Drug-Coated Balloon Angioplasty for Axillary Artery Stenosis.

We present a case report of a patient with symptomatic bilateral severe axillary artery stenosis who underwent drug-coated balloon angioplasty. A 59-year-old female with a past medical history of peripheral artery disease presented with bilateral upper extremity claudication on exertion and episodes of syncope. Peripheral angiography showed significant bilateral upper extremity peripheral artery disease (PAD) including bilateral severe axillary artery stenosis. The patient underwent endovascular management with drug-coated balloon angioplasty of the axillary artery bilaterally. Symptoms completely resolved and the patient continues to be on follow-up. Arterial duplex studies on both upper extremities showed no evidence of high-grade stenosis six years after intervention. Drug coated balloon angioplasty can be a successful modality of endovascular management for patients with symptomatic severe axillary artery stenosis. However, more randomized controlled data is required before making any conclusion.

Clot in Transit: Therapy via Peripherally Inserted Central Catheter Line.

There are currently no definitive guidelines for the optimal management of clots in transit (CIT) due to a distinct lack of quality research to suggest a recommended therapy. The three main treatment modalities that are commonly utilized for pulmonary emboli (PE) (a sequela of CIT) are thrombolysis, pulmonary embolectomy, and anticoagulation alone. The current recommendation for severe PE with hemodynamic collapse is to consult cardiothoracic surgery for clot retrieval. One ongoing area of research involves the use of catheter-directed application of thrombolytic agents as it may have similar outcomes to the systemic application while minimizing the risk of bleeding events due to a lower dose of medication used. We report the case of a patient in whom, by taking advantage of an already placed peripherally inserted central catheter (PICC) line, tissue plasminogen activator (tPA) was successfully delivered at a localized site near the clot for active thrombolysis while only causing minimal adverse effects related to recent laminectomy/fasciectomy and foraminotomy compared to what may have been observed with systemic tPA administration.

Modified fibrinolytic therapy as treatment of mechanical aortic valve thrombosis.

Prosthetic valve thrombosis is a rare phenomenon with limited treatment options. Current management choices include anticoagulation with or without fibrinolysis or surgical valve replacement for appropriate candidates. We report an alternative fibrinolytic and anticoagulation regimen resulting in successful treatment of a patient presenting with mechanical aortic valve thrombosis.

Applications of minimally invasive cardiac output monitors.

Because of the increasing age of the population, critical care and emergency medicine physicians have seen an increased number of critically ill patients over the last decade. Moreover, the trend of hospital closures in the United States t imposes a burden of increased efficiency. Hence, the identification of devices that facilitate accurate but rapid assessments of hemodynamic parameters without the added burden of invasiveness becomes tantamount. The purpose of this review is to understand the applications and limitations of these new technologies.