Treatment of skin soft tissue embolism after hyaluronic acid injection for injection rhinoplasty in Asian patients.

INTRODUCTION: The purpose of this manuscript is to investigate the treatment of skin soft tissue embolization or vascular occlusion after the injection of hyaluronic acid (HA) for Injection Rhinoplasty (IR) in Asians with a special interest in the time occurrence of the occlusion. METHODS: A total of 35 cases were evaluated after receiving HA injections for IR who presented with a vascular occlusive event. They were divided into three stages based on the time to embolization. Immediate, ≤5 hours; early, ≤3 days; and late, >3 days. There were two cases of immediate, 28 deemed early, and five late. Methods to prevent tissue necrosis are reviewed in the manuscript based on these stages. RESULTS: Skin color gradually recovered to normal after 11 treatments in 11 patients with mild embolization. No ischemic aggravation or skin necrosis was observed in 19 patients with moderate embolization; red scarring was seen in two and hypertrophic scar with uneven skin color in one patient. The five patients in the severe category had longer healing, more red scars, and more hypertrophic scarring. CONCLUSION: The treatment of skin soft tissue embolization or vascular occlusion after HA IR in Asians can be effected by identifying the stage and degree of embolization and treating appropriately with the outlines presented in this manuscript.

Retained embolized fragment of totally implantable central venous catheter in right ventricle: it is really necessary to remove?

INTRODUCTION: Central venous catheters are often required in oncologic patients for long-term safe administration of chemotherapeutic agents, antibiotics, and parenteral nutrition. Rupture of these devices and intracardiac migration is a rare complication. METHODS: We report one spontaneous rupture and embolization of a totally implantable vascular access device (TIVAD) in an asymptomatic patient. RESULTS: A 50-year-old woman received a TIVAD silicone catheter 8 FR for adjuvant chemotherapy. After 3 years of port time in situ, during a follow-up control, a catheter malfunction was found and radiologic investigations showed a rupture and migration of the catheter to the right ventricle. The attempt to remove the fragment under fluoroscopic control using the femoral route was unsuccessful. We did not try a surgical approach because of the complete absence of symptomatology and hemodynamic impairment. CONCLUSIONS: The catheter rupture and intracardiac embolization is a rare complication associated with totally implantable or tunneled central venous catheters. When such an event happens, the patient should be managed by expert hemodynamists or interventional radiologists making an effort to remove the fragment without surgical measures. When the intravascular percutaneous route fails, the possibility to leave the fragmented catheter in heart chambers should be evaluated, being surgery questionable in asymptomatic patients.

A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia.

OBJECTIVES: Few centers have adopted endovascular therapy for the treatment of acute mesenteric ischemia (AMI). We sought to evaluate the effect of endovascular therapy on outcomes for the treatment of AMI. METHODS: A single-center, retrospective cohort review was performed on all consecutive patients with thrombotic or embolic AMI presenting between 1999 and 2008. Patients with mesenteric venous thrombosis, nonocclusive mesenteric ischemia, and ischemia associated with aortic dissection were excluded. Demographic factors, preoperative metabolic status, and etiology were compared. Primary clinical outcomes included endovascular technical success, operative complications, and in-hospital mortality. RESULTS: Seventy consecutive patients were identified with AMI (mean age, 64 ± 13 years). Etiology of mesenteric ischemia was 65% thrombotic and 35% embolic occlusions. Endovascular revascularization was the preferred treatment (81%) vs operative therapy (19%). Successful endovascular treatment was achieved in 87%. Endovascular therapy required laparotomy in 69% vs traditional therapy in 100% (P < .05), with a median 52-cm necrotic bowel resected (interquartile range [IQR], 11-140 cm) vs 160 cm (IQR, 90-250 cm; P < .05), respectively. Acute renal failure and pulmonary failure occurred less frequently with endovascular therapy (27% vs 50%; P < .05 and 27% vs 64%; P < .05). Successful endovascular treatment resulted in a mortality rate of 36% compared with 50% (P < .05) with traditional therapy, whereas the mortality rate for endovascular failures was 50%. Endovascular therapy was associated with improved mortality in thrombotic AMI (odds ratio, 0.10; 95% confidence interval, 0.10-0.76; P < .05). CONCLUSIONS: Endovascular therapy has altered the management of AMI, and there are measurable advantages to this approach. Using endovascular therapy as the primary modality for AMI reduces complications and improves outcomes.

Aortobifemoral embolism in an 18-year old patient following cisplatin and 5-fluorouracil chemotherapy for nasopharyngeal carcinoma.

After cisplatin / 5-fluorouracil chemotherapy for nasopharyngeal carcinoma, an 18-year female patient developed aortobifemoral embolism. Besides chemotherapy, additional risk factors for arterial thromboembolic events were smoking, contraceptive medication and adjuvant antiemetic treatment with dexamethasone. Thrombophilia screening was negative. Thromboembolic complications during or after cisplatin have been reported in a frequency of 17.6 % in lung cancer patients, and in 8.4 % of patients with germ cell tumors. The incidence of arterial thromboembolic events was 9.3 % and 1.7 %, respectively. The pathogenesis of cisplatin induced thromboembolism is thought to be caused by endothelial damage leading to endothelial cell dysfunction, increased von Willebrand factor plasma levels, and hypomagnesaemia.

Hyperbaric treatment of arterial CO2 embolism occuring after laparoscopic surgery: a case report.

Arterial carbon dioxide (CO2) embolism is a serious and sometimes fatal iatrogenic medical condition encountered in surgery. A thirty-five year old Caucasian female developed a CO2 embolism during a laparoscopic appendectomy. After initial resuscitation and completion of the surgery, she was treated with hyperbaric oxygen (HBO2) to help reduce the size of large CO2 bubbles that had migrated into her left ventricle during surgery. The HBO2 protocol was 2.8 atmospheres for 90 minutes, which resolved the problem with no adverse effects.

Ocular massage in a case of central retinal artery occlusion the successful treatment of a hitherto undescribed type of embolism.

BACKGROUND: The pathogenesis of central retinal artery occlusions (CRAO) varies, depending upon the underlying disease. An embolic origin of an occlusion often occurs. PATIENT AND METHODS: A 50-year-old man with an occlusion of the left internal carotid artery was examined because of a left central retinal artery occlusion. Fluorescein angiography revealed that in no blood vessel could any circulation of blood be demonstrated. The slight vascular filling with dye mainly came from collateral circulation at the disc. RESULTS: Ocular massage was carried out. After a delay of several minutes, the vessels of the fundus became increasingly filled with blood. The patient noticed continuing recovery in the vision of his left eye. During fluorescein angiography, carried out one day later, white embolic clots appeared in the arteries of the papilla, some of them moving with the velocity of the blood flow through the retinal vessels and reaching the periphery of the retina and immediately disappearing. Others moved more slowly. This was seen repeatedly over several minutes. CONCLUSIONS: In this patient we have recorded in a fluorescein angiogram bright boluses visible in the blood of the retinal arteries. We suggest that conglomerations of blood cells can also cause an obstruction of blood flow. The observation of this kind of bright clots (boluses) visible in the blood of the retinal arteries we did not find described in the literature. In such a situation ocular massage is extremely helpful. Therefore, ocular massage should be carried out in every patient with CRAO.

Copper vapor laser and optical fiber catheter system for liquefaction and removal of thrombus in occluded arteries.

An instrument consisting of a copper vapor laser coupled to an optical fiber/chemical injector catheter for the treatment of occluded arteries has been constructed and tested. The combined application of three steps: the pre-irradiation injection of a light absorbing dye, HPD; brief copper laser irradiation (at 578 nm); and a urokinase infusion after the irradiation, produced the striking effect of liquefaction and resolution of thrombus. The histological examination of the arteries after the treatment showed no apparent damage to the arterial wall.