RESUMO
Catheter directed thrombolysis has been described as a treatment for large pulmonary emboli resistant to systemic therapy [Kelly P, Carroll N, Grant C, Barrett C, Kocka V. Successful treatment of massive pulmonary embolism with prolonged catheter-directed thrombolysis. Heart Vessels 2006;21:124?6]. We now describe a case in which local catheter directed thrombolysis, via a peripherally inserted central catheter (PICC), was used to treat a large thrombus surrounding the tip of an indwelling central venous line that was causing superior vena cava obstruction (SVCO), in a patient with cystic fibrosis.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Fibrose Cística/complicações , Terapia Trombolítica/métodos , Trombose/tratamento farmacológico , Trombose/etiologia , Adulto , Feminino , Fibrinolíticos/uso terapêutico , Heparina/uso terapêutico , Humanos , Ativador de Plasminogênio Tecidual/uso terapêuticoAssuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hipertensão Pulmonar/tratamento farmacológico , Piperazinas/uso terapêutico , Vasodilatadores/uso terapêutico , Disfunção Ventricular Direita/tratamento farmacológico , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Inibidores de Fosfodiesterase/uso terapêutico , Purinas , Citrato de Sildenafila , SulfonasRESUMO
We treated a patient who developed a posterior tracheal wall perforation and severe respiratory compromise following percutaneous tracheostomy, using a covered expandable metallic stent. The stent was deployed under direct vision using rigid and fibreoptic bronchoscopy. The defect was sealed and the right lung, which had been collapsed, was re-expanded. The patient was subsequently weaned from mechanical ventilation. Late complications included halitosis, which was treated with nebulized colistin sulphate, and the development of intratracheal granulation tissue, which was cleared using low power (10 W) Nd:YAG laser.