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1.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500313

RESUMO

Novel COVID-19 continues to intrigue medical professionals with its varied presentations. Though it affects the respiratory tract primarily, thrombogenesis has been the Achilles' heel. A 44-year-old man diagnosed with COVID-19 presented with upper limb pain at a local hospital and was found to have thrombosis of the right axillary artery. Despite a successful embolectomy at the local hospital, there was re-occlusion of the axillary artery and the limb became ischaemic. He was referred to our institution by which time the limb became gangrenous above the elbow and had to be amputated. Extensive sloughing of the nerves was also seen in the local area. Hypercoagulability presenting with various manifestations is common in COVID-19 and needs early anticoagulation. We present this asymptomatic patient who lost a limb to this COVID-19 sequelae.


Assuntos
Amputação , Braço/cirurgia , Artéria Axilar , Gangrena/cirurgia , Isquemia/cirurgia , Trombose/complicações , Adulto , Braço/irrigação sanguínea , Braço/patologia , Artéria Axilar/cirurgia , Embolectomia , Gangrena/etiologia , Gangrena/patologia , Humanos , Isquemia/etiologia , Isquemia/patologia , Masculino , Recidiva , Trombose/cirurgia
2.
Angiol Sosud Khir ; 26(4): 63-69, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332307

RESUMO

Described in the article is a clinical case report regarding successful surgical treatment of a female patient with total floating thrombosis of the inferior vena cava and thrombosis of the right atrium, complicated by pulmonary embolism. Our patient was a 42-year-old woman presenting with a clinical pattern of iliofemoral thrombosis. The examination revealed floating thrombosis of the inferior venal cava, right atrial thrombosis, and massive pulmonary embolism. Given the presence of absolute contraindications to systemic thrombolysis, it was decided to carry out surgical treatment by means of a hybrid-operation procedure. The woman underwent successful direct thrombectomy from the right-atrium cavity and branches of the pulmonary artery in conditions of artificial blood circulation, simultaneously accompanied by removing the floating thrombus from the inferior vena cava with the help of the 'Track' system, as well as by placement of a cava filter. Also presented herein is a review of the world experience gained in treating this pathology, followed by substantiation of using a hybrid approach for achieving an optimal clinical outcome.


Assuntos
Embolia Pulmonar , Trombose , Filtros de Veia Cava , Adulto , Feminino , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Trombectomia , Trombose/diagnóstico , Trombose/etiologia , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
3.
Methodist Debakey Cardiovasc J ; 16(3): e8-e10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133369

RESUMO

Sinus of Valsalva aneurysm (SOVA) is an unusual cardiac anomaly that is potentially fatal with rupture. It is often asymptomatic but has various presentations. We describe a case of a 67-year-old male who presented with atypical chest pain. Transthoracic echocardiogram and cardiac computed tomography scan confirmed a large SOVA complicated by thrombus formation and compression of the left atrium and left ventricular outflow tract. The patient successfully underwent a Bentall procedure-surgical aortic aneurysm repair with mechanical aortic valve conduit. We discuss several clinical decision-making branch points to highlight the complexity of managing this condition. Even in asymptomatic or minimally symptomatic patients with SOVA, surgery may be indicated if the aneurysm meets the criteria for size or has thrombus formation or compressive effects.


Assuntos
Aneurisma Aórtico/complicações , Seio Aórtico , Trombose/etiologia , Idoso , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Humanos , Masculino , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(42): e22500, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080684

RESUMO

INTRODUCTION: We report the youngest documented patient (38 years old) to develop an acute popliteal artery thrombus following primary total knee arthroplasty (TKA). PATIENT CONCERNS: The patient presented for an elective TKA secondary to posttraumatic arthritis. Past medical history included a tibial plateau fracture, two knee arthroscopies and an elevated body mass index (37.53). A right TKA was performed with no intraoperative complications. Two hours postoperatively, the right foot was poikilothermic and lacking dorsalis pedal pulse. DIAGNOSIS: Popliteal artery thrombus confirmed by angiogram and venous duplex. INTERVENTIONS: Immediate vascular surgery consult and subsequent embolectomy. OUTCOMES: At 1 year postoperatively, the patient is doing well with no further complications. CONCLUSION: Due to the lack of significant past medical history putting this patient at risk, future research should focus on prior trauma, age, and BMI as risk factors, specifically in patients undergoing TKA.


Assuntos
Artroplastia do Joelho , Artéria Poplítea , Complicações Pós-Operatórias/etiologia , Trombose/etiologia , Adulto , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Trombose/diagnóstico por imagem , Trombose/cirurgia
5.
Anticancer Res ; 40(11): 6465-6471, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109585

RESUMO

AIM: To assess the utility of the perioperative use of direct oral anticoagulants for patients with hepatocellular carcinoma (HCC) with cancer-associated thrombosis. CASE REPORT: An 83-year-old woman was admitted with a solitary HCC (10-cm diameter), as well as with multiple sites of venous thromboembolism and macroscopic portal vein tumor thrombosis. She had appropriate liver function without viral hepatitis, triple-positive tumor markers, and secondary polycythemia. Edoxaban at 30 mg was initiated 10 days before surgery to remove HCC. Complete remission of the pulmonary embolism and stability of the deep vein thrombosis and massive superior mesenteric vein thrombosis were recognized preoperatively. An extended left hepatectomy was successfully performed. To avoid hemorrhage complications, we used intravenous administration of nafamostat mesylate for 2 days, thereafter we restarted edoxaban. Superior mesenteric vein thrombosis resolved 5 months after surgery. CONCLUSION: Perioperative oral administration of edoxaban was useful in multidisciplinary treatment for a patient with advanced HCC with cancer-associated thrombosis.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Trombose/tratamento farmacológico , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Fígado/efeitos dos fármacos , Fígado/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Trombose/complicações , Trombose/patologia , Trombose/cirurgia
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
7.
Sanid. mil ; 76(3): 170-172, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196231

RESUMO

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


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


Assuntos
Humanos , Feminino , Idoso , Artéria Ilíaca/diagnóstico por imagem , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Betacoronavirus , Trombose/cirurgia , Artéria Ilíaca/fisiopatologia , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Embolectomia/métodos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Transtornos da Coagulação Sanguínea/complicações
9.
Ann Thorac Cardiovasc Surg ; 26(5): 286-289, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32814726

RESUMO

A 63-year-old man with protein C deficiency underwent thoracoscopic esophagectomy and digestive reconstruction using a gastric tube for thoracic esophageal cancer. On postoperative day 3, the gastric tube was removed because of anastomotic leakage and gastric tube necrosis. Digestive reconstruction using a free jejunal graft was attempted 140 days after the first surgery. However, thrombus formation in the artery and vein of the jejunal graft resulted in a failed reconstruction. Ten days after this surgery, digestive reconstruction using the colon was performed with intraoperative heparin administered for anticoagulation control. The surgery was successful, with no thrombus formation afterward. When performing digestive reconstruction in patients with conditions predisposing to thrombus formation, perioperative management should be completed with careful attention toward preventing thrombus formation. In particular, appropriate anticoagulation control, such as the administration of intraoperative heparin, is recommended in patients with protein C deficiency because necrosis of the reconstructed organ is likely.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Deficiência de Proteína C/complicações , Procedimentos Cirúrgicos Reconstrutivos , Toracoscopia , Trombose/etiologia , Idoso , Anticoagulantes/uso terapêutico , Neoplasias Esofágicas/patologia , Humanos , Masculino , Deficiência de Proteína C/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Fatores de Risco , Trombose/diagnóstico por imagem , Trombose/cirurgia , Falha de Tratamento
11.
Eur J Vasc Endovasc Surg ; 60(5): 721-729, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32807672

RESUMO

OBJECTIVE: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. METHODS: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). RESULTS: During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. CONCLUSION: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.


Assuntos
Aneurisma/cirurgia , Isquemia/cirurgia , Salvamento de Membro/estatística & dados numéricos , Artéria Poplítea/patologia , Trombose/cirurgia , Doença Aguda/epidemiologia , Doença Aguda/terapia , Idoso , Amputação/estatística & dados numéricos , Aneurisma/complicações , Aneurisma/epidemiologia , Aneurisma/patologia , Austrália/epidemiologia , Brasil/epidemiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Europa (Continente)/epidemiologia , Feminino , Carga Global da Doença , Humanos , Incidência , Isquemia/epidemiologia , Isquemia/etiologia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Artéria Poplítea/cirurgia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodos , Enxerto Vascular/estatística & dados numéricos , Grau de Desobstrução Vascular
12.
Am J Case Rep ; 21: e925753, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32724028

RESUMO

BACKGROUND The novel COVID-19 disease caused by the SARS-CoV-2 virus is a highly infectious disease that originated in Wuhan, China, and has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been implicated in damage to other organ systems as well as coagulopathy. The present report describes the first presumptive case of COVID-19-associated acute superior mesenteric artery thrombosis and acute intestinal ischemia. CASE REPORT A 55-year old man presented to the emergency department with nausea, generalized abdominal pain and diarrhea; he denied having a fever or any respiratory symptoms. Computed tomography (CT) of the abdomen and pelvis revealed bilateral pulmonary ground-glass opacities. He tested positive for SARS-CoV-2, and was treated with hydroxychloroquine, azithromycin and ceftriaxone, and was discharged home after five days of inpatient treatment. One week later, the patient returned with recurrent nausea, vomiting and worsening diffuse abdominal pain. A CT scan of the abdomen showed a 1.6-cm clot, causing high grade narrowing of the proximal superior mesenteric artery and bowel ischemia. The patient emergently underwent exploratory laparotomy, thromboembolectomy and resection of the ischemic small bowel. A post-operative complete hypercoagulable workup was unrevealing. CONCLUSIONS Despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. Clinicians managing patients with suspected or confirmed SARS-CoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.


Assuntos
Infecções por Coronavirus/complicações , Intestinos/irrigação sanguínea , Isquemia/virologia , Oclusão Vascular Mesentérica/virologia , Pneumonia Viral/complicações , Trombose/virologia , Dor Abdominal/etiologia , Betacoronavirus , Diarreia/etiologia , Embolectomia , Humanos , Infarto/diagnóstico , Infarto/cirurgia , Infarto/virologia , Intestinos/diagnóstico por imagem , Intestinos/cirurgia , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/cirurgia , Pessoa de Meia-Idade , Pandemias , Trombectomia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Tomografia Computadorizada por Raios X
13.
Vasc Endovascular Surg ; 54(8): 670-675, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32720863

RESUMO

OBJECTIVES: Surgical thrombectomy for acute arteriovenous fistula (AVF) thrombosis is one of the primary salvage intervention. The independent risk factors affecting the patency of AVF after a successful thrombectomy are yet unknown. Here, the author aimed to report the results of surgically corrected AVFs and the independent risk factors which may cause early failure following the surgical salvage. METHODS: The study cohort comprised 24 patients who had acute AVF thrombosis and underwent successful surgical thrombectomy in the first 24 to 48 hours between January 2016 and April 2020 in our center. The study group was divided into patients with recurrent AVF thrombosis (n = 11, 45.8%) and without recurrent AVF thrombosis (n = 13, 54.1%) following surgical thrombectomy with a follow-up of 22.4 ± 6.8 months. Postthrombectomy primary and secondary patency of AVF were also evaluated. RESULTS: The mean age of the cohort was 58.1 ± 15.2 years. A simple thrombectomy was performed for all cases. Only 2 cases have required a revision at the anastomosis due to severe intimal hyperplasia. Postthrombectomy primary patency rate was 45.5% for 18 months. Receiver operating characteristic analysis was performed with a resulting area under the curve value of 0.81 (95% CI: 0.35-0.94, P = .006) for flow (mL)/d-dimer (ng/mL) <0.63 in predicting recurrent AVF thrombosis following surgical thrombectomy. CONCLUSIONS: Flow (mL)/d-dimer (ng/mL) <0.63 was independent predictor of recurrent thrombosis (RT) of a surgically salvaged AVF. The patients at risk for RT or who may benefit from further intervention should be identified with predictive parameters.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Oclusão de Enxerto Vascular/cirurgia , Diálise Renal , Trombectomia , Trombose/cirurgia , Grau de Desobstrução Vascular , Adulto , Idoso , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Feminino , Oclusão de Enxerto Vascular/sangue , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Fatores de Risco , Trombectomia/efeitos adversos , Trombose/sangue , Trombose/diagnóstico , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
14.
Stroke ; 51(8): 2488-2494, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32684141

RESUMO

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MTB) is a reference treatment for acute ischemic stroke, with several endovascular strategies currently available. However, no quantitative methods are available for the selection of the best endovascular strategy or to predict the difficulty of clot removal. We aimed to investigate the predictive value of an endovascular strategy based on radiomic features extracted from the clot on preinterventional, noncontrast computed tomography to identify patients with first-attempt recanalization with thromboaspiration and to predict the overall number of passages needed with an MTB device for successful recanalization. METHODS: We performed a study including 2 cohorts of patients admitted to our hospital: a retrospective training cohort (n=109) and a prospective validation cohort (n=47). Thrombi were segmented on noncontrast computed tomography, followed by the automatic computation of 1485 thrombus-related radiomic features. After selection of the relevant features, 2 machine learning models were developed on the training cohort to predict (1) first-attempt recanalization with thromboaspiration and (2) the overall number of passages with MTB devices for successful recanalization. The performance of the models was evaluated on the prospective validation cohort. RESULTS: A small subset of radiomic features (n=9) was predictive of first-attempt recanalization with thromboaspiration (receiver operating characteristic curve-area under the curve, 0.88). The same subset also predicted the overall number of passages required for successful recanalization (explained variance, 0.70; mean squared error, 0.76; Pearson correlation coefficient, 0.73; P<0.05). CONCLUSIONS: Clot-based radiomics have the ability to predict an MTB strategy for successful recanalization in acute ischemic stroke, thus allowing a potentially better selection of the MTB strategy, as well as patients who are most likely to benefit from the intervention.


Assuntos
Isquemia Encefálica/cirurgia , Revascularização Cerebral/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Trombose/cirurgia , Idoso , Isquemia Encefálica/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombose/diagnóstico por imagem , Resultado do Tratamento
15.
BMC Neurol ; 20(1): 232, 2020 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-32505180

RESUMO

BACKGROUND: Partially thrombosed giant aneurysms at the basilar apex (BA) artery are challenging lesions with a poor prognosis if left untreated. Here we describe a rare case of extensive brain edema after growth of a surgically treated and thrombosed giant basilar apex aneurysm. CASE PRESENTATION: We performed a proximal surgical basilar artery occlusion on a 64-year-old female with a partially thrombosed giant BA aneurysm. MRI showed no ischemic lesions but showed marked edema adjacent to the aneurysm. She had a good recovery, but 3 months after surgical occlusion, her gait deteriorated together with urinary incontinence and worsening right hemiparesis. MRI showed that the aneurysm had grown and developed intramural hemorrhage, which caused extensive brain edema and obstructive hydrocephalus. She was treated by a ventriculoperitoneal shunt placement. Follow-up MRI showed progressive brain edema resolution, complete thrombosis of the lumen and shrinkage of the aneurysm. At 5 years follow-up the patient had an excellent functional outcome. CONCLUSIONS: Delayed growth of a surgically treated and thrombosed giant aneurysm from wall dissection demonstrates that discontinuity with the initial parent artery does not always prevent progressive enlargement. The development of transmural vascular connections between the intraluminal thrombus and adventitial neovascularization by the vasa vasorum on the apex of the BA seems to be a key event in delayed aneurysm growth. Extensive brain edema might translate an inflammatory edematous reaction to an abrupt enlargement of the aneurysm.


Assuntos
Artéria Basilar , Edema Encefálico , Aneurisma Intracraniano , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/fisiopatologia , Artéria Basilar/cirurgia , Edema Encefálico/etiologia , Edema Encefálico/cirurgia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/cirurgia , Derivação Ventriculoperitoneal
16.
J Card Surg ; 35(7): 1638-1639, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32557777

RESUMO

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


Assuntos
Embolectomia/métodos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Trombose/patologia , Trombose/cirurgia , Ecocardiografia Transesofagiana , Forame Oval/patologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Embolia Pulmonar/patologia , Embolia Pulmonar/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
World Neurosurg ; 140: 237-240, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32387404

RESUMO

BACKGROUND: In-stent thrombosis is a potentially dangerous complication of flow diversion for cerebral aneurysms. The optimal management strategy for such thrombosis is not known. Here we present a case of acute ischemic stroke caused by occlusion of a Pipeline Embolization Device (PED) construct placed 18 months earlier for treatment of a fusiform middle cerebral artery aneurysm. This was successfully treated with mechanical thrombectomy with good neurologic outcome. CASE DESCRIPTION: A 40-year-old woman presented with acute onset of left-sided weakness and occlusion of the right middle cerebral artery harboring a PED construct. Intraarterial glycoprotein IIb/IIIa inhibitor was administered without success. Mechanical thrombectomy was then performed using a stent retriever and aspiration, and the patient was loaded with dual antiplatelet therapy. The patient showed initial neurologic improvement but several hours later demonstrated recurrent symptoms due to reocclusion of the PED construct. This was again treated with mechanical thrombectomy followed by an intravenous P2Y12 inhibitor infusion. She ultimately made an excellent neurologic recovery with persistent patency of the PED construct. CONCLUSIONS: Mechanical thrombectomy with a stent retriever and aspiration is a therapeutic option for treatment of delayed thrombosis of a flow-diverting stent.


Assuntos
Isquemia Encefálica/etiologia , Aneurisma Intracraniano/cirurgia , Stents/efeitos adversos , Acidente Vascular Cerebral/etiologia , Trombectomia/métodos , Trombose/etiologia , Adulto , Isquemia Encefálica/cirurgia , Feminino , Humanos , Acidente Vascular Cerebral/cirurgia , Trombose/cirurgia , Resultado do Tratamento
18.
J Card Surg ; 35(7): 1673-1675, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32365429

RESUMO

There are no consensus guidelines on the management of catheter-related right atrial thrombus. We present the case of a 29-year-old female with end-stage renal disease who was found to have a large right atrial thrombus associated with her tunneled dialysis catheter during preoperative workup for renal transplant. She exhibited signs and symptoms of superior vena cava syndrome and NYHA class III congestive heart failure. She was successfully treated with surgical thrombectomy and demonstrated rapid resolution of her symptoms postoperatively.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cateteres/efeitos adversos , Diálise/efeitos adversos , Diálise/instrumentação , Cardiopatias/etiologia , Cardiopatias/cirurgia , Síndrome da Veia Cava Superior/etiologia , Trombectomia/métodos , Trombose/etiologia , Trombose/cirurgia , Adulto , Feminino , Átrios do Coração , Humanos , Falência Renal Crônica/terapia , Resultado do Tratamento
20.
BMC Cardiovasc Disord ; 20(1): 252, 2020 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460708

RESUMO

BACKGROUND: Peripherally inserted central catheters (PICCs) are widely used in cancer patients for administering chemotherapy drugs, antibiotics, and nutrients. PICC-related thrombi are not uncommon and may result in pulmonary embolism and the formation of thrombi in the right atrium. The latter are associated with an increased risk of subsequent morbidity or mortality because of their potential for embolization in the pulmonary vasculature. CASE PRESENTATION: A 16-year-old male with acute lymphoblastic leukemia (ALL) was admitted to our hospital after an echocardiographic examination revealed a ring-like structure in the right atrium that was still present after 6 months' anticoagulation treatment with aspirin. The boy had had a PICC inserted 2 years previously for chemotherapy; the PICC was intact and successfully removed 18 months after insertion when chemotherapy is finished. Subsequent computer tomography and radiography differentiated right atrial ring-shaped mass with a diameter of approximately 15 mm. Cardiac surgery was performed to remove the mass which was found to be a calcified thrombus. CONCLUSION: Although this is a rare occurrence, recognition of the possibility of a calcified thrombus may minimize the misdiagnosis of PICC-related thrombus and allow surgical retrieval if the thrombus is sufficiently large.


Assuntos
Antineoplásicos/administração & dosagem , Calcinose/cirurgia , Cateterismo Periférico/efeitos adversos , Átrios do Coração/cirurgia , Cardiopatias/cirurgia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Trombose/cirurgia , Adolescente , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Átrios do Coração/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , Masculino , Trombose/diagnóstico por imagem , Trombose/etiologia , Resultado do Tratamento
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