Use of Embolectomy With Local Anesthesia for Anticoagulation Failure in Radial Artery Thrombosis.

OBJECTIVE: Although prevention of radial artery thrombosis and cardiac complications after interventions using radial access is well investigated, there is yet no clinical study that completely evaluated access-related complications. However, there is still no consensus on what exact treatment should be used in these patients. In clinical practice, analgesic, anticoagulant, and antiplatelet treatments usually improve symptoms in patients with pain; however, in some patients, complaints may persist and may not respond to these treatments. In these patients, low-risk embolectomy with a small skin incision may be beneficial. METHODS: A total of 102 patients with radial artery thrombosis after cardiac catheterization were included in the study between 2016 March and 2018 December. After the patients' initial evaluation, anticoagulation with enoxaparin or tinzaparin and antiplatelet therapy with acetylsalicylic acid and oral/local analgesic/anti-inflammatory and local anesthetic therapy were administered for 1 month. Patients whose symptoms resolved after medical treatment were followed up as outpatients. Embolectomy was performed in consenting patients who did not respond to the medical treatment. RESULTS: Of 102 patients included in the study, 33 underwent embolectomy, whereas 69 received only medical treatment. None of the patients experienced any complications, morbidity, or mortality in the peroperative period and during the medical treatment. The pretreatment symptom scores of patients who actively use their hands in daily life and profession were significantly higher than the scores of patients who are relatively less active (P = .013). Pretreatment symptom scores were negatively correlated with age (r = -0.584); symptom scores increased significantly with the decrease of patient age. No benefit from medical treatment and need for surgery was significantly greater in patients who are younger and use their hands actively in daily life and profession (P = .028). The decrease in symptom scores after treatment was significantly greater in the surgical group than in the medical group (P = .003). CONCLUSION: Radial access should be exercised with care in patients who may develop significant thrombosis-related complaints and it is necessary to decide whether radial access is essential. If patients have ongoing symptoms despite medical treatment, embolectomy can be considered as a treatment option.

The effects of the metabolic syndrome on coronary artery bypass grafting surgery.

BACKGROUND: The metabolic syndrome (MS) is a clustering of factors that are associated with increased cardiovascular risk. A low-grade inflammatory process acts as the underlying pathophysiology, which suggests that the MS may have a detrimental effect on coronary interventions, including coronary artery bypass grafting (CABG) surgery performed with cardiopulmonary bypass (CPB). We aimed to evaluate the effect of the MS on morbidity and mortality rates in the early postoperative period in patients undergoing CABG. METHODS: We prospectively included 152 patients (109 males and 43 females; mean age 60.1 ± 8.6 years) who underwent elective CABG on CPB between January and September 2011. Early postoperative morbidity and mortality rates were compared between subjects with and without the MS. Diagnosis of the MS was based on the American National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. RESULTS: Of the study group, 64 patients (42%) had the MS. The two groups were similar in age and gender. In the postoperative period, rates of atrial fibrillation, wound infection, pulmonary complications, and lengths of intubation, hospitalisation and intensive care unit stay were significantly higher in MS patients (p < 0.01). The MS was significantly associated with wound infection (OR 6.64, 95% CI: 1.72-25.75), pulmonary complications (OR 6.44, 95% CI: 1.58-26.33), arrhythmia (OR 5.47, 95% CI: 1.50-19.97) and prolonged intubation (OR 1.17, 95% CI: 1.05-1.32). The mortality rate was 3.1% in the MS group and 1.1% in the non-MS group, with no significant difference (p > 0.05). CONCLUSION: The MS was associated with a higher rate of early postoperative morbidity following CABG, without having a significant effect on the mortality rate.

Improvements in pulmonary artery pressure and right ventricular function after ultrasound-accelerated catheter-directed thrombolysis for the treatment of pulmonary embolism.

OBJECTIVE: To evaluate the efficacy of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the treatment of patients with massive and submassive pulmonary embolism (PE). METHOD: Twenty-two patients (13 males and nine females; age range, 38 to 71 years; mean age, 53.7 years) with massive or submassive PE were treated with UACDT with the EKOS EkoSonic® system. All patients exhibited acute symptoms, computed tomography (CT) evidence of large thrombus burden, and evidence of right ventricular (RV) dysfunction and/or failure. Clinical outcomes and complications, RV pressures, and thrombus clearance were evaluated. RESULTS: Treatment of 22 patients resulted in complete thrombus clearance (≥90%) in 77.2% of the patients, and near-complete (50% to 90%) clearance in 22.8%. The median tissue plasminogen activator (tPA) dose for all patients in our study was 21.0 mg (range 16 to 35 mg) and the median infusion time was 20.5 hours (range 12 to 28 hours). Measurements before and after treatment showed a decrease in pulmonary artery pressure (67 ± 14 to 34 ± 11 mmHg [systolic], p < 0.001). The RV/LV ratio decreased from 1.29 ± 0.17 to 0.92 ± 0.11 at follow-up (p < 0.001). Modified Miller score was significantly reduced (from 28 ± 4 to 13 ± 5, p < 0.001) in 21 of 22 (95%) patients who survived to discharge. There were only two minor access site bleeding complications, neither requiring transfusion. CONCLUSION: This study demonstrates safety and effectiveness of UACDT in patients with acute PE with a large thrombus burden.

An unusual presentation of pericardial cyst: recurrent syncope in a young patient.

Although pericardial cysts are generally benign structures and detected incidentally, they may be associated with life-threatening complications. We present the case of a 24 year-old man with a giant hemorrhagic pericardial cyst diagnosed after evaluation for recurrent syncope which caused compression of the right ventricle. Spontaneous hemorrhage into a pericardial cyst is an extremely rare event, and to our knowledge this is the first case in which a pericardial cyst has been shown to cause recurrent syncope.