subarachnoidal hemorrhage due to head trauma and multiple lower extremity fractures. VCF were applied in Istanbul Medical Faculty, Department of Radiology. For cannulation line of permanent VCF (LGM Venatech-B. Braun) right femoral vein was used. For temporary filters (Proliser Cordis-Johnson and Johnson Company), right internal jugular vein was the preferred way. Two multitrauma patients who had permanent filters died due to sepsis and multiorgan failure. In the follow up of other patients during the average period of 7.6 months, any problem due VCF application or by related complication and PE did not occur. Although larger patient groups with follow up period are necessary to evaluate better, we think that in PE prophylaxis, VCF is safe and effective modality.

[Thrombolysis of acute arterial occlusion with rt PA]. / Akut arter tikanmalarinin rt PA ile trombolitik tedavisi.

The use of thrombolytic agents to treat peripheral arterial occlusions is a new method. There have been clinical trials with Streptokinase, Urokinase and rt-PA (recombinant tissue plasminogen activator). Despite its advantages, information about complications caused by the use of rt-PA and about its place in treatment is still not complete. And there are not enough studies that are made to form a safe protocol for the use of rt-PA in the treatment of acute peripheral arterial occlusions. The aim of this study was to establish a dose range for rt-PA and to follow the patients with a protocol during and after thrombolysis. Between May 1999 to January 2000, 14 patients with symptoms of pain, poikilothermia, cyanosis and loss of function came to Istanbul Medical Faculty Emergency Surgery Unit. Bolus injection of 5 mgr of rt-PA was followed by 15 minutes of interval. The extent of thrombolysis was checked by angiography and then bolus injection of 5 mgr of rt-PA was repeated. After angiographic control, patients having insufficient thrombolysis, received 0.05 mgr/kg/hour of infusion for 12 hours. At the end of 12 hours, thrombolytic treatment ended with a control angiography. A thromboembolectomy operation was made to patients still having an occlusion after thrombolysis. On the other hand, to avoid re-occlusions, all of the patients received 1.5 mgr/kg/day low molecular weight heparin (enoxyparine).

Thrombolysis of Acute Arterial Occlusion with rt-PA.

The use of thrombolytic agents to treat peripheral arterial occlusions is a new method. Despite its advantages, information about complications caused by the use of rt-PA and about its place in treatment is still incomplete. The aim of this study was to establish a dose range for rt-PA and to follow the patients with a protocol during and after thrombolysis. Between May 1999 to January 2000, 14 patients with symptoms of peripheral arterial occlusion came to Istanbul Medical Faculty Emergency Surgery Unit. The duration of ischaemia before their hospitalization took an average of 44 hours. (Range 3 hours-7 days). A pulse-spray catheter was directed to the thrombus under angiographic control. Bolus injection of 5 mg of rt-PA was followed by 15 minutes of interval. The extent of thrombolysis was checked by angiography and then bolus injection of 5 mg of rt- PA was repeated. After angiographic control, patients having insufficient thrombolysis, received 0.05 mg/kg/hour of infusion for 12 hours. At the end of 12 hours, thrombolytic treatment ended with a control angiography. A thromboembolectomy operation was made to patients still having an occlusion after thrombolysis. To avoid re-occlusions, all of the patients received 1.5 mg/kg/day low molecular weight heparin (enoxaparin) for 1 week. At the end of thrombolysis, 9 patients had complete lysis. A patient, having an occlusion in superior mesenteric artery had 60% recanalisation. 2 patients (14%) having 90% stenosis, needed a balloon angioplasty besides thrombolysis, and both of them had complete reperfusion. 2 patients (14%) needed a thromboembolectomy operation due to insufficient thrombolysis. 2 patients (14%) had a minor bleeding after thrombolytic treatment. After thrombolysis, 2 patients (14%) had a stroke. There were no amputations. 1 of the patients having a stroke, died 2 days after thrombolytic treatment 1 patient died due to myocardial infarction during thrombolysis. 1 patient (7%) died due to diabetic coma on the 20th day. Acute myocardial infarction was the cause of death in 1 patient on the 25th day. In conclusion pulse spray thrombolysis with rt-PA is safe and efficient. Moreover there is a reduction in complications and need for surgical procedure. The recent problem is to find the optimum dosages for the best thrombolysis and for least complications.