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2.
BMC Cancer ; 21(1): 1020, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521375

RESUMO

BACKGROUND: There is currently no widely-accepted consensus for the management of hepatocellular carcinoma with portal vein tumor thrombus. We evaluate the safety and efficacy of ultrasound-guided percutaneous brachytherapy with iodine-125 seeds for the treatment of hepatocellular carcinoma with portal vein-branch tumor thrombus (PVBTT). METHODS: Sixty-nine hepatocellular carcinoma patients with PVBTT were enrolled; 34 received transarterial chemoembolization (TACE) combined with iodine-125 seeds implanted in the PVBTT; 35 were treated with TACE alone. Adverse events, objective response rate, disease control rate, progression-free survival, and overall survival were compared between the two groups. Tumor responses of PVBTT and intrahepatic tumor were correlated. Multivariate and subgroup analyses were conducted for overall survival. RESULTS: No grade 3 or 4 adverse events were recorded, and there was no difference in grade 1 or 2 adverse events between the two groups. Objective response rate and disease control rate for PVBTT were 58.9 and 91.2%, respectively, in the combined treatment group, which were significantly greater than the 5.7 and 54.3% rates, respectively, in the TACE-alone group (both p's ≤ 0.001). Intrahepatic tumor response was positively correlated with the PVBTT response (γ = 0.782, p < 0.01). Survival outcomes were better in the combined treatment group than in the TACE-alone group: the median progression-free survival for PVBTT was 9 months versus 3 months (HR = 0.187 [95% CI: 0.101, 0.345], p < 0.001), and the median overall survival was 11 months versus 7 months (HR = 0.448 [95% CI: 0.265, 0.758], p = 0.003). Multivariate analysis revealed that application of brachytherapy and lower grade PVBTT (Vp1 + Vp2 vs. Vp3) were protective predictors of overall survival. In stratified analysis, the benefit of overall survival was more significant in the subgroup of PVBTT Vp1 + Vp2 rather than in Vp3. CONCLUSIONS: The combination of iodine-125 seed brachytherapy guided by ultrasound and TACE is a convenient, safe, and effective treatment for patients with HCC and PVBTT, conferring a better survival benefit than TACE alone.


Assuntos
Braquiterapia/métodos , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Hepáticas/terapia , Veia Porta , Trombose Venosa/terapia , Braquiterapia/efeitos adversos , Braquiterapia/instrumentação , Braquiterapia/mortalidade , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/mortalidade , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Humanos , Radioisótopos do Iodo/efeitos adversos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade
3.
BMJ Case Rep ; 14(9)2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544722

RESUMO

A 63-year-old diabetic woman presented to the outpatient clinic with a 1-week history of abdominal pain. On complete evaluation, she was diagnosed to have essential thrombocythemia. Abdominal imaging revealed portal vein thrombosis with a large splenic infarct. The patient was started on anticoagulant, antiplatelet and cytoreductive therapy. In view of persistent high platelet count, plasma apheresis was done, following which the patient's platelet counts were reduced. Essential thrombocythemia has a high rate of complications, resulting in significant morbidity and mortality. Few cases of this disease and its treatment have been described in the literature, especially pertaining to the Indian scenario. Further studies are needed to establish a multidisciplinary algorithm for its diagnosis and to elucidate the guidelines for the successful treatment of the condition.


Assuntos
Infarto do Baço , Trombocitemia Essencial , Trombose Venosa , Feminino , Humanos , Pessoa de Meia-Idade , Contagem de Plaquetas , Veia Porta/diagnóstico por imagem , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Infarto do Baço/terapia , Veia Esplênica , Trombocitemia Essencial/complicações , Trombocitemia Essencial/terapia , Trombose Venosa/terapia
4.
Angiol Sosud Khir ; 27(3): 147-152, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528599

RESUMO

Presented in this article is a clinical case report regarding treatment of a patient with deep vein thrombosis complicated by venous gangrene having developed 10 days after the onset of the disease. Conservative therapy (infusion of colloids and crystalloids, anticoagulants, agents improving microcirculation, venotonics, nonsteroidal anti-inflammatory drugs, elevated position of the limb) made it possible to stabilize the patient's condition, but not improving haemodynamics of the affected limb. A decision was made to use endovascular techniques. Treatment was carried out in three stages. The first stage during 48 hours consisted in regional catheter thrombolysis with urokinase, exerting a minimal clinical effect. The second stage was percutaneous mechanical thrombectomy after which the diameter of thrombosed veins became free by half, with the beginning of disease regression. The third stage consisted in venous stenting of residual stenosis of the iliac vein, resulting in normalization of the venous outflow from the affected limb. A conclusion was drawn on feasibility of combined use of regional thrombolysis, percutaneous mechanical thrombectomy, and venous stenting in treatment of venous gangrene.


Assuntos
Gangrena , Trombose Venosa , Gangrena/diagnóstico , Gangrena/etiologia , Humanos , Veia Ilíaca , Stents , Trombectomia , Terapia Trombolítica , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/terapia
5.
Radiology ; 301(1): 242-246, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34543144

RESUMO

History A 50-year-old woman presented to the emergency department of our hospital with a 2-day history of lower limb pain associated with unusual asthenia and diffuse arthralgia over the past 3 weeks. She was a native of Guinea and had lived in France for most of her life, working as a personal care assistant. Her only medical history of note was an occurrence of fetal death at 12 weeks gestation when she was 35 years old. She had bilateral lower limb swelling, without changes in skin temperature or color. All proximal and distal arterial pulses were felt. General physical examination findings were otherwise unremarkable. Her laboratory tests showed a decreased hemoglobin concentration of 8.9 g/dL (normal range, 12-16 g/dL), a decreased platelet count of 45 × 109/L (normal range, [150-400] × 109/L), a C-reactive protein level of 158 mg/L (normal range, <5 mg/L), and a d-dimer level of 2000 mg/L (normal range, <500 mg/L]). Compression US of the lower limbs revealed bilateral calf vein thrombosis involving the fibular and posterior tibial veins. Curative anticoagulation using low-molecular-weight heparin (enoxaparin, subcutaneous injection of 100 units per kilogram of body weight twice a day) was started. The day after the start of anticoagulation therapy, the patient reported dyspnea and acute chest and abdominal pain. Her vital signs were assessed, and she had elevated blood pressure and increased heart rate and respiratory rate, but she remained afebrile. Her cardiac auscultation was unremarkable, besides tachycardia. Skin examination revealed small areas of necrosis on the fingertips of her right hand. Laboratory studies were repeated and showed an increase in serum creatinine level from a baseline value of 0.49 mg/dL to a new value of 1.01 mg/dL (normal range, 0.6-1.1 mg/dL), an apparition of low-grade proteinuria of 0.43 g per day (normal range, <0.3 g/ day), and a high serum troponin level of 1066 ng/L (normal range, <14 ng/L), whereas electrocardiography showed no ST segment modification and echocardiography revealed a moderately altered left ventricular ejection fraction (45%). There was no coronary occlusion seen at emergency coronarography. Contrast-enhanced CT of the chest, abdomen, and pelvis was performed (Figs 1, 2) together with cardiac MRI (Figs 3, 4).


Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/terapia , Aspirina/uso terapêutico , Enoxaparina/uso terapêutico , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Troca Plasmática/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Trombose Venosa/terapia
6.
J Stroke Cerebrovasc Dis ; 30(9): 105954, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217069

RESUMO

OBJECTIVES: An isolated intraventricular cerebral varix is a rare entity. Although it is generally asymptomatic, there have been reports of symptomatic cases. Here, we report a case of right hemiplegia and aphasia due to venous infarction caused by thrombosis of the intraventricular varix. CASE PRESENTATION: A 79-year-old woman presented with right-sided hemiplegia and aphasia accompanied by conjugate eye deviation to the left. She had a history of hypertension, dyslipidemia, and asymptomatic isolated cerebral varix located in the left lateral ventricle. Blood analysis indicated no abnormalities in coagulation or fibrinolysis. Plain head computed tomography showed an intraventricular varix in the form of a high-density mass, indicating acute phase thrombosis, and contrast-enhanced computed tomography depicted a filling defect in the varix. In addition, fluid-attenuated inversion recovery imaging showed hyperintense lesions in the deep white matter of the frontal-parietal lobe, indicating venous infarction due to occlusion of the varix of the thalamostriate vein. Glycerol and prophylactic levetiracetam were administered, and she was transferred to another hospital for rehabilitation 23 days after treatment initiation. CONCLUSION: This is the first reported case in which a typically asymptomatic condition, intraventricular cerebral varix, caused venous infarction due to thrombosis and occlusion of the varix of the thalamostriate vein. Careful selection of the treatment strategy is required on a case-by-case basis because an intraventricular varix can cause both bleeding and infarction, which are treated differently.


Assuntos
Infarto Cerebral/etiologia , Trombose Intracraniana/etiologia , Varizes/complicações , Trombose Venosa/etiologia , Idoso , Afasia/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Feminino , Hemiplegia/etiologia , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/terapia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
7.
Eur J Vasc Endovasc Surg ; 62(2): 241-249, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210599

RESUMO

OBJECTIVE: Management and outcomes of superficial vein thrombosis (SVT) are highly variable and not well described. Therefore, the INvestigating SIGnificant Health TrendS in the management of SVT (INSIGHTS-SVT) study collected prospective data under real life conditions. METHODS: Prospective observational study of objectively confirmed acute isolated SVT. The primary outcome was a composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), and extension or recurrence of SVT at three months. The primary safety outcome was clinically relevant bleeding. RESULTS: A total of 1 150 patients were included (mean age 60.2 ± 14.7 years; 64.9% women; mean BMI 29.4 ± 6.3 kg/m2). SVT was below the knee in 54.5%, above the knee in 26.7%, above and below the knee in 18.8%. At baseline, 93.6% received pharmacological treatment (65.7% fondaparinux, 23.2% heparins, 4.3% direct oral anticoagulants [DOACs], 14.5% analgesics), 77.0% compression treatment, and 1.9% surgery; 6.4% did not receive any anticoagulation. The primary outcome occurred in 5.8%; 4.7% had recurrent or extended SVT, 1.7% DVT, and 0.8% PE. Clinically relevant non-major bleeding occurred in 1.2% and major bleeding in 0.3%. Complete clinical recovery of SVT was reported in 708 patients (62.4%). Primary outcome adjusted by propensity score and for treatment duration was lower with fondaparinux compared with low molecular weight heparin (4.4% vs. 9.6%; hazard ratio [HR] 0.51; 95% confidence interval [CI] 0.3 - 0.9; p = .017). On multivariable analysis, associated factors for primary outcome included another SVT prior to the present SVT event (HR 2.3), age per year (HR 0.97), duration of drug treatment per week (HR 0.92), and thrombus length (HR 1.03). CONCLUSION: At three month follow up, patients with isolated SVT are at risk of thromboembolic complications (mainly recurrent or extended SVT), despite anticoagulation. In this real life study, about one third had received either heparins, oral anticoagulants, or no anticoagulation.


Assuntos
Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Fondaparinux/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose Venosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Feminino , Fondaparinux/efeitos adversos , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Úlcera da Perna/complicações , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/etiologia , Recidiva , Fatores de Risco , Meias de Compressão , Resultado do Tratamento , Varizes/complicações , Insuficiência Venosa/complicações , Trombose Venosa/etiologia
8.
J Neurol Sci ; 427: 117532, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34134058

RESUMO

BACKGROUND: Vaccine induced immune mediated thrombocytopenia or VITT, is a recent and rare phenomenon of thrombosis with thrombocytopenia, frequently including cerebral venous thromboses (CVT), that has been described following vaccination with adenovirus vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2·S Johnson and Johnson (Janssen/J&J). The evaluation and management of suspected cases of CVT post COVID-19 vaccination are critical skills for a broad range of healthcare providers. METHODS: A collaborative comprehensive review of literature was conducted among a global group of expert neurologists and hematologists. FINDINGS: Strategies for rapid evaluation and treatment of the CVT in the context of possible VITT exist, including inflammatory marker measurements, PF4 assays, and non-heparin anticoagulation.


Assuntos
COVID-19 , Trombose Venosa , Vacinas contra COVID-19 , Humanos , SARS-CoV-2 , Vacinação/efeitos adversos , Trombose Venosa/terapia
9.
Chest ; 159(6): e361-e364, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34099150

RESUMO

Research on COVID-19, the cause of a rapidly worsening pandemic, has led to the observation of laboratory derangements such as a propensity towards a hypercoagulable state. However, there are currently no reports on the incidence of pulmonary venous thrombosis in the setting of COVID-19. We report a case in which follow-up chest CT scans revealed an expansile filling defect in a branch of the right inferior pulmonary vein, which is consistent with pulmonary venous thrombosis. Our objective was to provide insight into an uncommon sequela of COVID-19 and consequently garner increased clinical suspicion for pulmonary VTE during hospitalization.


Assuntos
COVID-19/complicações , Veias Pulmonares , Trombose Venosa/diagnóstico , Trombose Venosa/virologia , Adulto , COVID-19/diagnóstico , COVID-19/terapia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Trombose Venosa/terapia
11.
BMJ Open Qual ; 10(2)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34117006

RESUMO

Deep vein thrombosis (DVT) is an acute medical condition that requires urgent diagnosis and treatment to prevent significant morbidity and mortality. Patients with DVT frequently present to the emergency department (ED) because the necessary diagnostic investigations and medical treatment for successful outpatient management are not readily accessible in the outpatient clinics. A collaborative quality improvement project was undertaken to implement and evaluate a standardised outpatient treatment pathway designed to direct patients with a newly diagnosed DVT from the ultrasound department to the thrombosis clinic, where guideline-based management for DVT can be accomplished without ED visits. During the baseline period (1 February 2017 to 31 January 2019), the number of ED visits for DVT was 383 with an average of 16 visits per month. During the intervention period (1 February 2019 to 31 January 2020), the number of ED visits for DVT was 106 with an average of 8.8 visits per month. This represents almost a 50% reduction in the average ED visits during the intervention period. A standardised outpatient treatment pathway can significantly reduce the number of ED visits in patients with DVT, potentially improving patient care and reducing ED overcrowding.


Assuntos
Pacientes Ambulatoriais , Trombose Venosa , Assistência Ambulatorial , Serviço Hospitalar de Emergência , Humanos , Ultrassonografia , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Trombose Venosa/terapia
12.
J Dig Dis ; 22(8): 496-502, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34189839

RESUMO

OBJECTIVE: In this study we aimed to compare patient outcomes between the use of transarterial radioembolization (TARE) and sorafenib in patients with hepatocellular carcinoma (HCC) and intrahepatic portal vein tumor thrombosis (PVTT). METHODS: A total of 65 patients with HCC and intrahepatic PVTT treated in five Italian hospitals between 2012 and 2018 were included in the analysis. Those with any previous treatment, extension of PVTT to the main portal tract and extrahepatic involvement were excluded. Propensity score matching analysis and Bayesian model averaging analysis were performed. RESULTS: Of the 41 patients treated with TARE and 24 with sorafenib, 11 patients were downstaged to curative-intent surgery (liver transplant in three and hepatectomy in eight), including 10 treated with TARE and one with sorafenib. TARE was more effective than sorafenib in downstaging patients to surgery, achieving a mean survival of 54 months. In the 54 patients without downstaging after treatment, of whom 31 were treated with TARE and 23 with sorafenib, median survival was 20.3 and 9.1 months, respectively (P = 0.001), with different 1-, 2- and 3-year OS rates (64.5%, 42.6% and 37.3% vs 39.1%, 13.0% and 0%). Both propensity score and Bayesian model averaging confirmed an improvement in overall survival in the TARE group compared with sorafenib treatment. CONCLUSIONS: TARE was more effective than sorafenib in downstaging patients with HCC to surgery, providing a significant improvement in survival. Even in patients who were not downstaged to surgery, survival appeared to be superior with TARE over sorafenib.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Trombose Venosa , Teorema de Bayes , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/terapia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/terapia , Veia Porta , Pontuação de Propensão , Estudos Retrospectivos , Sorafenibe/uso terapêutico , Resultado do Tratamento , Trombose Venosa/etiologia , Trombose Venosa/terapia
13.
Viruses ; 13(5)2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064763

RESUMO

Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.


Assuntos
COVID-19/complicações , COVID-19/diagnóstico , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Idoso de 80 Anos ou mais , Transtornos da Coagulação Sanguínea/complicações , Humanos , Masculino , Recidiva Local de Neoplasia , Reação em Cadeia da Polimerase , RNA Viral , Recidiva , Fatores de Risco , Extremidade Superior/irrigação sanguínea , Trombose Venosa/terapia
14.
Int Angiol ; 40(4): 277-282, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34008932

RESUMO

There remain many questions regarding the pathophysiology and risk factors for endothermal heat induced thrombosis formation. Moreover, there are a paucity of data on the timing of its occurrence, and there has been no consensus regarding for its treatment. The purpose of this review was to summarize the current knowledge on the pathophysiology, risk factors and treatment strategies for endothermal heat induced thrombosis. The PubMed database was searched from 2001 to present for endothermal heat induced thrombosis, EHIT, deep vein thrombosis, chronic venous insufficiency, varicose veins, endovenous laser and radiofrequency ablation (treatment). All relevant articles identified by the authors mentioning endothermal heat induced thrombosis were included in this review. A multitude of risk factors, several pathophysiological hypotheses and different treatment strategies are described in the literature. Endothermal heat induced thrombosis is marginally understood. There remains a theoretical risk for significant venous thromboembolic complications. With the new uniform classification of EHIT (American Venous Forum), healthcare providers should continue to investigate the nature of this event.


Assuntos
Ablação por Cateter , Terapia a Laser , Trombose , Varizes , Insuficiência Venosa , Trombose Venosa , Temperatura Alta , Humanos , Veia Safena/cirurgia , Trombose/etiologia , Trombose/terapia , Resultado do Tratamento , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/terapia
15.
Medicine (Baltimore) ; 100(21): e26081, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032742

RESUMO

RATIONALE: Hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT) is traditionally considered an advanced-stage cancer with a poor prognosis. There is no standard treatment for patients diagnosed as HCC with IVCTT. PATIENT CONCERNS: A 52-year-old man was admitted to our hospital because of suspected hepatic mass during a health examination. DIAGNOSES: Computed tomography (CT) showed a hepatic mass approximately 4.3 cm × 6.3 cm in size located in segment VII of the liver, with thrombus in the inferior vena cava. The mass exhibited a pattern of early enhancement and washout on contrast-enhanced CT. Alpha-fetoprotein was 614.1 ng/mL (normal value, <8 ng/mL). The preoperative diagnosis was HCC with IVCTT. INTERVENTIONS: Two months after stereotactic body radiotherapy combined with sorafenib therapy, a planned open anatomical resection of the right posterior lobe of the liver was performed. OUTCOMES: The patient is alive without disease 12 months after surgery, and the level of alpha-fetoprotein is normal. LESSONS: The patient diagnosed as HCC with IVCTT was successfully treated by stereotactic body radiotherapy combined with molecularly targeted drugs followed by surgical treatment. If confirmed in future studies, this would suggest a promising strategy for the management of HCC with IVCTT.


Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Trombose Venosa/terapia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Quimiorradioterapia Adjuvante/métodos , Hepatectomia , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Invasividade Neoplásica , Radiocirurgia , Sorafenibe/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia
16.
Postgrad Med ; 133(sup1): 42-50, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33863270

RESUMO

Deep venous thrombosis (DVT) is a major cause of acute and chronic morbidity, mortality, and increased healthcare costs. Endovascular methods for thrombus removal and reestablishing venous patency are increasing in both scope and usage. The most commonly used method for endovascular thrombectomy is catheter-directed thrombolysis (CDT). Several studies have shown promise for CDT in alleviating acute symptomatology in acute lower extremity DVT as well as mitigating potential long-term consequences of DVT, such as post-thrombotic syndrome (PTS). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial is the largest and most comprehensive randomized-controlled trial to date evaluating CDT compared to anticoagulation alone for the treatment of acute symptomatic proximal lower extremity DVT. This review discusses the current status of CDT and adjunctive endovascular interventions for DVT, particularly in the context of the ATTRACT trial.


Assuntos
Procedimentos Endovasculares , Trombólise Mecânica/métodos , Terapia Trombolítica/métodos , Trombose Venosa/terapia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Humanos , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
17.
J Cardiovasc Surg (Torino) ; 62(5): 447-455, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33870678

RESUMO

Compression of the left common iliac vein by the overlying right common iliac artery is a benign anatomic abnormality in most individuals. However, in patients with significant vein compression, outflow obstruction and chronic intraluminal venous damage may lead to May-Thurner Syndrome. This syndrome commonly manifests as unilateral left leg swelling or acute iliofemoral deep venous thrombosis. In addition to clinical findings, diagnosis is made with ultrasound, computed tomography venography, or magnetic resonance venography. The extent of compression of the iliac vein is best determined by venography with intravascular ultrasound. Symptoms and hemodynamic significance of the compression guides the ideal treatment approach. Iliocaval stenting has become the standard treatment for this condition and has promising patency rates and clinical outcomes. This review paper provided an overview of pathophysiology, and utility and limitations of the existing diagnostic modalities and treatment options in the management of May-Thurner Syndrome.


Assuntos
Angioplastia com Balão , Veia Ilíaca , Síndrome de May-Thurner/terapia , Terapia Trombolítica , Trombose Venosa/terapia , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Recidiva , Stents , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
18.
J Neurol Sci ; 425: 117467, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33894614

RESUMO

BACKGROUND: The occurrence of cerebral venous thrombosis (CVT) in patients with spontaneous intracranial hypotension (SIH) raises difficult practical questions regarding the management of the two conditions. The first-line therapy for CVT is anticoagulation (AC); however, its potential benefit in SIH/CVT patients, especially if complicated by subdural haematoma, must be carefully evaluated taking account of the intracranial haemorrhage risk. Venous system recanalization and good prognosis in SIH/CVT patients treated with epidural blood patch (EBP), the main treatment option for SIH, have been already described. METHODS: We reviewed our cases of SIH complicated by CVT among a cohort of 445 SIH patients observed and treated during the last years. All published case reports and case series reporting patients with SIH and CVT were also ascertained and reviewed. RESULTS: Eight (2%) out of 445 patients suffering with SIH, were also diagnosed with CVT. All patients observed had orthostatic headache, three of them experienced a change in their headache pattern over the SIH course. Six out of eight patients received both AC and EBP treatments. Two patients were treated using only AC or EBP. A bilateral subdural haematoma enlargement after 1 month of AC was observed in one case. Complete CVT recanalization after treatment was obtained in three patients, including two with multiple CVT at baseline; partial CVT recanalization was achieved in two patients. Three patients experienced no CVT recanalization. After 6-48 months' follow-up all patients were still asymptomatic. CONCLUSIONS: The use of AC therapy should be weighed against the intracranial haemorrage risk and should be monitored carefully if initiated. Effective and prompt EBP, even without AC therapy, might lead to a good prognosis in selected cases.


Assuntos
Hipotensão Intracraniana , Trombose Intracraniana , Trombose Venosa , Placa de Sangue Epidural , Hematoma Subdural , Humanos , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/diagnóstico por imagem , Hipotensão Intracraniana/terapia , Trombose Intracraniana/complicações , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
19.
Int J Mol Sci ; 22(8)2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33917767

RESUMO

Venous thromboembolism, a complex disease combining deep vein thrombosis (DVT) and its most dangerous complication, pulmonary embolism (PE), strikes millions of people worldwide [...].


Assuntos
Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Biomarcadores , Gerenciamento Clínico , Suscetibilidade a Doenças , Humanos , Trombose Venosa/metabolismo , Trombose Venosa/terapia
20.
J Stroke Cerebrovasc Dis ; 30(7): 105811, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33915391

RESUMO

OBJECTIVE: To determine factors at hospitalization of cerebral venous thrombosis (CVT) which determine outcome at one year. METHODS: This was an ambispective study with outcome at one year follow up. Patients angiographically proven as CVT were included in study and functional modified Rankin Scale (mRS) determined at one year. They were dichotomized into "good" outcome (mRS 0-1) and "poor" outcome (mRS 2-6). Variables at admission were compared on univariate and then by cox proportional hazard regression for significance. Complications during follow up period were also compared. RESULTS: One hundred and seventy five patients were included, data of 71 was collected prospectively. One hundred and seventeen (66.9%) had "good" outcome while 58 (33.1%) had "poor" outcome. Univariate analysis showed poor outcome associated with age < 30 years, female sex, focal deficit, GCS ≤ 12, ≥3 sinuses involved and intracerebral haemorrhage. On Cox proportional hazard regression only GCS ≤ 12 was significant. Around 96% had complete/ partial recanalization at 6 months. Over one year, the complications included dural AV fistula in 10 (5.7%), intracranial hypertension in 4 (2.3%), venous thromboembolism in 6 (3.4%) and arterial infarct in 4 (2.3%). Proportions with complications in each group were similar. At one year 41 patients (25.2%) were continued on anticoagulation and 97 (55.2%) on antiepileptic drugs. Proportion in each group were similar. CONCLUSION: In patients with CVT, GCS ≤ 12 at admission was a predictor of poor functional outcome (mRS 2-6) at one year. During this period, complications were few and similar in the both the groups.


Assuntos
Avaliação da Deficiência , Escala de Coma de Glasgow , Admissão do Paciente , Trombose dos Seios Intracranianos/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Anticoagulantes/uso terapêutico , Anticonvulsivantes/uso terapêutico , Feminino , Estado Funcional , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombose dos Seios Intracranianos/fisiopatologia , Trombose dos Seios Intracranianos/terapia , Fatores de Tempo , Trombose Venosa/fisiopatologia , Trombose Venosa/terapia
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