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1.
Khirurgiia (Mosk) ; (1): 90-92, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395518

RESUMO

We report a complex reconstruction of arteriovenous fistula (AVF). Proximal stenosis of cephalic vein was followed by aneurysms of fistulous veins (distal segment of cephalic vein and median cubital vein) complicated by AVF thrombosis. Blood outflow from AVF was retrograde. One week after thrombosis, an aneurysm of median cubital vein containing dense clots was excised. We resected cephalic vein wall and repaired the vessel. Anastomosis with the brachial artery was created distal to the last anastomosis. Proximal cephalic vein repair was performed using resected aneurysm walls. After a year, AVF has been successfully used for hemodialysis.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Diálise Renal , Doenças Vasculares/cirurgia , Veias/cirurgia , Aneurisma/etiologia , Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Artéria Braquial/diagnóstico por imagem , Humanos , Resultado do Tratamento , Doenças Vasculares/etiologia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/etiologia , Insuficiência Venosa/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
2.
Br J Radiol ; 94(1117): 20200415, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33245679

RESUMO

OBJECTIVE: To evaluate the use of transarterial chemoembolisation (TACE) combined with microwave ablation (MWA) to treat patients with hepatocellular carcinoma (HCC) and type Ⅱ-Ⅲ portal vein tumour thrombosis (PVTT) intolerant to targeted drug (TG) therapy. METHODS: A total of 18 patients with HCC and type Ⅱ-Ⅲ PVTT intolerant to TG were enrolled between June 2015 and December 2019, who were treated with TACE + MWA (MWA group). 24 patients were treated with TACE + TG (TG group; control cohort). Time to progression and overall survival (OS) were analysed along with the incidence of adverse events. RESULTS: The median follow-up time was 19.0 months (9.0-32.0 months). The median OS was 17.0 months (8.3-29.3 months; MWA group) and 13.5 months (5.5-22.5 months; TG group) and was not significantly different. The 1- and 2 year OS was also comparable (MWA group: 66.7%, 44.4% vs Target group: 41.7%, 29.2%). Time to progression showed no distinct differences (MWA group: 11.5 months; TG group: 9.0 months) between the two groups. Moreover, the incidence of major Grade 3-4 adverse events in the MWA group (5.6%) was similar to those in the TG group (8.3%). CONCLUSION: TACE + MWA and TACE + TG were comparable in their safety and efficacy in patients with HCC, type Ⅱ-Ⅲ PVTT, and intolerance to TG. ADVANCES IN KNOWLEDGE: TACE + MWA can be used as a palliative treatment alternative for TACE + TG in patients with HCC, type Ⅱ-Ⅲ PVTT, and intolerance to TG.


Assuntos
Técnicas de Ablação/métodos , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Veia Porta/patologia , Trombose Venosa/terapia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Fígado/cirurgia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
3.
Vasa ; 50(1): 74-77, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33291997

RESUMO

A 74-year-old woman presented with acute symptomatic left thigh and calf swelling; imaging demonstrated evidence of occlusive thrombosis from the upper left common iliac vein to the mid-thigh. Single session zero-thrombolysis venous thrombectomy was performed using the ReVeneTM Thrombectomy Catheter.


Assuntos
Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Trombectomia/métodos , Trombose Venosa/cirurgia , Idoso , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Qualidade de Vida , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem
4.
BMC Surg ; 20(1): 272, 2020 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-33160340

RESUMO

BACKGROUND: Metastatic germ cell cancer of the testis is characterized by favorable prognosis since effective treatment methods are available even in cases of extensive disease. Retroperitoneal masses frequently encroach major blood vessels requiring a vascular intervention usually performed in association with the post-chemotherapy retroperitoneal lymph node dissection (RPLND). Reported clinical case describes a successful pre-treatment endovascular surgery for abdominal aortic rupture allowing for full-dose systemic chemotherapy administration, and subsequent radical surgical intervention at primary tumor site as well as metastatic retroperitoneal lymph node dissection including the reconstruction of inferior caval vein. CASE PRESENTATION: Patient presented with left-sided testicular tumor and voluminous retroperitoneal mass with vascular involvement. Soon after the patient had been admitted for the first cycle of cisplatin-based chemotherapy, computed tomographic angiography (CTA) revealed a dorsal aortic wall rupture with active extravasation and irregular pseudoaneurysmatic dilatation of the aorta below the leak area. Retroperitoneal intratumoral hemorrhage associated with the bilateral iliac venous thrombosis required an endovascular repair procedure of infrarenal abdominal aorta. CONCLUSIONS: Following the successful endovascular aortic repair 3 cycles of BEP (bleomycin, etoposide, cisplatin) regimen were administered with subsequent delayed left radical orchiectomy and RPLND associated with vena cava inferior (VCI) resection. Reconstruction of VCI was originally not deemed necessary as collateral blood flow appeared sufficient, however, intraoperative complications resulted in the need for unilateral VCI reconstruction, using the interposed bypass between right common iliac vein and infrarenal segment of VCI. Histopathologic examination of the attained specimen detected no vital cancer structures. The patient remains disease-free 18 months after the RPLND.


Assuntos
Ruptura Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Hemorragia/cirurgia , Neoplasias Embrionárias de Células Germinativas , Neoplasias Retroperitoneais , Neoplasias Testiculares , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/patologia , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Angiografia por Tomografia Computadorizada , Etoposídeo/administração & dosagem , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Veia Ilíaca , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/secundário , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/tratamento farmacológico , Neoplasias Retroperitoneais/secundário , Neoplasias Retroperitoneais/cirurgia , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/tratamento farmacológico , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia
5.
Sci Rep ; 10(1): 15952, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32994455

RESUMO

To determine the prophylactic effect of using combined 1% alcoholic chlorhexidine gluconate and chlorhexidine gel-impregnated dressings (CGCD) on catheter-related thrombosis (CRT) in critically ill patients. This retrospective cohort study was performed in an intensive care unit from November 2009 to August 2014. The CRT incidence diagnosed with ultrasound examination was compared between patients applying CGCD and combined 10% aqueous povidone-iodine and standard transparent dressings (PITD) after central venous catheter insertion into the internal jugular vein for ≥ 48 h. CRT was stratified into early (within 7 days) and late (days 8-14) thromboses. Multivariate analyses using logistic regression models clarified the relationships between early- and late-CRT risks and skin antiseptic and catheter site dressing combinations. CRT occurred in 74 of 134 patients (55%), including 52 with early CRT and 22 with late CRT. Patients receiving CGCD had a significantly lower incidence of early CRT than those receiving PITD (odds ratio = 0.18; 95% confidence interval = 0.07-0.45, p < .001). No significant association was evident between using CGCD and late CRT (p = .514). Compared to PITD, CGCD reduced the CRT risk over 7 days in critically ill patients.UMIN Clinical Trials Registry: UMIN000037492.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Trombose Venosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais , Bandagens , Infecções Relacionadas a Cateter/etiologia , Cateteres Venosos Centrais/efeitos adversos , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Estudos de Coortes , Estado Terminal , Contaminação de Equipamentos/prevenção & controle , Feminino , Géis/uso terapêutico , Humanos , Unidades de Terapia Intensiva , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Povidona-Iodo/uso terapêutico , Procedimentos Cirúrgicos Profiláticos/métodos , Estudos Retrospectivos , Fatores de Risco
6.
Anticancer Res ; 40(10): 5837-5844, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988913

RESUMO

BACKGROUND/AIM: Renal cell carcinoma (RCC) is one of the most common malignancies of the urinary tract. Venous migration, tumor thrombus and metastases are often seen in patients with RCC and are adverse prognostic factors. Intravascular tumor growth along the renal vein into the inferior vena cava occurs in up to 10% of all patients with RCC. Furthermore, extension of the tumor reaching the right atrium is detected in approximately 1% of all patients. Synchronous involvement of pulmonary arteries with tumor emboli is very rare and challenging. Management of metastatic RCC includes surgical resection of renal and metastatic lesions. We present 3 cases of patients with RCC tumor thrombus extending into the inferior vena cava (IVC) and with pulmonary emboli of the tumor thrombus into one of the branches of the main pulmonary artery. All the cases had simultaneous resection of the kidney tumor with the tumor thrombus and pulmonary lobectomy that included the tumor emboli with satisfactory outcome. CASE REPORT: We present a series of cases of RCC with tumor extension into the inferior vena cava (IVC) and with tumor emboli to the pulmonary arteries. Surgical procedure in all cases consisted of radical nephrectomy with IVC tumor thrombus resection, along with a thoracotomy with lung resection including the tumor emboli to one of the branches of the main pulmonary artery. Synchronous metastatic lesions were found on the liver in one case and contiguous extension of renal tumor to the pancreas in another. CONCLUSION: In patients with IVC thrombus with synchronous pulmonary artery tumor embolus, such as the cases presented in this series, a careful multidisciplinary management approach is preferable. Transplant technique used in our open approach minimizes complications, blood loss, and provides excellent visualization for abdominal vascular manipulation of IVC. This provides a potentially curable treatment option with acceptable survival rates.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Pulmonares/cirurgia , Artéria Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Adulto , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Metástase Neoplásica , Células Neoplásicas Circulantes/metabolismo , Células Neoplásicas Circulantes/patologia , Nefrectomia/métodos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Veias Renais/cirurgia , Trombose/diagnóstico por imagem , Trombose/patologia , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia , Trombose Venosa/cirurgia
8.
Am Surg ; 86(8): 1005-1009, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32997953

RESUMO

INTRODUCTION: Interteam performance and Clavien-Dindo (C-D) complications in renal cell carcinoma with inferior vena cava thrombectomy (RCC-IVCT) have not been reported. We aimed to describe complications by the degree of complexity and surgical teams in a collaborative effort between a National Cancer Institute-designated Comprehensive Cancer Center and a Quaternary Care Teaching Hospital. METHODS: Between January 2011 and May 2019, 73 consecutive RCC-IVCT were included. C-D grades III or higher were captured. Teams involved were urologic-oncology, vascular, hepatobiliary/transplant, and cardiothoracic. The Mayo Clinic tumor thrombus classification was used. RESULTS: Overall complication rate was 42% (n = 31). Nineteen percent had grade III, 18% had grade IV, and 6% had grade V complications. Patients with level IV thrombus had the highest in-hospital mortality rate (75%). Thrombus level did not show a correlation to complication rates (14% level I, 45% level II, 32% level III, 42% level IV). A positive correlation found between the number of teams involved and complication rates (35% with 2-team, 59% with 3-team, P = .059). Thromboembolic events (6% vs 24%, P = .02) and disposition other than home (22% vs 48%, P = .01) were statistically lower for the 2-team groups. Two-team in-hospital mortality was 1/51 (2%) versus 3-team (3/22,14%, (P = .07). No statistical differences were found in infections, thromboembolic events, and grades of complications between surgical teams. CONCLUSIONS: Despite similar interteam performance, the consistency of surgeons in high complexity cases could improve outcomes further. Complexity was higher for hepatobiliary/transplant and cardiothoracic teams. A combination of intraoperative events and patient selection (comorbidities and age) contributed to death. Overall, in-hospital mortality was lower than in most reported series.


Assuntos
Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Equipe de Assistência ao Paciente , Trombectomia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Adulto , Idoso , Institutos de Câncer , Florida , Mortalidade Hospitalar , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/etiologia
9.
Chirurgia (Bucur) ; 115(4): 505-510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876024

RESUMO

Introduction: Spermatic vein thrombosis is a rare entity with poor clinical distinctive signs for the differential diagnosis, which raises numerous controversies about the appropriate management. Case report: A 55 years old man presents at the emergency room for left scrotal pain and swelling evolving for two weeks. The patient denied any recent local traumatic event. Physical examination revealed an approximately 15 to 20 cm length mass from the posterior scrotum to the external inguinal orifice. The other genitals had a healthy appearance at the moment of the examination. An incarcerated hernia couldn't be excluded. The Doppler ultrasound evaluation of the scrotum con firmed the suspicion of left testicular vein thrombosis with complete cessation of blood flow. Both testicles appeared to have regular blood flow. CT scan established that the thrombus extended up to the left external inguinal orifice. Surgical treatment was preferred to address an eventually incarcerated hernia. The left testicular vein was excised from the external orifice. Postoperative management consisted of apixaban for 30 days, and the cardiology department thus conducted the treatment. Conclusions: Doppler ultrasound evaluation of the scrotum represents the gold standard diagnostic test for spermatic vein thrombosis. There are still controversies about the management approach of this pathology, conservative or surgical.


Assuntos
Doenças Testiculares/diagnóstico por imagem , Testículo/irrigação sanguínea , Trombose Venosa/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Escroto/irrigação sanguínea , Escroto/diagnóstico por imagem , Doenças Testiculares/diagnóstico , Doenças Testiculares/cirurgia , Testículo/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Doppler , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/cirurgia
10.
BMC Surg ; 20(1): 185, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32792015

RESUMO

BACKGROUND: We aimed to explore the causal analysis, clinical characteristics and treatment strategies of laparoscopic conversion to open approach (LCTOA) in radical nephrectomy and tumor thrombectomy. METHODS: We included all patients with Mayo level I-III renal tumors with inferior vena cava (IVC) tumor thrombus who underwent laparoscopic radical nephrectomy and tumor thrombectomy as the first choice from May 2015 to July 2019. RESULTS: There were 70 cases of renal tumor with IVC tumor thrombus treated with a laparoscopic approach as the first choice; 31 Mayo level I, 30 Mayo level II, and 9 Mayo level III. A completely laparoscopic approach was performed in 51 cases (72.9%), and 19 cases (27.1%) underwent active or passive LCTOA. The LCTOA group had higher median preoperative serum creatinine (110.0 µmol/L vs 92.0 µmol/L; P = 0.026), longer postoperative hospital stay (9 days vs 7 days; P = 0.008), longer median operation time (374 min vs 311 min; P = 0.017), higher median intraoperative hemorrhage volume (1300 vs 600 ml; P = 0.020), and higher proportion of male patients (94.7% vs 66.7%; P = 0.016) vs the completely laparoscopic group, respectively. Although preoperative serum creatinine and gender were risk factors in the univariate analysis, multivariate analysis revealed no independent risk factors for LCTOA. We divided the reasons for LCTOA into active conversion and passive conversion; 4 (21.1%) cases underwent active conversion, and 15 (78.9%) underwent passive conversion. Most of the patients undergoing passive conversion had multiple concurrent risk factors, among which perirenal adhesion (30.9%), organ invasion (16.4%), and IVC adhesion (25.5%) were the most common. Fourteen (73.7%) cases underwent renal treatment, and 5 (26.3%) cases underwent tumor thrombus treatment. CONCLUSIONS: The LCTOA group had a higher median preoperative serum creatinine concentration, longer hospital stay, longer median operation time, and higher median intraoperative hemorrhage volume. However, none of the predictors in our study was an independent risk factor for LCTOA. Perirenal adhesion, organ invasion, and IVC adhesion were the most common causes of LCTOA. Considering the limitations of this study, studies with large sample sizes are required to validate our conclusions.


Assuntos
Carcinoma de Células Renais , Conversão para Cirurgia Aberta , Neoplasias Renais , Nefrectomia/métodos , Trombectomia/métodos , Neoplasias Vasculares/cirurgia , Idoso , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Vasculares/complicações , Neoplasias Vasculares/secundário , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
11.
BMC Surg ; 20(1): 174, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738882

RESUMO

BACKGROUND: Portal vein tumor thrombus (PVTT) is common in hepatocellular carcinoma (HCC). Recent studies indicate that more aggressive treatments, including surgical resection or locoregional treatment, may benefit selected HCC patients with PVTT. External radiation therapy and infusion chemotherapy were found to achieve good outcomes; however, the use of low-energy x-ray radiation system (INTRABEAM), intraoperative radiation therapy, and portal vein infusion chemotherapy for PVTT has not been reported. We present a case of HCC with PVTT. The patient underwent hemihepatectomy and thrombectomy along with intraoperative radiotherapy (IORT) using a portable INTRABEAM radiation system. Subsequently, to treat PVTT, portal vein infusion chemotherapy with FOLFOX (leucovorin [Folinic acid], fluorouracil, and oxaliplatin) regimen was administered. There were no obvious post-operative complications. After 20 months follow-up period, no obvious tumor recurrence had been observed, and PVTT gradually disappeared completely. CONCLUSIONS: IORT using the INTRABEAM radiation system combined with portal vein infusion chemotherapy is promising for select patients with PVTT.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Veia Porta , Trombose Venosa/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/terapia , Terapia Combinada , Fluoruracila/uso terapêutico , Hepatectomia , Humanos , Cuidados Intraoperatórios , Leucovorina/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/terapia , Masculino , Compostos Organoplatínicos/uso terapêutico , Radioterapia Adjuvante , Estudos Retrospectivos , Trombectomia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/radioterapia , Trombose Venosa/cirurgia
13.
JAMA Netw Open ; 3(7): e2011079, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32701160

RESUMO

Importance: Venous thromboembolism is the second overall leading cause of death for patients with cancer, and there is an approximately 2-fold increase in fatal pulmonary embolism (PE) in patients with cancer. Inferior vena cava (IVC) filters are designed to prevent PE, but defining the appropriate use of IVC filters in patients with cancer remains a substantial unmet clinical need. Objective: To evaluate the association of IVC filters with the development of PE in patients with cancer and deep venous thrombosis (DVT). Design, Setting, and Participants: A population-based cohort study was conducted using administrative data on 88 585 patients from the state inpatient databases for California (2005-2011) and Florida (2005-2014). Based on diagnostic and procedure codes, patients with cancer and acute lower extremity DVT were identified. All subsequent hospital visits for these patients were evaluated for the placement of an IVC filter, the development of new PE, the development of new DVT, and in-hospital mortality. Data analysis was performed from September 1 to December 1, 2019. Exposures: Placement of an IVC filter. Main Outcomes and Measures: The association of IVC filter placement with rates of new PE and DVT was estimated using a propensity score matching algorithm and competing risk analysis. Results: The study cohort comprised 88 585 patients (45 074 male; median age, 71.0 years [range, 1.0-104.0 years]) with malignant neoplasms who presented to a health care institution with a diagnosis of acute lower extremity DVT. Of these patients, 33 740 (38.1%) underwent IVC filter placement; patients with risk factors such as upper gastrointestinal bleeding (odds ratio, 1.32; 95% CI, 1.29-1.37), intracranial hemorrhage (odds ratio, 1.21; 95% CI, 1.19-1.24), and coagulopathy (odds ratio, 1.09; 95% CI, 1.08-1.10) were more likely to receive an IVC filter. A total of 4492 patients (5.1%) developed a new PE after their initial DVT diagnosis. There was a significant improvement in PE-free survival for these patients compared with those who did not receive IVC filters across the full, unbalanced study cohort as well as after propensity score matching and competing risk analysis (hazard ratio, 0.69; 95% CI, 0.64-0.75; P < .001). Furthermore, IVC filter placement reduced the development of PE in patients with very high-risk malignant neoplasms (eg, pancreaticobiliary cancer), high-risk malignant neoplasms (eg, lung cancer), and low-risk malignant neoplasms (eg, prostate cancer). After accounting for anticoagulation use and imbalanced risk factors, IVC filter placement did not increase the risk of new DVT development. Conclusions and Relevance: This study suggests that, for patients with cancer and DVT and bleeding risk factors, IVC filter placement is associated with an increased rate of PE-free survival.


Assuntos
Neoplasias/complicações , Trombose Venosa/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Razão de Chances , Embolia Pulmonar/epidemiologia , Fatores de Risco , Resultado do Tratamento , Filtros de Veia Cava , Trombose Venosa/etiologia
14.
Vasc Endovascular Surg ; 54(7): 646-649, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32638640

RESUMO

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic multisystem inflammatory condition with associated endothelial dysfunction and dysregulated coagulation. Although deep venous thrombosis (DVT) in IBD has been well described, arterial thrombosis and thromboembolism are less commonly appreciated. METHODS: A 63-year-old male with a known history of Crohn disease presented with acute-onset right arm pain. His past vascular history was significant for left lower extremity DVT with an existing inferior vena cava filter and acute ischemia of the right lower extremity requiring a below-knee amputation a year ago. Imaging revealed acute brachial, ulnar, and radial artery thrombosis. RESULTS: Patient underwent an open right brachial, radial, and ulnar thrombectomy to restore vascular flow. He required multiple exploration and thrombectomy for reocclusion of the vessels in the early postoperative period. He later developed a rapidly deteriorating clinical status, flank ecchymosis and swelling concerning for soft tissue ischemia, and compartment syndrome heralding an eventual hemodynamic collapse. On exploration, he was found to have chronic fibrosis of his left femoral vein and femoral artery occlusion. Clinically, the patient deteriorated rapidly, which resulted in his demise. CONCLUSION: The inflammatory reaction in IBD leads to arterial stiffening and hypercoagulability, which should theoretically increase the risk for vascular disease. Although the link between IBD and DVT is well established, arterial thrombosis and thromboembolism remain widely debated, with some implications for therapeutic intervention. The link between vascular thrombosis and IBD must be examined further, as the treatment and prevention of vascular complications in IBD depends on our understanding of this relationship.


Assuntos
Arteriopatias Oclusivas/etiologia , Doença de Crohn/complicações , Artéria Femoral , Veia Femoral , Extremidade Inferior/irrigação sanguínea , Extremidade Superior/irrigação sanguínea , Trombose Venosa/etiologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/cirurgia , Doença de Crohn/diagnóstico , Evolução Fatal , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Artéria Femoral/cirurgia , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Veia Femoral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Trombectomia , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Trombose Venosa/cirurgia
15.
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
16.
PLoS One ; 15(6): e0235003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555683

RESUMO

INTRODUCTION: Deep vein thrombosis (DVT) is a frequent burden and a post-thrombotic syndrome (PTS) can be a serious long-term consequence. Iliofemoral DVT should be associated with severe forms of PTS. Therefore an early thrombus removal has been recommended in specific conditions. The aim of this study was to find out both, the long-term results after surgical thrombectomy of iliofemoral DVT in respect of the development of PTS as well as the venous hemodynamics after surgery concerning venous reflux and venous obstruction. METHODS: Sixty-seven patients who underwent surgical thrombectomy between the years 2000 and 2014 were included in this study; iliofemoral DVT was present in 52 of these patients. 35 patients could be reinvestigated after a mean follow-up of 8.5 years. CEAP (Clinical-Etiological-Anatomical-Pathophysiological) and Villalta scores were recorded in order to describe and assess PTS. Follow-up examinations included a detailed duplex mapping. Venous hemodynamics were measured by digital photoplethysmography and venous occlusion plethysmography. RESULTS: The primary patency rate of the iliofemoral segment was 88% after 8.5 years. 48% of all patients showed reflux in deep vein segments. Mild or moderate PTS occurred in 57% of all patients. Notably, there was no patient with an active ulcer or severe PTS. The mean venous outflow volume of all patients in the treated legs was 66.1 ml/100ml/min and significantly less than in the controlled contralateral non-treated legs (p<0.05). The mean venous refilling time was 16.3 seconds, while the mean value of the non-treated contralateral legs was 25.6 seconds and therefore significantly higher (p<0.05). CONCLUSION: Even though venous hemodynamics are significantly inferior in the treated legs, this study demonstrates excellent patency rates and good clinical outcome after surgical thrombectomy of iliofemoral veins.


Assuntos
Veia Femoral/cirurgia , Trombectomia/métodos , Trombose Venosa/cirurgia , Feminino , Veia Femoral/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/complicações
17.
J Orthop Trauma ; 34(8): 389-394, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32427809

RESUMO

Mounting evidence suggests that the pathogenesis of coronavirus disease 2019 (COVID-19) involves a hyperinflammatory response predisposing patients to thromboembolic disease and acute respiratory distress. In the setting of severe blunt trauma, damaged tissues induce a local and systemic inflammatory response through similar pathways to COVID-19. As such, patients with COVID-19 sustaining orthopaedic trauma injuries may have an amplified response to the traumatic insult because of their baseline hyperinflammatory and hypercoagulable states. These patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. In this article, we review the current evidence regarding pathogenesis of COVID-19 and its implications on the management of orthopaedic trauma patients by discussing a case and the most recent literature. LEVEL OF EVIDENCE:: Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Infecções por Coronavirus/complicações , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Controle de Infecções/métodos , Pneumonia Viral/complicações , Trombose Venosa/cirurgia , Idoso de 80 Anos ou mais , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Procedimentos Ortopédicos/métodos , Pandemias , Segurança do Paciente , Pneumonia Viral/diagnóstico , Medição de Risco , Trombectomia/métodos , Resultado do Tratamento , Trombose Venosa/diagnóstico
18.
Anticancer Res ; 40(5): 2889-2893, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366439

RESUMO

BACKGROUND/AIM: Thrombosis internal jugular vein (IJV) with cervical adenopathy, as first manifestation of gastric cancer is rare. We aimed to compare resection of the cervical mass followed by gastrectomy with gastrectomy alone. PATIENTS AND METHODS: Nine patients presenting thrombosis of the IJV for gastric carcinoma were divided into two groups. Patients in group A (n=3) underwent anticoagulation treatment, gastrectomy and adjuvant treatment. Patients in group B (n=6) underwent resection of the cervical mass and internal jugular vein (radical neck dissection), and then gastrectomy and adjuvant treatment. RESULTS: Median survival was 15.3 months in group A (range=11-19 months) and 31.2 months in group B (range=7-44 months) (p=0.11). Late cervical recurrence/complications occurred in 2 patients in group A and none in group B (p=0.02). CONCLUSION: Resection of thrombosed IJV and satellite lymph nodes, due to a primary gastric cancer may contribute to diagnosis of the disease, limit pulmonary embolic complications and improve quality of life.


Assuntos
Veias Jugulares/patologia , Linfonodos/cirurgia , Neoplasias Gástricas/complicações , Trombose Venosa/cirurgia , Feminino , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
19.
J Card Surg ; 35(6): 1380-1382, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353896

RESUMO

Intravascular tumor extension in the inferior vena cava (IVC) is known to occur with abdominal tumors, such as renal cell, hepatocellular, adrenal cell carcinoma, and Wilm's tumor. We encountered a 53-year-old male patient presenting with pulmonary embolism and a right atrial mass with imaging evidence of an adrenal tumor extending into the IVC, up to the right atrium. The patient underwent surgery for the resection of the tumor using cardiopulmonary bypass by a team of cardiothoracic surgeons and urologists. Histology identified the tumor as hepatocellular carcinoma, which developed as ectopic hepatic tissue in the right adrenal gland.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Hepatocelular/cirurgia , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/cirurgia , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Carcinoma Hepatocelular/patologia , Ponte Cardiopulmonar , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Veia Cava Inferior/patologia , Trombose Venosa/etiologia , Trombose Venosa/patologia
20.
Transplant Proc ; 52(6): 1802-1806, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32448668

RESUMO

BACKGROUND: Portal vein (PV) reconstruction is an important surgical skill for living donor liver transplantation (LDLT), especially for patients with portal vein thrombosis (PVT). However, this technique remains a critical problem in LDLT because of technical demands and requirements for appropriate venous graft harvesting. This study aimed to evaluate the surgical procedure used for PV reconstruction and outcomes in LDLT recipients with PVT. METHODS: Between March 2002 and December 2018, 128 adult LDLTs were performed. Fourteen recipients (10.8%) had PVT at the time of LDLT, classified as grade I in 2, grade II in 5, grade III in 6, and grade IV in 1, according to the Yerdel classification. We retrospectively analyzed the surgical procedure and postoperative complications associated with PV reconstruction of recipients with PVT. RESULTS: Surgical treatments for 14 recipients with PVT were as follows: thrombectomies in 2 recipients, replacement of interpositional venous grafts using the internal jugular vein (IJV) in 3 recipients and the external iliac vein (EIV) in 6 recipients, mesoportal jump grafts using the IJV in 1 recipient and the IJV + EIV in 1 recipient, and renoportal anastomosis using the EIV in 1 recipient. Among interpositional venous grafts, 5 venous grafts (IJV: 2, EIV: 3) passed the dorsal side of the pancreas without using the jump graft. Postoperative complications associated with PV anastomosis occurred in 1 of 14 (7.1%) recipients, who developed anastomosis bleeding caused by coagulation disorders at 27 days after LDLT, without any strictures of PV anastomoses. The overall survival rate at 5 years posttransplant was not statistically different between recipients with and without PVT (50.0% vs 65.0%, P = .163). CONCLUSION: Our techniques of PV reconstruction, using the appropriate venous grafts and route, are feasible, resulting in a prognosis comparable to that of recipients without PVT.


Assuntos
Hepatopatias/cirurgia , Transplante de Fígado/métodos , Veia Porta/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Enxerto Vascular/métodos , Trombose Venosa/cirurgia , Adulto , Anastomose Cirúrgica , Estudos de Viabilidade , Feminino , Humanos , Veia Ilíaca/transplante , Veias Jugulares/transplante , Hepatopatias/complicações , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Trombectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Resultado do Tratamento , Trombose Venosa/complicações , Adulto Jovem
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