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1.
Sanid. mil ; 76(3): 170-172, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196231

RESUMO

Se presenta un caso de isquemia arterial aguda en extremidad inferior izquierda por trombosis aortoiliaca, en paciente diagnosticada de neumonía bilateral con compromiso respiratorio severo durante la infección por SARS-CoV-2. Se realiza angio TC abdominopélvico ante sospecha de afectación iliofemoral izquierda y femoropoplitea derecha sin factores de riesgo cardioembólicos ni clínica previa de claudicación. A pesar del mal estado general de la paciente con necesidad de aporte de oxígeno a alto flujo se realiza cirugía para salvamento de extremidad. La intervención se realizó bajo anestesia local y en posición anti-Trendelemburg para asegurar la saturación de oxígeno. Se realiza tromboembolectomía iliofemoral de la extremidad sintomática, consiguiendo la recuperación funcional de la extremidad


We present a case of acute arterial ischemia in left lower limb due to aortoiliac thrombosis in a patient with SARS-CoV-2 pneumonia with severe respiratory distress. Abdominal CT angiography was performed with high suspect of left iliofemoral and right femoropopliteal compromise without cardioembolic risk factors nor previous intermittent claudication. Despite patient's poor condition, who needed supplementation of high flow oxygen, a salvage surgery was performed in order to preserve the extremity. The intervention was performed under local anesthesia and reverse Trendelenburg position in order to keep appropriate oxygen saturation. The procedure consisted of mechanical iliofemoral thromboembolectomy of the symptomatic limb achieving functional recovery


Assuntos
Humanos , Feminino , Idoso , Artéria Ilíaca/diagnóstico por imagem , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Betacoronavirus , Trombose/cirurgia , Artéria Ilíaca/fisiopatologia , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Embolectomia/métodos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Transtornos da Coagulação Sanguínea/complicações
2.
J Card Surg ; 35(8): 2050-2052, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652608

RESUMO

Acute pulmonary embolism (APE) is a well-described complication following surgical procedures. The incidence of such a complication can be related to the presence of a peculiar patient's condition. Cryoglobulinemia, which consists in the presence of one or more immunoglobulins in the serum that precipitate at temperatures below 37°C and redissolve on warming, seems to increase the risk of thrombotic events. Treatment options of APE, according to clinical severity, include systemic thrombolysis, surgical embolectomy, and systemic anticoagulation. Thrombolysis is considered the first-line treatment, whereas surgery is reserved in case of extremely-compromised hemodynamic conditions related to massive central embolism, and in case of contraindication to thrombolysis. Here, we report a case of acute massive pulmonary embolism occurring at the end of a surgical procedure for a thymic carcinoma resection, in a patient with cryoglobulinemia, which required an emergent surgical pulmonary embolectomy.


Assuntos
Crioglobulinemia/complicações , Embolectomia/métodos , Posicionamento do Paciente/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Doença Aguda , Ecocardiografia Transesofagiana , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Índice de Gravidade de Doença , Toracotomia , Tomografia Computadorizada por Raios X
3.
J Cardiothorac Surg ; 15(1): 123, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493377

RESUMO

BACKGROUND: Heart failure complicated by pulmonary embolism is an extremely rare condition described in the literature. We report a case of very young patient with advanced heart failure against the background of dilated cardiomyopathy of unknown etiology with the presence of blood clots in both ventricles. CASE PRESENTATION: The course of treatment was complicated by acute pulmonary embolism. In emergency setting the patient was qualified for combine surgery pulmonary embolization and implantation of a continuous flow pump as a bridge for heart transplantation. The post-operative course is described in detail as well as reimplantation of the pump due to early thrombosis. CONCLUSIONS: Performed surgical procedures combined with alteration in anticoagulant drugs was sufficient to stabilize the clinical condition.


Assuntos
Anticoagulantes/uso terapêutico , Cardiomiopatia Dilatada/terapia , Embolectomia/métodos , Insuficiência Cardíaca/terapia , Coração Auxiliar , Embolia Pulmonar/terapia , Trombectomia/métodos , Trombose/terapia , Adolescente , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia , Cardiopatias/complicações , Cardiopatias/terapia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Transplante de Coração , Ventrículos do Coração , Humanos , Masculino , Implantação de Prótese , Artéria Pulmonar , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Trombose/complicações
4.
J Card Surg ; 35(7): 1531-1538, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32598529

RESUMO

BACKGROUND: Surgical pulmonary embolectomy (SPE) has been around since the early days of cardiac surgery. But with the increase in thrombolytic and intervention options, indications of SPE have been limited. Literature suggests that risk stratification has been a key step in getting good results. We are analyzing serum lactate levels for risk stratification in massive and submassive pulmonary embolism (PE). METHODS: This study is a retrospective analysis of 82 cases that underwent SPE between January 1997 and January 2020. Patients were divided into two groups stratified by venous serum lactate levels on the first admission (Group I: normolactatemia <2 mmol/L, Group II: hyperlactatemia, >2 mmol/L). Primary endpoints were all-cause in-hospital mortality and secondary endpoints were cardiopulmonary bypass time, extracorporeal membrane oxygenator (ECMO) insertion, low cardiac output, blood product use, and right ventricular functions in the follow-up. RESULTS: Our study had an overall follow-up of 23 years with a median of 3.18 years. Overall, the in-hospital mortality rate was 8.54%. Group II had a higher mortality rate (P = .015) and morbidity incidences like cardiopulmonary bypass time (P = .008), ECMO insertion (P = .036), and open chest after surgery (P = .015). Although 5-year survival was better in group I a compared to group II (81%, 95% CI, 69%-93% vs 65%, 95% CI, 46%-84%), the log rank test showed no statistical survival difference among both groups on long-term follow-up. CONCLUSIONS: Long term survival after SPE is good and these results can further be improved by proper PE risk stratification. Alongside computed tomography and echocardiography, the importance of biomarkers like serum lactate can be explored in the PE management algorithm.


Assuntos
Embolectomia/métodos , Lactatos/sangue , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Ponte Cardiopulmonar , Embolectomia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
J Card Surg ; 35(7): 1638-1639, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32557777

RESUMO

Pulmonary embolism can be associated with paradox embolism requiring immediate surgical therapy regardless of hemodynamic status. Here we present images illustrating a giant transit thrombus as a concomitant finding in a patient with pulmonary artery embolism.


Assuntos
Embolectomia/métodos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Trombose/patologia , Trombose/cirurgia , Ecocardiografia Transesofagiana , Forame Oval/patologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Embolia Pulmonar/patologia , Embolia Pulmonar/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
J Card Surg ; 35(8): 1787-1792, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32557825

RESUMO

PURPOSE: Despite paucity of data, there exists growing popularity of catheter-based extraction methods for intravascular thrombi and vegetations. We describe a large single center experience with vacuum-assisted extraction techniques (VAET) for right-sided intravascular and cardiac masses. METHODS: We retrospectively reviewed the perioperative course of patients undergoing VAET between 2014 and 2019. Primary outcomes were survival and freedom from recurrent bacteremia. Procedural success was a composite definition of survival, majority of mass extraction, absence of recurrent bacteremia, and valve function not requiring further intervention during index hospitalization. RESULTS: Of the entire cohort (n = 58), 48% and 52% underwent VAET for vegetations and sterile thrombi, respectively. Of those with positive cultures, the most common organism isolated was Staphylococcus aureus (48%). Preoperative active bacteremia was present in 36% (21/58) and of these patients, 76% (16/21) had neither recurrent nor persistent bacteremia post-op. The majority of masses (67%, 38/58) were debulked with an average reduction in size of 42%. Conversion to open surgery occurred in 3.5% (2/58). Intraoperative and 30-day survival were 98% (57/58) and 90% (28/31), respectively. Overall success was 86% (50/58). The prevalence of moderate/severe tricuspid regurgitation was 37% pre-op and 61% post-op. Average length of intensive care unit and overall hospital stay was 5.6 and 16 days, respectively. CONCLUSIONS: In this single center experience, VAET was conducted safely with a high degree of success and freedom from short-term recurrent bacteremia. This minimally invasive procedure is an attractive alternative to traditional open techniques for removal of right-sided intravascular and cardiac masses.


Assuntos
Embolectomia/métodos , Vácuo , Trombose Venosa/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Estudos Retrospectivos , Fatores de Tempo
7.
Medicine (Baltimore) ; 99(19): e19943, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384440

RESUMO

RATIONALE: The preoperative diagnosis of massive pulmonary tumor embolism associated with renal neoplasms is relatively rare. In most cases, pulmonary tumor embolism is detected intraoperatively during renal tumor resection. Moreover, primary renal sarcoma is rare, and primary renal sarcoma complicated by pulmonary tumor embolism is extremely rare; accordingly, there is no optimal treatment for such cases. Herein, we report a case of renal sarcoma associated with pulmonary tumor embolism. PATIENT CONCERNS: A 39-year-old man was admitted to the emergency room owing to the sudden onset of dyspnea and palpitation. DIAGNOSIS: Contrast-enhanced computed tomography (CT) revealed a large mass in the right kidney involving the infrahepatic inferior vena cava, with massive pulmonary emboli in both the pulmonary arteries. INTERVENTIONS: Emergency pulmonary embolectomy with radical nephrectomy was performed. OUTCOMES: The patient experienced apparent remission of dyspnea, and resolution of right ventricle dysfunction. However, although remnant emboli were detected in the segmental arteries on postoperative CT, complete resolution of pulmonary embolism was observed after adjuvant chemotherapy. LESSONS: Thus, concomitant cytoreductive nephrectomy with pulmonary embolectomy along with chemotherapy may be effective for patients with renal sarcoma with pulmonary tumor embolism.


Assuntos
Neoplasias Renais/complicações , Neoplasias Pulmonares/complicações , Embolia Pulmonar/etiologia , Sarcoma/complicações , Adulto , Embolectomia/métodos , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Nefrectomia/métodos , Artéria Pulmonar/patologia , Embolia Pulmonar/patologia , Embolia Pulmonar/cirurgia , Sarcoma/secundário , Sarcoma/cirurgia , Veia Cava Inferior/patologia
8.
Ann Thorac Surg ; 110(5): e403-e404, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32360384

RESUMO

A cluster of pneumonia cases caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly throughout China, Europe, and the United States. The pneumonia might evolve to acute respiratory distress syndrome, requiring assisted mechanical ventilation. The prolonged immobilization combined with respiratory failure, sepsis, and dehydration might expose SARS-CoV-2 patients to increased risk of complication, including pulmonary embolism. We report a case of SARS-CoV-2 complicated by a massive pulmonary embolism in a patient who underwent successful surgical embolectomy. We believe that maintaining the same proactive attitude suggested by current European Society of Cardiology and European Respiratory Society guidelines might help in reducing morality and improving survival in SARS-COV-2 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Embolectomia/métodos , Pneumonia Viral/complicações , Embolia Pulmonar/cirurgia , Doença Aguda , Infecções por Coronavirus/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Radiografia Torácica
9.
Ann Thorac Surg ; 110(5): e409-e411, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32305287

RESUMO

Acute pulmonary embolism is an uncharacteristic presentation in patients with coronavirus 2019 (COVID-19). Here we describe the case of a young woman presenting with severe pulmonary embolism, without any associated symptoms of infections. A clot in a patent foramen ovale was noted. Despite emergency surgical embolectomy, her clinical conditions continued to deteriorate. She was put on extracorporeal life support and tested positive for COVID-19. She died of multiorgan failure on day 10. COVID-19 may have a thrombogenic effect, and it may need to be considered in cases of pulmonary embolism and in the absence of any obvious risk factor.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Embolectomia/métodos , Pneumonia Viral/complicações , Embolia Pulmonar/etiologia , Doença Aguda , Infecções por Coronavirus/epidemiologia , Ecocardiografia Transesofagiana , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Tomografia Computadorizada por Raios X
11.
Clin Plast Surg ; 47(2): 261-265, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115051

RESUMO

This article discusses the pathophysiology, presentation, cause, and treatment of ischemic pain in the surgical patient. Causes of ischemic pain vary but all fundamentally cause local acidosis in the peripheral tissues, which causes signals to be passed through ascending pain pathways to the thalamus and eventual cerebral cortex where it is interpreted as ischemic pain. Ischemic pain is classically associated with an insidious onset but can present in the acute or chronic setting. Treatments are aimed at improving perfusion to the affected tissue. Surgical options include repairing damaged vessels, bypassing diseased vessels, performing thrombectomy, or embolectomy. Numerous conservative therapies exist.


Assuntos
Embolectomia/métodos , Isquemia/complicações , Manejo da Dor/métodos , Dor/etiologia , Tromboembolia/complicações , Terapia Trombolítica/métodos , Humanos , Isquemia/terapia , Tromboembolia/terapia
12.
Ann Thorac Surg ; 110(3): 1072-1080, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32151576

RESUMO

BACKGROUND: Acute pulmonary embolism (PE) is associated with significant mortality. Surgical embolectomy is a viable treatment option; however, it remains controversial as a result of variable outcomes. This review investigates patient outcomes after surgical embolectomy for acute PE. METHODS: An electronic search was performed to identify articles reporting surgical embolectomy for treatment of PE. 32 studies were included comprising 936 patients. Demographic, perioperative, and outcome data were extracted and pooled for systematic review. RESULTS: Mean patient age was 56.3 years (95% confidence interval [CI], 52.5, 60.1), and 50% were male (95% CI, 46, 55); 82% had right ventricular dysfunction (95% CI, 62, 93), 80% (95% CI, 67, 89) had unstable hemodynamics, and 9% (95% CI, 5, 16) experienced cardiac arrest. Massive PE and submassive PE were present in 83% (95% CI, 43, 97)] and 13% (95% CI, 2, 56) of patients, respectively. Before embolectomy, 33% of patients (95% CI, 14, 60) underwent systemic thrombolysis, and 14% (95% CI, 8, 24) underwent catheter embolectomy. Preoperatively, 47% of patients were ventilated (95% CI, 26; 70), and 36% had percutaneous cardiopulmonary support (95% CI, 11, 71). Mean operative time and mean cardiopulmonary bypass time were 170 minutes (95% CI, 101, 239) and 56 minutes (95% CI, 42, 70), respectively. Intraoperative mortality was 4% (95% CI, 2, 8). Mean hospital and intensive care unit stay were 10 days (95% CI, 6, 14) and 2 days (95% CI, 1, 3), respectively. Mean postoperative systolic pulmonary artery pressure (sPAP) was significantly decreased from the preoperative period (sPAP 57.8, mm Hg; 95% CI, 53, 62.7) to the postoperative period (sPAP, 31.3 mm Hg; 24.9, 37.8); P < .01). In-hospital mortality was 16% (95% CI, 12, 21). Overall survival at 5 years was 73% (95% CI, 64, 81). CONCLUSIONS: Surgical embolectomy is an acceptable treatment option with favorable outcomes.


Assuntos
Embolectomia/métodos , Embolia Pulmonar/cirurgia , Doença Aguda , Humanos , Duração da Cirurgia , Resultado do Tratamento
13.
Am J Cardiol ; 125(8): 1276-1279, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32085867

RESUMO

In the absence of a randomized controlled trial, it is important to obtain as much evidence as possible by other methods on whether inferior vena cava (IVC) filters reduce mortality in patients who undergo pulmonary embolectomy. Therefore, this retrospective cohort study based data from the National Inpatient Sample 2009 to 2014 was undertaken. We assessed in-hospital all-cause mortality in stable and unstable (in shock or on ventilator support) patients with acute pulmonary embolism who underwent pulmonary embolectomy. International Classification of Diseases-9-Clinical Modification (ICD-9-CM) codes were used to identify patients. Co-morbidities were assessed by the updated Charlson co-morbidity index. A time-dependent analysis was performed to control for immortal time bias. In stable patients who underwent pulmonary embolectomy, mortality with an IVC filter was 50 of 1,212 (4.1%) compared with 202 of 755 (27%) with no IVC filter (p <0.0001). In unstable patients, mortality with an IVC filter was 108 of 598 (18%) compared with 179 of 358 (50%) with no IVC filter (p <0.0001). Mortality was reduced with IVC filters only if the filters were inserted in the first 4 or 5 days. Co-morbid conditions and immortal time bias could not explain these results. We conclude that both stable and unstable patients who underwent pulmonary embolectomy had a lower mortality with IVC filters if inserted in the first 4 or 5 days.


Assuntos
Embolectomia/métodos , Mortalidade Hospitalar , Embolia Pulmonar/cirurgia , Filtros de Veia Cava/estatística & dados numéricos , Adulto , Idoso , Estudos de Casos e Controles , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Choque/etiologia , Fatores de Tempo
15.
Interact Cardiovasc Thorac Surg ; 30(3): 388-393, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31834382

RESUMO

OBJECTIVES: Patients with life-threatening pulmonary emboli (PE) have traditionally been treated with anticoagulation alone, yet emerging data suggest that more aggressive therapy may improve short-term outcomes. The purpose of this study was to compare postoperative outcomes between catheter-directed thrombolysis (CDL) and surgical pulmonary embolectomy (SPE) in the treatment of life-threatening PE. METHODS: A retrospective single-centre observational study was conducted for patients who underwent SPE or CDL at a single US academic centre. Preprocedural and postprocedural echocardiographic data were collected. Unadjusted regression models were constructed to assess the significance of the between-group postoperative differences. RESULTS: A total of 126 patients suffered a life-threatening PE during the study period [60 SPE (47.6%), 66 CDL 52.4%]. Ten (24.4%) SPE patients and 10 (15.2%) CDL patients had massive PEs marked by preprocedural hypotension. Six (10.0%) SPE patients and 4 (6.0%) CDL patients suffered a preprocedure cardiac arrest (P = 0.41). In-hospital mortality rate was 3.3% (2) for SPE, and 3.0% (2) for CDL (P = 0.99). SPE patients were more likely to require prolonged ventilation (15.0% vs 1.5%, P = 0.01). No significant differences were found in other major complications. At baseline echocardiography, 76.9% of SPE patients and 56.9% of CDL patients had moderate or severe right ventricular (RV) dysfunction. Both treatment groups showed marked and durable improvement in echocardiographic markers of RV function from baseline at midterm follow-up. CONCLUSIONS: Both SPE and CDL can be applied to well-selected high-risk patients with low rates of morbidity and mortality. Further research is necessary to delineate which patients would benefit most from either SPE or CDL following a life-threatening PE.


Assuntos
Cateterismo Cardíaco/métodos , Embolectomia/métodos , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
16.
R I Med J (2013) ; 102(10): 43-47, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31795534

RESUMO

Acute pulmonary embolism (PE) causes significant morbidity and mortality, particularly for patients with subsequent right ventricular (RV) dysfunction. Once diagnosed, risk stratification is imperative for therapeutic decision making and centers on evaluation of RV function. Treatment includes supportive care, systemic anticoagulation, and consideration of reperfusion therapy. In addition to systemic anticoagulation, patients with high-risk PE should receive reperfusion therapy, typically with systemic thrombolysis. The role of reperfusion therapies, which include catheter-based interventions, systemic thrombolysis, and surgical embolectomy, are controversial in the management of intermediate risk PE. Catheter directed thrombolysis (CDT) can be considered in certain intermediate risk patients although prospective, comparative data for its use are lacking. Surgical or catheter embolectomy are viable treatment options for high-risk patients in whom reperfusion therapy is warranted but who have absolute contraindications to thrombolysis. Further research is needed to better elucidate which patients with PE would most benefit from advanced reperfusion therapies.


Assuntos
Embolectomia/métodos , Fibrinolíticos/administração & dosagem , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Tomada de Decisão Clínica , Embolectomia/efeitos adversos , Prática Clínica Baseada em Evidências/tendências , Fibrinolíticos/efeitos adversos , Humanos , Seleção de Pacientes , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento
17.
J Pak Med Assoc ; 69(10): 1557-1558, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31622317

RESUMO

Acute mesenteric ischaemia is a worrisome clinical condition with high mortality. We present a 90 years old male patient, known case of atrial flutter who developed acute mesenteric ischaemia. This was due to superior mesenteric artery embolus. He underwent successful superior mesenteric embolectomy and made a smooth recovery. He was symptom free and was discharged from hospital on 5th postoperative day on lifelong anticoagulants. Early diagnosis, adequate resuscitation and attention to finer technical details of superior mesenteric emboelctomy can save a life in selected patients.


Assuntos
Embolectomia/métodos , Embolia/cirurgia , Artéria Mesentérica Superior/cirurgia , Isquemia Mesentérica/cirurgia , Doença Aguda , Idoso de 80 Anos ou mais , Flutter Atrial/complicações , Embolia/etiologia , Humanos , Laparoscopia , Masculino , Isquemia Mesentérica/etiologia
18.
World Neurosurg ; 132: 292-294, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476459

RESUMO

BACKGROUND: Endovascular embolization is an important tool in the management of multiple pathologies as a preoperative adjunct in the care of arteriovenous malformations or vascular tumors. CASE DESCRIPTION: We report a case of delayed distal Onyx migration after surgical resection of a glomus vagale tumor, which had been preoperatively embolized. In this report, the patient underwent successful embolectomy of the migrated Onyx fragment using manual aspiration. CONCLUSIONS: This case represents the first in the literature to describe this potential delayed complication, as well as its management strategy.


Assuntos
Embolectomia/métodos , Migração de Corpo Estranho/cirurgia , Tumor Glômico/terapia , Neoplasias de Cabeça e Pescoço/terapia , Artéria Cerebral Média/cirurgia , Artéria Oftálmica/cirurgia , Polivinil , Tantálio , Adulto , Angiografia por Tomografia Computadorizada , Combinação de Medicamentos , Embolização Terapêutica , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Oftálmica/diagnóstico por imagem
19.
Am J Cardiol ; 124(9): 1465-1469, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31495443

RESUMO

Treatment strategies for complex patients with pulmonary embolism (PE) are often debated given patient heterogeneity, multitude of available treatment modalities, and lack of consensus guidelines. Although multidisciplinary Pulmonary Embolism Response Teams (PERT) are emerging to address this lack of consensus, their impact on patient outcomes is not entirely clear. This analysis was conducted to compare outcomes of all patients with PE before and after PERT availability. We analyzed all adult patients admitted with acute PE diagnosed on computed tomography scans in the 18 months before and after the institution of PERT at a large tertiary care hospital. Among 769 consecutive inpatients with PE, PERT era patients had lower rates of major or clinically relevant nonmajor bleeding (17.0% vs 8.3%, p = 0.002), shorter time-to-therapeutic anticoagulation (16.3 hour vs 12.6 hour, p = 0.009) and decreased use of inferior vena cava filters (22.2% vs 16.4%, p = 0.004). There was an increase in the use of thrombolytics/catheter-based strategies, however, this did not achieve statistical significance (p = 0.07). There was a significant decrease in 30-day/inpatient mortality (8.5% vs 4.7%, p = 0.03). These differences in outcomes were more pronounced in intermediate and high-risk patients (mortality 10.0% vs 5.3%, p = 0.02). The availability of multidisciplinary PERT was associated with improved outcomes including 30-day mortality. Patients with higher severity of PE seemed to derive most benefit from PERT availability.


Assuntos
Anticoagulantes/uso terapêutico , Hemorragia/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Embolia Pulmonar/terapia , Adulto , Idoso , Assistência à Saúde , Embolectomia/métodos , Embolectomia/estatística & dados numéricos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Hemorragia/induzido quimicamente , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Trombolítica/métodos , Terapia Trombolítica/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Filtros de Veia Cava/estatística & dados numéricos
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