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1.
Int Heart J ; 62(1): 211-215, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518660

RESUMO

Anticoagulation is recommended for the treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT). In some cases, an inferior vena cava (IVC) filter is used to prevent PE. We report the case of a 70-year-old woman who developed non-massive PE and proximal DVT, which were treated using an IVC filter; two filters were placed owing to the fracture of the filters. Few previous reports have discussed IVC fractures and the difficulty in detecting such fractures on computed tomography before retrieval. Based on our experience, we suggest that a temporary IVC filter for DVT treatment should be considered carefully.


Assuntos
Filtros de Veia Cava/efeitos adversos , Idoso , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
2.
Rev. bras. cancerol ; 67(1): e-01841, 2021.
Artigo em Português | LILACS | ID: biblio-1146871

RESUMO

Introdução: O tromboembolismo venoso é uma condição potencialmente fatal e frequente no paciente oncológico. Muitas vezes, a anticoagulação é inviável, e a colocação do filtro de veia cava (FVC) torna-se uma opção. A indicação clínica, entretanto, é controversa e gera alto custo. Objetivo: Descrever as características demográficas, clínicas e epidemiológicas dos pacientes com colocação de FVC e seu impacto na sobrevida global. Método: Estudo de coorte retrospectiva com pacientes em tratamento oncológico no INCA, que tiveram FVC implantado de janeiro/2015 até abril/2017. Na análise de sobrevida global em cinco anos, foram considerados o tempo entre o diagnóstico de câncer e o óbito por qualquer causa. Realizaram-se análise descritiva, estimativas de sobrevida (Kaplan-Meier) e regressão de Cox. Resultados: Foram incluídos 74 pacientes com média de idade 54 (+-15) anos. Em sua maioria, apresentavam tumores ginecológicos (52,7%) e digestivos (20,3%). O tempo mediano entre o diagnóstico de câncer e a colocação do FVC foi de 3,48 meses (0-203). No seguimento, foram observados 40 óbitos (54,1%) com mediana de tempo de 25 meses (IC 95%; 1,76-47,32). Na análise ajustada, verificou-se risco 5,63 vezes maior de morrer nos pacientes com colocação do FVC em até seis meses após o diagnóstico de câncer (HR=4,99; IC 95%; 2,20-11,33; p<0,001), e risco 2,47 vezes maior entre aqueles que não fizeram no pré-operatório (HR=2,47; IC 95%; 1,08-5,66; p=0,032). Conclusão: A colocação do FVC foi realizada com maior frequência em pacientes com tumores ginecológicos e em até seis meses após o diagnóstico de câncer foi associada a maior risco de óbito.


Introduction: Venous thromboembolism is a potentially fatal condition and frequent in oncologic patients. Quite often full anticoagulation is unfeasible, and placement of an inferior vena cava (IVC) filter becomes an option. Clinical indication, however, is controversial and expensive. Objective: To describe the demographic, clinical and epidemiological characteristics of oncologic patients submitted to IVC filter placement and their impact on global survival. Method: Retrospective cohort study with patients undergoing cancer treatment at INCA submitted to IVC filter placement from January 2015 to April 2017. Time between cancer diagnoses and death from any cause was considered for the analysis of the global 5-years survival. Descriptive analysis, survival estimates (Kaplan-Meyer) and Cox regression were performed. Results: 74 patients with a mean age of 54 (+15) years were included. Most of them had gynecological (52.7%) and digestive (20.3%) tumors. The median time between cancer diagnosis and IVC filter placement was 3.48 months (0-203). In the follow-up, 40 deaths (54.1%) were observed with a median time of 25 months (95% CI; 1.76 to 47.32). In the adjusted analysis, 5.63 times greater risk of death was verified in patients with IVC filter placement within six months after cancer diagnosis (HR=4.99; 95% CI; 2.20-11.33; p<0.001), and 2.47 times greater risk among those who did not do it at pre-operation (HR=2.47; 95% CI; 1.08-5.66; p=0.032). Conclusion: IVC filter placement was performed more frequently in patients with gynecological tumors and in until six months after cancer diagnosis was associated with increased risk of death.


Introducción: El tromboembolismo venoso es una afección potencialmente mortal y frecuente en pacientes con cáncer. La anticoagulación a menudo no es factible, y la colocación de un filtro de vena cava (FVC) se convierte en una opción. Sin embargo, las indicaciones clínicas son controvertidas y generan un alto costo. Objetivo: Describir las características demográficas, clínicas y epidemiológicas de los pacientes con colocación de CVF y su impacto en la supervivencia general. Método: Estudio de cohorte retrospectivo de pacientes sometidos a tratamiento contra el cáncer en INCA a quienes se les implantó FVC entre enero de 2015 y abril de 2017. En el análisis de la supervivencia general a cinco años, el tiempo transcurrido entre el diagnóstico de cáncer y la muerte cualquier causa Se realizó un análisis descriptivo, estimaciones de supervivencia (Kaplan-Meier) y regresión de Cox. Resultados: Se incluyeron 74 pacientes con una edad media de 54 (+-15) años. La mayoría de ellos tenían tumores ginecológicos (52,7%) y digestivos (20,3%). La mediana del tiempo entre el diagnóstico de cáncer y la colocación de FVC fue de 3,48 meses (0-203). En el período de seguimiento, se observaron 40 muertes (54,1%) con una mediana de tiempo de 25 meses (IC 95%: 1,76 a 47,32). En el análisis ajustado, se observó un riesgo de muerte 5,63 veces mayor en pacientes con colocación de FVC dentro de los seis meses posteriores al diagnóstico de cáncer (HR=4,99; IC 95%: 2,20-11,33; p<0,001) y 2,47 veces mayor riesgo entre aquellos que no lo hicieron antes de la operación (HR=2,47; IC 95%; 1,08-5,66; p=0,032). Conclusión: La colocación de FVC se realizó con mayor frecuencia en pacientes con tumores ginecológicos. La colocación de FVC dentro de los seis meses posteriores al diagnóstico de cáncer se asoció con un mayor riesgo de muerte.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Filtros de Veia Cava/efeitos adversos , Tromboembolia Venosa/mortalidade , Neoplasias/mortalidade , Prognóstico , Fatores de Tempo , Análise de Sobrevida , Estudos Retrospectivos , Tromboembolia Venosa/cirurgia , Tromboembolia Venosa/complicações , Neoplasias dos Genitais Femininos/complicações , Neoplasias dos Genitais Femininos/mortalidade , Neoplasias/complicações
3.
Angiol Sosud Khir ; 26(4): 149-154, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332317

RESUMO

Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.


Assuntos
Laparoscopia , Embolia Pulmonar , Filtros de Veia Cava , Remoção de Dispositivo , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
4.
Cochrane Database Syst Rev ; 10: CD006212, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33027844

RESUMO

BACKGROUND: Pulmonary emboli (PE), or blood clots in the lungs,can be potentially fatal. Anticoagulation is the first line therapy to prevent PE. In some instances anticoagulation fails to prevent more emboli, or cannot be given because the person has a high risk of bleeding. Inferior vena caval filters (VCFs) are metal alloy devices that mechanically trap fragmented emboli from the deep leg veins en route to the pulmonary circulation. Retrievable filters are designed to be introduced and removed percutaneously. Although their deployment seems of theoretical benefit, their clinical efficacy and adverse event profile is unclear. This is the third update of a Cochrane Review first published in 2007. OBJECTIVES: To assess the evidence for the effectiveness and safety of vena caval filters (VCFs) in preventing pulmonary embolism (PE). SEARCH METHODS: For this review update, the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (last searched 10 September 2019) and the Cochrane Register of Controlled Trials (CENTRAL) (2019, Issue 8) via the Cochrane Register of Studies Online. The CIS also searched MEDLINE Ovid, EMBASE Ovid, CINAHL, and AMED (1 January 2017 to 10 September 2019) and trials registries to 10 September 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that examined the efficacy of VCFs in preventing PE. DATA COLLECTION AND ANALYSIS: For this update, studies were assessed and data extracted independently. We assessed study quality with Cochrane's 'Risk of bias' tool and used the GRADE approach to assess the overall certainty of the evidence. The outcomes of interest were PE, mortality, lower limb venous thrombosis, filter-related complications and major bleeding. MAIN RESULTS: We identified four new studies for this update, bringing the total to six included studies involving 1388 participants. The six studies were clinically heterogeneous and we were unable to carry out meta-analysis. Only two studies were considered to be both applicable in current clinical settings and of good methodological quality. One was a randomised open-label trial studying the effect of a retrievable inferior vena caval filter plus anticoagulation versus anticoagulation alone on risk of recurrent pulmonary embolism (PE) in 399 participants over three months. There was no evidence of a difference in the rates of PE, death, lower extremity deep vein thrombosis (DVT), or bleeding at three and six months after the intervention (moderate-certainty evidence). A filter was inserted in 193 people, but could only be successfully retrieved from 153. Minor filter complications were noted at six months. The second clinically relevant study was a randomised open-label trial of 240 participants who had sustained multiple traumatic injuries, allocated to a filter or no filter, three days after injury, in conjunction with anticoagulation and intermittent pneumatic compression. Prophylactic anticoagulation was initiated in both groups when it was thought safe to do so. There was no evidence of a difference in symptomatic PE, death, or lower limb venous thrombosis rates (moderate-certainty evidence). The only major filter complication was that one person required surgical removal of the filter. We are unable to draw any conclusions from the remaining four included studies. One study showed an increased incidence of long-term lower extremity DVT at eight years. Three studies are no longer clinically applicable because they utilised permanent filters which are seldom used now, or they did not use routine prophylactic anticoagulation which is current standard practice. The fourth study compared two filter types and was terminated prematurely as one filter group had a higher rate of thrombosis compared to the other filter type. AUTHORS' CONCLUSIONS: Two of the six identified studies were relevant for current clinical settings. One showed no evidence of a benefit of retrievable filters in acute PE for the outcomes of PE, death, DVT and bleeding during the initial three months in people who can receive anticoagulation (moderate-certainty evidence). The other study did not show any benefit for prophylactic filter insertion in people who sustained multiple traumatic injuries, with respect to symptomatic PE, mortality, or lower extremity venous thrombosis (moderate-certainty evidence). We can draw no firm conclusions regarding filter efficacy in the prevention of PE from the remaining four RCTs identified in this review. Further trials are needed to assess vena caval filter effectiveness and safety, and clinical differences between various filter types.


Assuntos
Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Anticoagulantes/uso terapêutico , Terapia Combinada/métodos , Humanos , Dispositivos de Compressão Pneumática Intermitente , Traumatismo Múltiplo/complicações , Embolia Pulmonar/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior , Trombose Venosa/complicações
5.
AJR Am J Roentgenol ; 215(4): 790-794, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32755356

RESUMO

OBJECTIVE. Utilization of retrievable inferior vena cava filters (rIVCFs) has come under increased scrutiny because of historically high rates of placement, generalized lack of retrieval when the inferior vena cava filter (IVCF) is no longer indicated, and reports of device-related complications. These events have led to an increased interest in IVCF retrieval, including the development of advanced endovascular retrieval techniques and the proliferation of specialized clinical practices for rIVCFs. We aim to describe the indications for IVCF retrieval, patient selection, procedural planning, and procedural complications and management. CONCLUSION. IVCFs continue to have a role in the prevention of pulmonary embolism in select patients. Rising awareness of device-related complications paired with historically low retrieval rates has prompted renewed emphasis and interest in filter retrieval. Diligent follow-up and procedural planning permit prompt and safe filter retrieval.


Assuntos
Remoção de Dispositivo/efeitos adversos , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava/efeitos adversos , Procedimentos Endovasculares , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia
7.
J Card Surg ; 35(7): 1642-1643, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32484974

RESUMO

BACKGROUND AND AIM: Complications of inferior vena cava filters are relatively common, and they vary according to different filter types and designs. We aim to present a case of penetrated inferior vena cava filter into the liver. METHODS: Case report. RESULTS: A 42-year old man with thrombophilia (prothrombin gene mutation) required the insertion of an inferior vena cava filter because of recurrent gastrointestinal bleeding associated with oral anticoagulation. However, it penetrated through the retro-hepatic vena cava into the liver, being manifested by constant, blunt abdominal pain. Endovascular retrieval was considered of extreme risk, though a surgical approach was performed under cardiopulmonary bypass with deep hypothermic circulatory arrest. The patient has recovered uneventfully with complete symptom relief. CONCLUSIONS: In symptomatic penetrated vena cava filters in which endovascular retrieval is not feasible, a surgical approach with appropriate planning is a safe and effective treatment.


Assuntos
Parada Circulatória Induzida por Hipotermia Profunda/métodos , Remoção de Dispositivo/métodos , Fígado/lesões , Fígado/cirurgia , Falha de Prótese , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/cirurgia , Adulto , Ponte Cardiopulmonar , Procedimentos Endovasculares/métodos , Humanos , Fígado/irrigação sanguínea , Masculino , Resultado do Tratamento
9.
Ann Thorac Surg ; 110(3): e153-e155, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32142816

RESUMO

Inferior vena cava filters are used for patients with pulmonary embolism or those with risk of embolization. Here we present a case of a 38-year-old man who underwent placement of an inferior vena cava filter because of deep vein thrombosis. The operating arm fractured and embolized to the posteromedial papillary muscle of mitral valve and the posterior inferior wall of the left ventricle through right atrium and atrioventricular septum, leading to large symptomatic mitral and tricuspid insufficiency and pericardial tamponade. Here we report a rare case where the filter migrated to the left ventricle and destroyed the mitral valve.


Assuntos
Migração de Corpo Estranho/diagnóstico , Ventrículos do Coração , Insuficiência da Valva Mitral/etiologia , Valva Mitral/lesões , Insuficiência da Valva Tricúspide/etiologia , Filtros de Veia Cava/efeitos adversos , Adulto , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/cirurgia , Veia Cava Inferior , Trombose Venosa/complicações
11.
Ann Vasc Surg ; 64: 408.e11-408.e14, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31634599

RESUMO

BACKGROUND: Inferior vena cava (IVC) filters are effective in preventing pulmonary embolism in patients at risk. This study aimed to investigate whether the dwell time of retrievable IVC filters have impact on IVC lumen diameter. METHODS: The clinical data of 36 patients treated with retrievable IVC filters from January 2016 to November 2018 were retrospectively collected. A total of 33 filters were successfully removed. At times of filter placement and removal, the IVC lumen diameter (at upper, middle, and lower levels of the filter), distance between the filter upper end and the right renal vein opening, and degree of filter tilt were measured. RESULTS: IVC filters were placed because of deep vein thrombosis in the lower limbs after fractures in 26 patients. The median dwell time of the IVC filters was 18 days. From the time of filter placement to that of removal, the IVC diameter decreased significantly at the middle (28.07 ± 5.92 vs. 25.73 ± 7.33 mm, P = 0.002) and lower levels (27.48 ± 4.73 vs. 26.36 ± 4.72 mm, P = 0.003) of the filters. No significant difference was noticed in the IVC diameter at the upper levels of the filters (27.78 ± 6.43 vs. 27.11 ± 6.63 mm, P = 0.082). Positive correlation was noticed between filter dwell time and IVC diameter changes at the upper (r = 0.381, P = 0.029) and middle (r = 0.555, P = 0.001) levels of the filters. No significant change was noticed in the distance from the filter upper end to the right renal vein opening and the degree of filter tilt. CONCLUSIONS: Retrievable IVC filters are associated with IVC stenosis. The severity of IVC stenosis is positively correlated with the dwell time of filters.


Assuntos
Remoção de Dispositivo , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Doenças Vasculares/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior , Trombose Venosa/terapia , Adulto , Constrição Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Trombose Venosa/diagnóstico por imagem
12.
Medicine (Baltimore) ; 98(47): e17835, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764778

RESUMO

INTRODUCTION: An Inferior vena cava (IVC) filter is an intravascular filter that is implanted into the IVC to prevent pulmonary embolism in medical, surgical, and trauma patients. The insertion of an IVC filter is a relatively safe procedure, but rarely may be associated with symptomatic perforation of the IVC wall, particularly in the long term. PATIENT CONCERNS AND DIAGNOSIS: A 74-year-old-woman with a medical history of IVC filter insertion visited the emergency department complaining of abdominal pain. A computed tomography scan showed perforation of the IVC wall and penetration into the duodenum by one of the filter's struts. INTERVENTIONS: We performed a laparotomy to remove the IVC filter. OUTCOMES: Postoperatively, the patient was admitted to the general ward. On hospital day 12, she was discharged without any complications. We followed her up and computed tomography did not show any abnormal findings six months after discharge. LESSONS: There is currently no evidence testifying to the benefits of IVC filter removal. Detailed, evidence-based guidelines on the indications, timing and procedure for IVC filter removal are needed. Documenting cases of long-term complications of IVC filter s such as in this patient serve to accelerate the publication of updated guidelines and are aimed at improving outcomes of similar cases in the future.


Assuntos
Duodeno/lesões , Perfuração Intestinal/etiologia , Complicações Pós-Operatórias/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/lesões , Idoso , Remoção de Dispositivo , Duodeno/cirurgia , Feminino , Humanos , Perfuração Intestinal/cirurgia , Complicações Pós-Operatórias/cirurgia , Veia Cava Inferior/cirurgia
13.
Can Assoc Radiol J ; 70(4): 367-382, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31570169

RESUMO

Inferior vena cava filters are commonly encountered devices on diagnostic imaging that were highlighted in a 2010 Food and Drug Administration safety advisory regarding their complications from long-term implantation. The Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) trial is an ongoing after-market study investigating the safety and utility of commonly utilized filters in practice today. While most of these filters are safe, prompt recognition and management of any filter-associated complication is imperative to prevent or reduce the morbidity and mortality associated with them. This review is aimed at discussing the appropriate utilization and placement of inferior vena cava filters in addition to the recognition of filter-associated complications on cross-sectional imaging. An overview of the PRESRVE trial filters is also provided to understand each filter's propensity for specific complications.


Assuntos
Diagnóstico por Imagem , Hemorragia/etiologia , Filtros de Veia Cava , Veia Cava Inferior , Remoção de Dispositivo , Humanos , Vigilância de Produtos Comercializados , Desenho de Prótese , Filtros de Veia Cava/efeitos adversos
14.
J Radiol Case Rep ; 13(3): 19-27, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31565174

RESUMO

Spontaneous rupture of the inferior vena cava (IVC) is a rare entity. We report a case of a spontaneous IVC rupture associated with IVC filter thrombosis in a patient presenting with severe atraumatic back pain. Computed tomography (CT) identified a retroperitoneal hematoma and suggested IVC thrombosis. Magnetic resonance (MR) imaging confirmed the presence of IVC filter thrombosis and demonstrated a large defect in the infrarenal IVC, with the vessel lumen in free communication with the adjacent hematoma. The patient was managed conservatively and discharged in stable condition. MR imaging played an important role in characterizing the CT findings, which were unclear.


Assuntos
Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/terapia , Tratamento Conservador , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Ruptura Espontânea/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
16.
Ann Card Anaesth ; 22(3): 337-339, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274503

RESUMO

A patient presented to our institution for an elective removal of an inferior vena cava (IVC) filter under local anesthesia. Once removed, it was noticed that the filter had a missing secondary leg. The patient had a chest CT done which showed a hyper-attenuating structure in the region of the tricuspid valve highly suspicious for the fractured strut of the filter. Upon these findings, the patient was taken once again to the surgical suite for an endovascular retrieval of the strut. For fear of a possible cardiac injury and a potential need for a sternotomy, the patient received general anesthesia and was placed with appropriate IV access and full cardiac monitors. The strut was removed successfully without any complications. Despite the relative benign nature of this endovascular procedure, one should always be prepared for an appropriate resuscitation in case of an occurrence of a surgical complication.


Assuntos
Remoção de Dispositivo/efeitos adversos , Filtros de Veia Cava/efeitos adversos , Idoso , Anestesiologia , Procedimentos Endovasculares , Feminino , Humanos , Tomografia Computadorizada por Raios X , Valva Tricúspide
17.
AJR Am J Roentgenol ; 213(5): 1152-1156, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31216197

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the safety and technical feasibility of inferior vena cava filter (IVCF) removal when filter elements penetrate adjacent bowel. MATERIALS AND METHODS. A multicenter retrospective review of IVCF retrievals between 2008 and 2018 was performed. Adult patients with either CT or endoscopic evidence of filter elements penetrating bowel before retrieval were included. Technical success of IVCF retrieval was recorded. Patient records were assessed for immediate, 30-day, and 90-day complications after retrieval. RESULTS. Thirty-nine consecutive adult patients (11 men and 28 women; mean age, 51.2 years; age range, 18-81 years) qualified for inclusion. Filter dwell time was a median of 148 days (range, 32-5395 days). No IVCFs were known to have migrated or caused iliocaval thrombosis. Five IVCFs (12.8%) had more than 15° tilt relative to the inferior vena cava (IVC) before retrieval. Three IVCFs (7.7%) had fractured elements identified at the time of retrieval. Mean international normalized ratio (INR) was 1.24 ± 0.53 (SD), and mean platelet count was 262 ± 139 × 103/µL. Ten patients (25.6%) were on antibiotics at the time of retrieval. All 39 IVCFs were successfully retrieved (technical success = 100%). Two patients experienced minor complications in the immediate postprocedural period, which resulted in a minor complication rate of 5.1%. There were no complications (major or minor) identified in any patient at 30 or 90 days after retrieval. The overall major complication rate was 0%. CONCLUSION. Endovascular retrieval of IVCFs with CT evidence of filter elements that have penetrated adjacent bowel is both safe and technically feasible.


Assuntos
Remoção de Dispositivo/métodos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Filtros de Veia Cava/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal , Estudos de Viabilidade , Feminino , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
18.
Diagn Interv Radiol ; 25(3): 238-241, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063144

RESUMO

A 47-year-old male with a remote renal transplant due to pediatric glomerulonephritis on oral anticoagulation for symptomatic deep venous thrombosis and pulmonary emboli presented with sudden hip and groin pain. The patient was found to have a spinal epidural hematoma, underwent reversal of anticoagulation, and subsequently developed worsening renal function. Imaging revealed occlusive iliocaval venous thrombosis with extension to the renal allograft. Given risk of epidural hematoma expansion, the patient was deemed high risk for thrombolysis. The AngioVac system was used for single session thrombus removal. The patient's renal function improved and no focal neurologic sequelae was noted postprocedure. Six-month follow-up showed persistent vessel patency.


Assuntos
Hematoma Epidural Espinal/diagnóstico , Veia Ilíaca/patologia , Transplante de Rim/efeitos adversos , Trombectomia/instrumentação , Veia Cava Inferior/patologia , Aloenxertos/irrigação sanguínea , Aloenxertos/patologia , Hematoma Epidural Espinal/complicações , Humanos , Veia Ilíaca/diagnóstico por imagem , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Trombose/patologia , Trombose/cirurgia , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem
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