الملخص
OBJECTIVE@#To retrospectively analyze clinical data of patients under 40 years old who underwent surgical treatment for renal tumors with tumor thrombus from January 2016 to December 2022 at Peking University Third Hospital, and to evaluate the surgical effect and investigate the relationship between clinicopathological characteristics and prognosis.@*METHODS@#The clinical data of 17 young patients with renal tumor thrombus were retrospectively analyzed, and the clinicopathological features and prognosis were summarized. The patients were grouped according to the presence or absence of symptoms, 2017 American Joint Committee on Cancer (AJCC) clinical stage, and postoperative combined adjuvant therapy. Kaplan-Meier method was used to plot the survival curve, and Log-rank test was used to compare the differences in postoperative survival time and progression-free survival time between the different groups. The relationship between clinicopathological features and prognosis was analyzed.@*RESULTS@#All the 17 patients received venous tumor thrombectomy, including 16 patients (94.1%) who underwent radical nephrectomy and 1 patient (5.9%) who underwent partial nephrectomy. Twelve patients (70.6%) had symptoms and 5 (29.4%) had no symptoms before operation. A total of 17 renal tumors were observed, with 2 patients (11.8%) identified as benign and 15 patients (88.2%) classified as malignant. Among the malignant tumors, 1 patient (6.7%) was diagnosed as clear cell carcinoma, while the remaining 14 patients (93.3%) were categorized as non-clear cell carcinoma. In terms of tumor stage, 8 patients (53.3%) were classified as stage Ⅲ according to the AJCC classification, while 7 patients (46.7%) were categorized as stage Ⅳ. Additionally, 6 patients (40%) received multiple adjuvant therapy, while 9 patients (60%) did not undergo such treatment. The follow-up period ranged from 2 to 78 months, with a median follow-up of 41 months. During this time, 3 patients (20%) died. The median survival time after surgery was 39.0 (2.3, 77.8) months, and the progression-free survival time was 16.4 (2.3, 77.8) months. There was no significant difference in postoperative survival time and progression-free survival time among young patients with renal tumor with tumor thrombus, based on the presence of symptoms before surgery (P=0.307, P=0.302), clinical stage of AJCC (P=0.340, P=0.492), and postoperative adjuvant therapy (P=0.459, P=0.253) group.@*CONCLUSION@#The pathological types of young patients with renal tumor with tumor thrombus are more complex and varied due to symptoms, and the proportion of non-clear cell carcinoma in malignant tumor with tumor thrombus is higher. Symptomatic and non-clear cell carcinoma may be potentially associated with poor prognosis. Surgical operation combined with adjuvant therapy is a relatively safe and effective treatment for young patients with renal tumor and tumor thrombus.
الموضوعات
Humans , Adult , Carcinoma, Renal Cell/surgery , Retrospective Studies , Vena Cava, Inferior/surgery , Kidney Neoplasms/surgery , Prognosis , Thrombosis/surgery , Thrombectomy/methods , Nephrectomy/methodsالملخص
OBJECTIVE@#To investigate and analyze the risk factors of massive hemorrhage in patients with renal cell carcinoma and venous tumor thrombus undergoing radical nephrectomy and removal of venous tumor thrombus.@*METHODS@#From January 2014 to June 2020, 241 patients with renal cancer and tumor thrombus in a single center of urology at Peking University Third Hospital were retrospectively analyzed. All patients underwent radical nephrectomy and removal of venous tumor thrombus. The relevant preoperative indicators, intraoperative conditions, and postoperative data were statistically analyzed by using statistical software of SPSS 18.0. The main end point of the study was intraoperative bleeding volume greater than 2 000 mL. Logistic regression analysis was used to determine the relevant influencing factors. First, single factor Logistic regression was used for preliminary screening of influencing factors, and variables with single factor Logistic regression analysis P < 0.05 were included in multivariate Logistic regression. In all statistical analyses, P < 0.05 is considered statistically significant.@*RESULTS@#Among the 241 patients included, there were 60 cases of massive hemorrhage, 48 males and 12 females, with a median age of 62 years. The number of non-massive hemorrhage was 181. There were 136 males and 45 females, with a median age of 59 years. Univariate analysis showed that the clinical symptoms (both systemic and local symptoms, OR 2.794, 95%CI 1.087-7.181, P=0.033), surgical approach (open surgery, OR 9.365, 95%CI 4.447-19.72, P < 0.001), Mayo grade (Mayo 3-4, OR 5.257, 95%CI 2.806-10.886, P < 0.001), American Society of Anesthesiologists (ASA) score (ASA level 3, OR 2.842, 95%CI 1.338-6.036, P=0.007), preoperative hemoglobin (OR 0.978, 95%CI 0.965-0.991, P=0.001), preoperative platelet count (OR 0.996, 95%CI 0.992-1.000, P=0.037), maximum tumor thrombus width (OR 1.061, 95%CI 1.033-1.091, P < 0.001), Complicated with bland thrombus (OR 4.493, 95%CI 2.264-8.915, P < 0.001), adrenalectomy (OR 3.101, 95%CI 1.614-5.958, P=0.001), segmental resection of the inferior vena cava (OR 2.857, 95%CI 1.395-5.852, P=0.004). There was a statistically significant difference in these aspects(P < 0.05). Multivariate Logistic regression analysis showed that there was a statistically significant difference in surgical approach (open surgery, OR 6.730, 95%CI 2.947-15.368;P < 0.001), Mayo grade (Mayo 3-4, OR 2.294, 95%CI 1.064-4.948, P=0.034), Complicated with bland thrombus (OR 3.236, 95%CI 1.492-7.020, P=0.003).@*CONCLUSION@#Combining the results of univariate and multivariate Logistic regression analysis, the surgical approach, Mayo grade, and tumor thrombus combined with conventional thrombus were associated risk factors for massive hemorrhage during surgery for renal cell carcinoma with tumor thrombus. Patients who undergo open surgery, high Mayo grade, and tumor thrombus combined with conventional thrombus are at a relatively higher risk of massive hemorrhage.
الموضوعات
Male , Female , Humans , Middle Aged , Carcinoma, Renal Cell/pathology , Retrospective Studies , Thrombosis/etiology , Kidney Neoplasms/pathology , Vena Cava, Inferior/surgery , Nephrectomy/methods , Thrombectomy/methods , Risk Factors , Hemorrhageالملخص
Objective To compare the clinical effects of three treatment methods including systemic thrombolysis(ST),catheter-directed thrombolysis(CDT),and AngioJet percutaneous mechanical thrombectomy(PMT)in acute lower extremity deep venous thrombosis(LEDVT). Methods The data of 82 patients diagnosed with LEDVT in the Department of Vascular and Gland Surgery of the First Affiliated Hospital of Hebei North University from January 2017 to December 2020 were collected.The patients were assigned into a ST group(n=50),a CDT group(n=16),and a PMT group(n=16)according to different treatment methods.The efficacy and safety were compared among the three groups. Results Compared with that before treatment,the circumferential diameter difference of both lower limbs on days 1,2,and 3 of treatment in the ST,CDT,and PMT groups reduced(all P<0.001).The PMT group showed smaller circumferential diameter difference of lower limbs on days 1,2,and 3 of treatment than the ST group(all P<0.001)and smaller circumferential diameter difference of the lower patellar margin on day 1 of treatment than the CDT group(P<0.001).The PMT group showed higher diminution rate for swelling of the affected limb at the upper and lower edges of the patella than the ST group(P<0.001)and higher diminution rate for swelling at the upper edge of the patella than the CDT group(P=0.026).The incidence of complications after treatment showed no significant differences among the three groups(all P>0.05).The median of hospital stay in the PMT group was shorter than that in the ST and CDT groups(P=0.002,P=0.001).The PMT group had higher thrombus clearance rate than the ST group(P=0.002)and no significant difference in the thrombus clearance rate from the CDT group(P=0.361).The vascular recanalization rates in the PMT(all P<0.001)and CDT(P<0.001,P=0.002,P=0.009)groups 3,6,and 12 months after treatment were higher than those in ST group,and there were no significant differences between PMT and CDT groups(P=0.341,P=0.210,P=0.341). Conclusions ST,CDT,and PMT demonstrated significant efficacy in the treatment of LEDVT,and PMT was superior to ST and CDT in terms of circumferential diameter difference of the lower limbs,diminution rate for swelling of the affected limb,thrombus clearance rate,length of hospital stay,and long-term vascular recanalization.There was no obvious difference in safety among the three therapies.
الموضوعات
Humans , Thrombolytic Therapy/methods , Fibrinolytic Agents/therapeutic use , Treatment Outcome , Thrombectomy/methods , Venous Thrombosis/drug therapy , Lower Extremity/blood supply , Catheters , Retrospective Studiesالملخص
BACKGROUND: Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region. AIM: To describe endovascular management of acute ischemic stroke in a Chilean public hospital. Material and Methods: Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital. RESULTS: In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died. CONCLUSIONS: Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.
الموضوعات
Humans , Male , Female , Brain Ischemia/etiology , Stroke/surgery , Stroke/etiology , Endovascular Procedures/methods , Ischemic Stroke/etiology , Chile , Retrospective Studies , Treatment Outcome , Thrombectomy/methods , Hospitals, Publicالملخص
BACKGROUND: Vena cava (VC) involvement in kidney tumors occurs in 4 to 10% of cases, and is associated with a higher mortality. Nephrectomy with thrombectomy of the VC, performed by a multidisciplinary team, improves survival. Aim: To report a series of consecutive nephrectomies with caval thrombectomy performed in an academic center. PATIENTS AND METHODS: We report 32 patients with cT3b and 3c renal tumors, who underwent radical nephrectomy with VC thrombectomy between 2001 and 2021. A descriptive analysis of clinical, surgical and pathological variables was performed. Overall survival (OS) and cancer-specific survival (CSS) was calculated using Kaplan-Meier curves. Results: The mean tumor size was 9.7 cm. According to Mayo classification 3/32 (9%) patients had a type I thrombus, 10/32 (31%) had a type II thrombus, 8/32 (25%) had a type III thrombus, and 5/32 (16%) had a type IV thrombus. The mean bleeding was 2000 cc. There was one intraoperative death. Nineteen percent of patients had complications >= 3 according to Clavien-Dindo classification. Reoperations occurred in 9%. Pre and postoperative creatinine levels were 1.17 and 1.91 mg/dl respectively (p < 0.01). Pre and postoperative Hematocrit levels were 47.9 and 31% respectively (p = 0.02). Sixty six percent of tumors were clear cell renal cancer, 9% were papillary and 3% were chromophobic. Mean OS was 10 months. Two-year SCE was 40%. CONCLUSIONS: Our results are similar to those reported elsewhere. Despite being an unusual pathology, the surgical technique has been improving, thanks to the multidisciplinary work of urologists and surgeons.
الموضوعات
Humans , Thrombosis/surgery , Thrombosis/complications , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Vena Cava, Inferior/surgery , Retrospective Studies , Thrombectomy/methods , Nephrectomy/adverse effects , Nephrectomy/methodsالملخص
ABSTRACT: Iliac vein thrombectomy is usually performed via access through veins located in the lower limbs, which makes it impossible to treat the deep femoral vein, which in turn is an important inflow route to the iliac vein stent. We describe a clinical case and the previously unpublished technique of percutaneous thrombectomy, angioplasty, and stent implantation performed in a single session and with a single access, obtained via the internal jugular vein.
RESUMO: A trombectomia mecânica venosa ilíaca geralmente é realizada por acesso em veias localizadas nos membros inferiores, o que impossibilita o tratamento da veia femoral profunda, que, por sua vez, é uma importante via de influxo ao stent venoso ilíaco. Descrevemos um caso clínico em que foi aplicada a técnica inédita de trombectomia percutânea, angioplastia e implante de stent, realizada por sessão e acesso único, obtido na veia jugular interna.
الموضوعات
Humans , Female , Adolescent , Thrombectomy/methods , Venous Thrombosis/surgery , Femoral Vein/surgery , Iliac Vein/surgery , Stents , Venous Thrombosis/diagnostic imaging , Femoral Vein/diagnostic imaging , Iliac Vein/diagnostic imaging , Jugular Veinsالملخص
Introducción: La insuficiencia renal crónica es una enfermedad frecuente que requiere del uso vital de la hemodiálisis, procedimiento común en los pacientes que la padecen, por lo cual resulta necesario disponer de un acceso vascular adecuado. Objetivo: Caracterizar a los pacientes con fístulas arterio-venosas para hemodiálisis en el Hospital Clínico-Quirúrgico "General Freyre de Andrade". Métodos: Se realizó un estudio descriptivo-retrospectivo en 88 pacientes con fístulas arterio-venosas. Se recogieron las siguientes variables: edad, sexo, tipo de acceso vascular, localización, complicaciones inmediatas y tardías, y procedimiento corrector. El período de estudio abarcó desde enero de 2018 hasta enero de 2019. Resultados: Se les realizaron a los pacientes un total de 88 fístulas arterio-venosas. Predominó el sexo masculino (67 por ciento). Prevaleció el grupo de edades de 50 a 59 años (36,4 por ciento). La fístula arterio-venosa humero-cefálica (48,9 por ciento) resultó el procedimiento más realizado. El hematoma, la trombosis y la infección fueron las complicaciones inmediatas con mayor frecuencia (3,4 por ciento). De las complicaciones tardías, predominó la trombosis (3,4 por ciento), mientras que la trombectomía prevaleció como procedimiento corrector (37,5 por ciento). Conclusiones: Como parte del acceso vascular, la fístula humero-cefálica presentó los mejores resultados en cuanto a permeabilidad y durabilidad. Por otra parte, la fístula humero-humeral constituyó una alternativa cuando no se pudieron usar las venas cefálica y basílica a nivel del pliegue del codo(AU)
Introduction: Chronic kidney disease is a frequent condition that demands the vital use of hemodialysis, a common procedure in patients who suffer from it; therefore, it is necessary to have adequate vascular access. Objective: To characterize patients with arteriovenous fistulas for hemodialysis at General Freyre de Andrade Clinical-Surgical Hospital. Methods: A descriptive-retrospective study was carried out in 88 patients with arteriovenous fistulas. The following variables were selected: age, sex, type of vascular access, location, immediate and late complications, and corrective procedure. The study period covered from January 2018 to January 2019. Results: A total of 88 arteriovenous fistulas were approached among all the patients. The male sex predominated (67 percent). The age group 50-59 years (36.4 percent) prevailed. The procedure for creating a humeral cephalic arteriovenous fistula (48.9 percent) was the most performed. Hematoma, thrombosis and infection were the immediate complications with the highest frequency (3.4 percent). Among late complications, thrombosis prevailed (3.4 percent); while thrombectomy prevailed as a corrective procedure (37.5 percent). Conclusions: As part of vascular access, the procedure for creating humeral cephalic fistula presented the best outcome in terms of patency and durability. On the other hand, the procedure for creating the humeral fistula was an alternative when the cephalic and basilic veins could not be used at the level of the elbow crease(AU)
الموضوعات
Humans , Male , Middle Aged , Thrombosis/complications , Renal Dialysis/methods , Thrombectomy/methods , Renal Insufficiency, Chronic , Epidemiology, Descriptiveالملخص
ABSTRACT Purpose: To evaluate the role of contrast-enhanced ultrasound (CEUS) in differentiating bland thrombus from tumor thrombus of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC). Materials and Methods: We retrospectively investigated 30 consecutive patients who underwent robot-assisted radical nephrectomy with IVC thrombectomy and had pathologically confirmed RCC. All patients underwent US and CEUS examination. Two off-line readers observed and recorded thrombus imaging information and enhancement patterns. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for bland thrombus were assessed. Results: Of the 30 patients, no adverse events occurred during administration of the contrast agent. Early enhancement of the mass within the IVC lumen on CEUS was an indicator of tumor thrombus. Bland thrombus showed no intraluminal flow on CEUS. There were eight (26.7%) patients with bland thrombus, including three level II, two level III, and three level IV. There were three cases with cephalic bland thrombus and five cases with caudal bland thrombus. Three caudal bland thrombi extended to the iliac vein and underwent surgical IVC interruption. Based on no intraluminal flow, for bland thrombus, CEUS had 87.5% sensitivity, 100% specificity, 96.7% accuracy, 100% positive predictive value and 95.6% negative predictive value. Conclusion: Our study demonstrates the potential of CEUS in the differentiation of bland and tumor thrombus of the IVC in patients with RCC. Since CEUS is an effective, inexpensive, and non-invasive method, it could be a reliable tool in the evaluation of IVC thrombus in patients with RCC.
الموضوعات
Humans , Male , Female , Adult , Vena Cava, Inferior/diagnostic imaging , Carcinoma, Renal Cell/diagnostic imaging , Ultrasonography, Doppler/methods , Venous Thrombosis , Kidney Neoplasms/diagnostic imaging , Vena Cava, Inferior/surgery , Vena Cava, Inferior/pathology , Magnetic Resonance Imaging , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathology , Reproducibility of Results , Retrospective Studies , Thrombectomy/methods , Contrast Media , Venous Thrombosis/surgery , Venous Thrombosis/pathology , Tumor Burden , Neoplasm Grading , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Middle Agedالملخص
The management of patients presenting with an ischemic vascular accident has evolved in recent years. Several studies opened the possibility for endovascular treatment of these patients, improving their functional results. The evidence-based anesthetic management has changed thanks to new relevant literature. In this article we want to briefly describe the changes in the state of the art according to the new clinical evidence.
El manejo de los pacientes que presentan un accidente vascular isquémico ha evolucionado en los últimos años. Varios estudios abrieron la posibilidad para el tratamiento endovascular de estos pacientes, mejorando sus resultados funcionales. El manejo anestésico basado en evidencia a cambiado gracias a nueva literatura relevante. En este artículo queremos describir brevemente los cambios en el estado del arte según la nueva evidencia clínica.
الموضوعات
Humans , Thrombectomy/methods , Ischemic Stroke/surgery , Anesthesia/methods , Conscious Sedationالموضوعات
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Thrombectomy/methods , Stroke/surgery , Randomized Controlled Trials as Topic , Cerebral Infarction/complications , Cerebral Infarction/diagnostic imaging , Multicenter Studies as Topic , Bayes Theorem , Combined Modality Therapy , Stroke/complications , Stroke/mortality , Intracranial Hemorrhages/etiology , Disability Evaluation , Endovascular Procedures , Fibrinolytic Agents/therapeutic use , Time-to-Treatmentالملخص
Abstract Advanced renal cell carcinoma accompanied by tumor thrombus in the venous system is present in up to 10% of cases. Extension of tumor thrombus above the diaphragm or into the right atrium represents level IV disease. Level IV tumors are typically treated with sterno-laparotomy approach with or without deep hypothermic circulatory arrest and veno-venous bypass. In this case report, the surgical technique for the resection of advanced RCC were described, with the concomitant use of transesophageal echocardiography for thrombus extraction without the veno-venous or cardiopulmonary bypass.
الموضوعات
Humans , Male , Female , Middle Aged , Carcinoma, Renal Cell/surgery , Thrombectomy/methods , Echocardiography, Transesophageal/methods , Venous Thrombosis/surgery , Kidney Neoplasms/surgery , Vena Cava, Inferior/surgery , Carcinoma, Renal Cell/diagnostic imaging , Tomography, X-Ray Computed , Reproducibility of Results , Treatment Outcome , Ultrasonography, Interventional , Venous Thrombosis/pathology , Kidney Neoplasms/diagnostic imagingالملخص
El Tromboembolismo pulmonar puede considerarse una de las complicaciones más graves en Medic ina. Consiste en la obstrucción de una arteria pulmonar, usualmente secundaria a un trombo. Esta obstrucción condiciona una disminución de la perfusión sanguínea a los alveolos, lo que lleva a la disminución de la oxigenación sanguínea corporal. Entre los síntomas más comunes, podemos obs erv ar disnea, dolor torácico y los signos más comunes son la disminución de la saturación de ox igeno, la taquipnea y la taquicardia. Con las mejoras tecnológicas y las mejoras en la precisión diagnóstica, la tomografía computada se ha convertido en el estudio de elección es pecíficamente, la Angiotomografía de Tórax.
Pulmonary Thromboembolism can be considered one of Medicine's most severe complications. It cons ists in the obstruction of a pulmonary artery, usually caused by a thrombus. This obstruction caus es a reduction of blood flow to the alveoli which consequently diminishes blood oxygenation for the rest of the body. The most common symptoms seen are dyspnea, thoracic pain and the most common clinical signs are tachycardia, tachypnea and a reduction in blood saturation. With the adv ances in technology and the improvements in diagnostic precision, Computed Tomography has become today's gold standard, specifically Computed Angiotomography.
الموضوعات
Humans , Male , Middle Aged , Pulmonary Embolism , Angiography/drug effects , Radiology, Interventional , Thrombectomy/methodsالملخص
This study explores the safety and effect of acute cerebral infarction treatment by microcatheter injection of tirofiban combined with a Solitaire AB stent and/or stent implantation. Emergency cerebral angiograms showing the responsible vascular occlusion of 120 acute cerebral infarction patients who underwent emergency endovascular thrombectomy were included in the study. These patients were randomly divided into two groups using the random number table method: treatment group (n=60) that received thrombectomy (with cerebral artery stents) combined with intracerebral injection of tirofiban and control group (n=60) that only received thrombectomy (with cerebral artery stents alone). The baseline data, cerebral angiography before and after surgery, hospitalization, and follow-up results of patients in these two groups were compared. Furthermore, the incidence of major adverse cerebrovascular events of these two groups was compared (90-day modified Rankin scale, a score of 0-2 indicates a good prognosis). The difference between baseline clinical data and brain angiography between these two groups was not statistically significant. Patients in the treatment group had a higher prevalence of thrombolysis in cerebral infarction grade 2b/3 than patients in the control group (88.3% (53/60) vs 66.7% (40/60), P=0.036). Moreover, the National Institutes of Health Stroke Scale scores 7 days after surgery and the 90-day prognosis were all better for the patients who received tirofiban (P=0.048 and P=0.024). Mechanical thrombectomy with Solitaire AB stents in combination with the injection of tirofiban through a microcatheter appears to be safe and effective for the endovascular treatment of acute ischemic stroke.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stents , Thrombectomy/methods , Stroke/therapy , Tirofiban/administration & dosage , Cerebral Revascularization/methods , Treatment Outcome , Combined Modality Therapyالملخص
Abstract: Patent Foramen Ovale (PFO) is one of the most frequent congenital defects in adults. Its prevalence in middle-aged adults is close to 25-30% and may cause paradoxical embolic phenomena. We report a 45 years old male admitted for an ischemic stroke with an occlusion of the left terminal internal carotid artery. A thrombectomy was performed. Searching for possible sources of emboli, a patent foramen ovale was detected in an echocardiography, with an hypoechogenic examination image passing through it. Anticoagulant therapy was started and the patient had an uneventful evolution.
الموضوعات
Humans , Male , Middle Aged , Embolism, Paradoxical/etiology , Foramen Ovale, Patent/complications , Echocardiography , Carotid Arteries , Risk Factors , Treatment Outcome , Thrombectomy/methods , Embolism, Paradoxical/surgery , Embolism, Paradoxical/diagnostic imaging , Stroke/etiology , Foramen Ovale, Patent/diagnostic imagingالملخص
Objetivo Determinar la frecuencia de las complicaciones observadas durante la trombectomía en el ictus isquémico agudo. Materiales y Métodos Se revisó de forma retrospectiva las trombectomías realizadas en nuestra institución cuando los ictus isquémicos tuvieron una indicación de tratamiento endovascular. Se registraron los diferentes dispositivos utilizados en ese periodo de tiempo y si presentaron relación con el desarrollo de las complicaciones inmediatas mediante arteriografía. Resultados De un total de 228 casos, se registraron complicaciones en el 16,6% de los casos. Se identificaron embolias (n » 31), hemorragias subaracnoideas (n » 2), hemorragia gangliobasal (n » 1), vasoespasmo (n » 1), disección (n » 1) y peusoaneurismas (n » 2). La embolia a nuevos territorios se presentó solo en 5 casos. Discusión El tratamiento endovascular ha demostrado ser efectivo para la recanalización en oclusión de gran vaso. El uso de dispositivos presume un riesgo por la manipulación de los vasos. Conclusión La embolia fue la complicación más frecuente. El tratamiento endovascular en el ictus genera un desenlace clínico favorable de los pacientes, al mismo tiempo, el bajo porcentaje de complicaciones que encontramos no suponen una afectación negativa en el desenlace final.
Purpose To determine the complications we observed during thrombectomy in acute ischemic stroke. Materials and Methods We reviewed retrospectively thrombectomies performed in our institution when endovascular treatment for stroke was done. The different devices used in this period of time were recorded and we determined if these were related to the development of immediate complications duringthe procedure visualized in arteriography. Results We had 228 cases, complications were found in 16.6% of the cases. Embolisms (n » 31), subarachnoid hemorrhages (n » 2), gangliobasal hemorrhage (n » 1), vasospasm (n » 1), dissection (n » 1) and peusoaneurysms (n » 2) were identified. 5 embolisms happened to new territories during thrombectomy. Discussion Endovascular treatment has been shown to be effective for recanalization in large vessel occlusion. The use of devices presumes a risk for the manipulation of the vessels. Conclusion Embolism was the most frequent complication. The endovascular treatment in the acute stroke produces a favorable clinical outcome of the patients and we found a low percentage of complications that would not suppose a negative affectation in the final outcome.
الموضوعات
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Thrombectomy/methods , Stroke/complications , Stroke/diagnostic imaging , Skull/diagnostic imaging , Spain , Vascular Diseases/complications , Catheterization/methods , Catheterization/statistics & numerical data , Carotid Artery, Internal/diagnostic imaging , Tomography, X-Ray Computed , Stents/statistics & numerical data , Retrospective Studies , Multicenter Study , Thrombectomy/statistics & numerical data , Embolism , Hemorrhageالملخص
OBJECTIVE@#To investigate the safety and feasibility of laparoscopic treatment for renal carcinoma with Mayo 0-2 level venous thrombosis.@*METHODS@#From January 2015 to February 2018, 58 renal carcinoma cases with venous thrombus underwent laparoscopic radical nephrectomy with inferior vena cava thrombectomy in Department of Urology, Peking University Third Hospital, of which, 51 cases were male, and 7 female, aged 29-82 years. According to the Mayo grade classification, 20 cases were level 0, 20 cases were level 1, and 18 cases were level 2, with left side being 22 cases, and right side 36 cases. The patients except for those complicated with hemorrhagic diseases, cardiac and pulmonary insufficiency, or those who could not tolerate anesthesia and surgical contraindications, underwent the operation after comprehensive examinations.@*RESULTS@#The 58 cases of renal tumor with venous tumor emboli were successfully completed with the surgeries, including 50 cases of totally laparoscopic surgery, 8 cases of laparoscopy surgery from convert to open (among the patients who were converted to open surgery, 7 were complicated with grade 2 tumor thrombus and 1 with grade 1 tumor thrombus). The main reasons for converting to open surgery were huge tumors (the largest of which was about 16 cm in diameter), severe adhesion and difficulty of separation. For different patients, different surgical methods and procedures were adopted according to the tumor direction and the different grade of tumor thrombus. Radical nephrectomy combined with vena cava tumor thrombus removal was performed in 55 cases and segmental resection of vena cava in 3 cases. The operation time was 132-557 min, and blood loss was 20-3 000 mL. Post-operative pathological types: 51 cases were clear cell carcinoma, 5 cases were type 2 of papillary carcinoma, 1 case was squamous cell carcinoma, and 1 case was chromophobe cell tumor. In the study, 47 cases were followed up for 1-36 months, and 4 cases died (the survival time was 5-15 months, with an average of 10.2 months).@*CONCLUSION@#Laparoscopic radical nephrectomy with inferior vena cava thrombectomy is a reasonable choice for renal tumor with Mayo 0-2 level venous thrombosis. For different tumor directions and different grades of tumor thrombus, an appropriate operation plan can give the maxim benefit to the patients with skillful surgeons.
الموضوعات
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Renal Cell , Kidney Neoplasms/complications , Laparoscopy , Nephrectomy/methods , Retrospective Studies , Thrombectomy/methods , Thrombosis/surgery , Vena Cava, Inferiorالملخص
O trombo venoso flutuante em veia femoral é um tipo de trombo com alto potencial de embolização pulmonar. Entretanto, ainda é controversa a conduta mais apropriada nesses casos. Tratamentos clínicos com anticoagulantes ou fibrinolíticos e trombectomias abertas ou por meio de dispositivos endovasculares vêm sendo empregados ainda sem um critério de indicação bem definido. Apresentamos três casos clínicos de trombos flutuantes em veia femoral, de etiologias distintas, cujos tratamentos e respectivas evoluções serão discutidos
A floating venous thrombus in the femoral vein is a type of thrombus with a high potential for pulmonary embolization. However, the most appropriate management for these cases is still controversial. Clinical treatments, using anticoagulants or fibrinolytics, open thrombectomies, or thrombectomies by means of endovascular devices have all been used, although the criteria for indication of each are not yet defined. We present 3 clinical cases of floating thrombi in femoral veins with different etiologies and discuss their respective treatments and outcomes
الموضوعات
Humans , Male , Female , Middle Aged , Aged , Femoral Vein/surgery , Venous Thrombosis/surgery , Anticoagulants/therapeutic use , Enoxaparin/administration & dosage , Lower Extremity , Pulmonary Embolism , Therapeutics/methods , Thrombectomy/methods , Thrombosis/surgery , Ultrasonics/methods , Warfarin/administration & dosageالملخص
Stroke is one of the main causes of death and disability worldwide, and the ischemic modality is responsible for the majority of these events. Despite its high occurrence and potentially unfavorable prognosis, the management options were scarce and barely effective until recent times, when a relatively new endovascular intervention with demonstrated superior efficacy as compared with that of classic management was reported in the medical literature. The theoretical basis of this study was conducted through research in virtual databases Public MEDLINE (PubMed) and Scientific Electronic Library Online (SciELO) using associations among the keywords "acute ischemic stroke", "ischemic stroke", "thrombectomy", "endovascular," and "intra-arterial thrombectomy". Clinical trials, meta-analysis, and pertinent literature reviews published in the last two years were reviewed and 14 articles were selected for complete and critical evaluations. The results of the randomized clinical trials, consequences of implantation of the intra-arterial thrombectomy as routine management for eligible groups, cost-effectiveness, and the most related complications and outcomes associated with the procedure are critically explored throughout this study (AU)
الموضوعات
Humans , Brain Ischemia/surgery , Stroke/surgery , Thrombectomy/methods , Endovascular Procedures , Thrombectomy/adverse effects , Thrombectomy/economicsالملخص
Esta revisión tiene como objetivo el uso de la Trombectomía Mecánica como técnica de primera elección en el tratamiento de Ictus Isquémico Agudo. Materiales y Método: La revisión incluye 9 pacientes con diagnóstico de Ictus Isquémico a los que se le realizo Trombectomía Mecánica, se utilizó el dispositivo de recanalización tipo Solitaire asociado a rtPA intraarterial 10 por ciento de la dosis intravenosa, los criterios diagnósticos: edad, período de ventana, imagen de TC al ingreso. Resultados: 8 pacientes (89 por ciento) correspondieron a oclusión de la circulación Anterior, 1 (11 por ciento) a la oclusión de circulación posterior, la efectividad terapéutica se la evalúo según la Escala de Rankin Modificada, 5 (55 por ciento) obtuvieron recuperación completa de sus funciones, 3 (33 por ciento) presentaron secuelas leves, y 1(11 por ciento) no obtuvo mejoría alguna. Discusión: Los resultados de nuestra revisión son alentadores sobre todo al reducir la secuela discapacitante, deja una ventana abierta para posteriores revisiones sobre estetratamiento.
This review aims to use Trombrectomy Mechanics and technique as choice in the treatment of Acute Ischemic Stroke. Materials and Methods: Age, period: The review included 9 patients with a diagnosis of Ischemic Stroke those who underwent Trombrectomy Mechanics, recanalization device type associated with intra-arterial rtPA Solitaire 10 percent of the intravenous dose, the diagnostic criteria was used with CT. Results: 8 patients (89 percent) were occluded circulation Earlier, 1 (11 percent) to occlusion of posterior circulation, the therapeutic succes was evaluated according to the modified Rankin scale, 5 (55 percent) had complete recovery its functions, 3 (33 percent) had mild sequelae, and 1 (11 percent) not obtained any improvement. Discussion: The results of our review are encouraging especially by reducing the disabling sequel, leave a window open for further review on this treatment.
الموضوعات
Humans , Stroke/surgery , Brain Ischemia , Tissue Plasminogen Activator , Thrombectomy/methods , Endovascular Procedures , Neurosurgical Procedures/methodsالملخص
ABSTRACT Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments. Objective To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs). Method Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015). Results From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020. Conclusion Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.
RESUMO Poucos pacientes se beneficiam do atual tratamento para o acidente vascular cerebral isquêmico agudo (AVCIA), incentivando o desenvolvimento de novos tratamentos. Objetivo Revisão sistemática da literatura sobre a eficácia e/ou segurança da trombectomia endovascular (TE) em AVCIA comparado com tratamento padrão (TP) e identificar ensaios clínicos randomizados controlados (ECR) atualmente em andamento. Método Buscas por ECRs foram conduzidas no Medline,Embase, International Clinical Trial Registry Platform, Clinicaltrials.gov e no ISRCTN registry (to June 15th, 2015). Resultados Oito ECRs publicados foram identificados, dos quais cinco mostraram superioridade do tratamento com trombectomia comparado ao TP. Dos 13 ERCs registrados, 3 foram suspensos, um não iniciou, um temstatus desconhecido e oito encerrarão recrutamento entre 2016 e 2020. Conclusão A evidência favorece a combinação do TP com a TE em relação ao TP somente. Os critérios de inclusão limitam o número daqueles que poderiam se beneficiar. Mais estudos são necessários para demonstrar o custo-efetividade desta intervenção.