Technical Feasibility of Suction Thrombectomy Using a Large-Bore Aspiration System in the Portomesenteric Venous System.

PURPOSE: To assess technical feasibility and safety of portal vein thrombectomy with suction thrombectomy using a large-bore thrombectomy device for portomesenteric venous thrombosis (PMVT). MATERIALS AND METHODS: After receiving approval from institutional review board, patients undergoing PMVT treatment using a large-bore aspiration thrombectomy device (Inari FlowTriever or ClotTriever) between July 2019 and June 2021 were identified at 2 medical centers. Charts were reviewed for demographic information, imaging findings, and procedural details. PMVT was categorized using the Yerdel grading system. The thrombectomy procedure was performed via transjugular access through the existing or a new transjugular intrahepatic portosystemic shunt (TIPS) or transsplenic or transhepatic approach. Technical success was defined as successful clot reduction and restoration of portal venous flow at the conclusion of the procedure. Patient outcomes based on clinical presentation, adverse events, and thrombectomy-associated adverse events were recorded. RESULTS: Twenty patients, with a median age of 58 years (range, 23-72 years), underwent large-bore aspiration thrombectomy, which was technically successful in 19 of 20 (95%) patients. In 9 of 20 (45%) patients, 9 of 20 (45%) patients, and 2 of 20 (10%) patients, the 20-F, 16-F, and 24-F devices were used, respectively. Fourteen patients had a pre-existing TIPS, and 6 patients had a TIPS created. In 5 of 20 (25%) patients, overnight lysis was performed in conjunction with Inari thrombectomy. Thrombus resolution with restoration of flow was achieved in 19 of 20 (95%) cases. There were no thrombectomy-associated adverse events. The mean follow-up time was 70 days (±113) at which time primary patency of the portal venous system was present in 16 of 20 (80%) patients. CONCLUSIONS: Large-bore aspiration portal vein thrombectomy is feasible for PMVT.

Filter-Assisted Shunt Embolization of Large Portosystemic Shunts: Technical Feasibility, Safety, and Outcomes.

PURPOSE: To describe the feasibility and outcomes of filter-assisted shunt embolization in patients with acquired large portosystemic shunts. METHODS: Two-center HIPAA compliant retrospective study of all patients who underwent filter-assisted shunt embolization between 03/2015-03/2021. Initial clinical evaluation, including demographic information, shunt sizing, and procedural details, was reviewed. Technical success was defined as successful occlusion of the targeted shunt. RESULTS: Eight patients (55 ± 10 years/88% male) had a large acquired portosystemic shunt which was suitable for filter-assisted shunt embolization. Indications for the procedure: 3 = pre-transplantation optimization, 2 = overt hepatic encephalopathy (HE), 1 = post-transplant thrombosis, 1 = portal vein thrombosis and encephalopathy, 1 = encephalopathy and variceal bleeding. Portosystemic shunts occurred between splenic and renal veins, inferior mesenteric and gonadal veins, and coronary veins. Mean shunt diameter was 27 ± 5 mm. The technical success of the procedure was 8/8 (100%). In 7 patients, a transjugular intrahepatic portosystemic shunt (TIPS) was also placed at the time of the shunt embolization due to either pre-transplant indication or sluggish portal flow. There were no intraprocedural complications from filter placement. OUTCOMES: 3 = currently listed for transplant, 2 = resolution of HE, 1 = made CMO, 1 patient with patent post-transplant vasculature. 1 = died as a complication related to TIPS placement (SIR Class F Complication). CONCLUSION: Filter-assisted shunt embolization is a technically feasible and safe technique to reduce or embolize large portosystemic shunts.

Intraoperative evaluation of the larynx following unilateral arytenoid lateralization for acquired idiopathic laryngeal paralysis in dogs.

The purposes of this study were to describe a modified surgical technique in which intraoperative extubation was performed to evaluate abduction of the arytenoid cartilage prior to tying the suture and to assess outcome and complication rates associated with this procedure. Medical records from 30 client-owned dogs with acquired idiopathic laryngeal paralysis were retrospectively reviewed. All clients were contacted by telephone to obtain follow-up information regarding their dog. Six of the 30 surgeries required additional dissection (primarily around the craniodorsal aspect of the cricoarytenoid joint) after the initial intraoperative laryngeal examination. The procedures in 29 of the 30 dogs were deemed a success by the owners. Three (10%) dogs developed postoperative aspiration pneumonia. One of these dogs required long-term antibiotic therapy. Twenty-nine dogs returned to normal activity, and none of the dogs had any exercise intolerance associated with respiratory difficulties. Three owners reported that their dogs were able to swim, and one dog hunted postoperatively. Results of this study suggest that intraoperative laryngeal examination may help limit postoperative complications by allowing for direct, intraoral visualization of the arytenoid cartilage. This enables a surgeon to modify the soft tissue dissection around the cricoarytenoid joint to ensure that adequate abduction is apparent.

Changes in Care for Acute Pulmonary Embolism Through A Multidisciplinary Pulmonary Embolism Response Team.

BACKGROUND: Optimal management of acute pulmonary embolism requires expertise offered by multiple subspecialties. As such, pulmonary embolism response teams (PERTs) have increased in prevalence, but the institutional consequences of a PERT are unclear. METHODS: We compared all patients that presented to our institution with an acute pulmonary embolism in the 3 years prior to and 3 years after the formation of our PERT. The primary outcome was in-hospital pulmonary embolism-related mortality before and after the formation of the PERT. Sub-analyses were performed among patients with elevated-risk pulmonary embolism. RESULTS: Between August 2012 and August 2018, 2042 patients were hospitalized at our institution with acute pulmonary embolism, 884 (41.3%) pre-PERT implementation and 1158 (56.7%) post-PERT implementation, of which 165 (14.2%) were evaluated by the PERT. There was no difference in pulmonary embolism-related mortality between the two time periods (2.6% pre-PERT implementation vs 2.9% post-PERT implementation, P = .89). There was increased risk stratification assessment by measurement of cardiac biomarkers and echocardiograms post-PERT implementation. Overall utilization of advanced therapy was similar between groups (5.4% pre-PERT implementation vs 5.4% post-PERT implementation, P = 1.0), with decreased use of systemic thrombolysis (3.8% pre-PERT implementation vs 2.1% post-PERT implementation, P = 0.02) and increased catheter-directed therapy (1.3% pre-PERT implementation vs 3.3% post-PERT implementation, P = 0.05) post-PERT implementation. Inferior vena cava filter use decreased after PERT implementation (10.7% pre-PERT implementation vs 6.9% post-PERT implementation, P = 0.002). Findings were similar when analyzing elevated-risk patients. CONCLUSION: Pulmonary embolism response teams may increase risk stratification assessment and alter application of advanced therapies, but a mortality benefit was not identified.

Evaluation of scintigraphy to assess incorporation of intercalary cortical bone grafts in sheep.

OBJECTIVE: To evaluate scintigraphy, radiography, and histomorphometric analysis for assessing incorporation of intercalary bone grafts and to compare incorporation of cortical autografts and allografts by the recipient. ANIMALS: 12 skeletally mature sheep. PROCEDURES: A 5-cm tibial defect was filled with a cortical allograft (n = 6) or autograft (6) and stabilized with an interlocking nail. Radiography, scintigraphy, and fluorochrome bone labeling were performed every 3 months for 24 months. Radiographic evaluation included grading of the host and graft union and assessment of implants and grafts. Technetium-99m-hydroxymethylene diphosphonate radionuclide uptake was measured. Sheep were euthanatized 24 months after surgery, and bone formation was evaluated via histomorphometric analysis of fluorochrome labeling. RESULTS: Complete union was detected on radiographs by 21 months in all sheep but developed earlier in sheep that received an autograft versus in those that received an allograft. Radionuclide uptake peaked at 3 months and returned to presurgical values at 12 months. Histomorphometric analysis revealed fluorochrome labeling corresponding to each time point, with most bone formation at 9 through 15 months. Scintigraphy findings did not correlate well with fluorochrome labeling of newly formed bone. CONCLUSIONS AND CLINICAL RELEVANCE: Although bone production around cortical bone grafts was detected by use of scintigraphy, this method did not provide accurate assessment of graft incorporation in sheep. Furthermore, bone produced by activated periosteum could not be distinguished scintgraphically from bone that replaced the graft. Intercalary autografts healed more rapidly and had greater incorporation into the host bone, compared with findings for allografts.

External coaptation.

External coaptation includes the use of casts, splints, bandages, or slings to help stabilize fractures or luxations, reduce postoperative swelling, or help to protect wounds. Although each of these can be highly effective, it is very important to understand the various types of devices available and the indications for each. Inappropriate use of an external coaptation device can lead to unsatisfactory results.

Use of force plate analysis to evaluate the efficacy of external beam radiation to alleviate osteosarcoma pain.

A standard of therapy for osteosarcoma includes amputation with or without adjuvant chemotherapy. There is a subset of dogs with osteosarcoma that are unsuitable for amputation. We evaluated kinetic variables in dogs with appendicular osteosarcoma treated with a single 8 Gy dose of radiation. Eighteen pet dogs with appendicular osteosarcoma received one 8 Gy fraction of palliative radiation on day 0. Force plate measurements and clinical assessments were made on days 0, 7, 14, and 21. Peak vertical forces (Fz) were recorded for each limb and a symmetric index (SI) was calculated. There were no significant changes in kinetic parameters after one 8 Gy dose of radiation therapy. Nine of these 18 dogs exhibited increased limb function at day 21 based on force plate analysis. Significant factors affecting Fz included gender and tumor location. There was a significant correlation between Fz and response to therapy based on SI at day 21. SI seems to be useful to objectively assess response in this mixed population of dogs. One 8 Gy fraction of radiation therapy alone did not reduce lameness associated with appendicular osteosarcoma, but a subset of dogs did have improved limb function after a single dose.

Evaluation of the abdomen using ultrasound following a ventral midline celiotomy.

Over the last 20 years, ultrasound has become a useful diagnostic tool in veterinary medicine. The purpose of this study was to use ultrasonographic examinations to determine if intra-abdominal contents could be visualized. Nineteen dogs, ranging from 8 months to 18 years of age were included. Each animal was evaluated sonographically prior to surgery, 24 h after surgery, and then 2-6 weeks following the surgical procedure. The results of our study suggest that ultrasound is an effective means for evaluation of the abdomen and surgery site following surgery. Both the abdomen and surgery site were clearly visualized in all dogs. In addition, subjective evaluation of the intra-abdominal contents was performed. The limiting factor in this study was not the presence of air, as was expected. Rather the limiting factor for appropriate visualization was pain. The information obtained could prove to be useful to surgeons and radiologists in assessing a patient's status postoperatively.