Lower limb amputation following venous cannulation for VA-ECMO: a case report.

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

Vascular Complications in the Era of Transcatheter Treatment of Adult Structural Heart Disease: A Single-Center Early Experience.

Transcatheter treatment is becoming the mainstay treatment for structural heart diseases (SHD) in prohibitive surgical risk patients. Recently with the encouraging results, it is being offered to regular risk patients. Peripheral vascular complications (VCs) are still inherent to these procedures due to the nature of this atherosclerotic high-risk group and the profile of the devices. This is a single-center early first year experience with such events occurring after initiating a SHD program treating severe aortic stenosis, aortic regurgitation, mitral valve prolapse and regurgitation, as well as paravalvular leaks. Out of 33 patients in this time period, 5 developed PV complications which are detailed in this article with their associated risk factors and management. These include access-related complications, closure device issues, arterial rupture post device embolization, and vessel dissection. Vascular complications of those procedures take special interest since they are associated with a worse long-term prognosis. Thus, prevention with proper planning remains of essence along with multidisciplinary management.

Prevalence and Correlation of Hypothyroidism With Pregnancy Outcomes Among Lebanese Women.

PURPOSE: Assessment of hypothyroidism prevalence and clinical significance among pregnant women in Lebanon. METHODS: We performed a single-center retrospective cohort study at the American University of Beirut Medical Center. Clinical, demographic, and laboratory data were collected and analyzed using trimester-specific ranges for hypothyroidism. RESULTS: Of 920 pregnant women, 17% had hypothyroidism during gestation. A history of previous miscarriage and morbid obesity were associated with hypothyroidism during pregnancy. Pregnant women with hypothyroidism were more likely to experience a miscarriage during the first trimester [odds ratio, 2.9; 95% confidence interval, (1.13 to 7.5); P = 0.02] and delivery at post-term (odds ratio, 3.9; 95% confidence interval, 1.05 to 14.9; P = 0.05). We found no substantial correlation with preterm or premature delivery, cesarean section delivery, or gestational hypertension despite increased odds among the hypothyroidism group. No substantial differences were found with respect to the fetal outcomes between the control and hypothyroidism groups. CONCLUSIONS: Hypothyroidism is prevalent in 17% of pregnant women in Lebanon and was associated with a history of miscarriage and morbid obesity. The presence of hypothyroidism correlated with miscarriage during the first trimester and with post-term delivery. Despite the lack of sufficient data supporting the efficacy of treatment of hypothyroidism during gestation, more studies should be conducted to assess the effect of hypothyroidism on gestational and fetal outcomes.