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1.
Anticancer Res ; 40(1): 305-313, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892581

RESUMO

BACKGROUND: Cancer-associated thrombosis (CAT), the second leading cause of death in patients with cancer can be treated with low molecular weight heparin (LMWH) according to guidelines. PATIENTS AND METHODS: A multicenter prospective observational study was carried out to record anti-thrombotic treatment practice, assess thrombosis recurrence and bleeding, and identify potential risk factors. Adult patients from 18 Oncology Departments throughout Greece were followed-up for 12 months. RESULTS: A total of 120 patients with CAT receiving anticoagulant treatment were enrolled (35% incidental); 85% were treated for more than 6 months, 95.8% were treated with tinzaparin and smaller percentages with other agents. Thrombosis recurred in three patients and there was minor bleeding in four patients. Bleeding was associated with high body mass index (>35 kg/m2), trauma history, renal insufficiency and bevacizumab use. CONCLUSION: Incidental thrombosis contributes significantly to CAT burden. Long-term use of LMWH seems to be effective and safe. Several risk factors associated with bleeding should be considered during anti-coagulation therapy planning.


Assuntos
Neoplasias/complicações , Trombose/etiologia , Trombose/terapia , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Fatores de Risco
2.
Rozhl Chir ; 98(10): 418-421, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31842573

RESUMO

Hepatic artery thrombosis is the most common vascular complication after liver transplantation. Early thrombosis is treated by surgical revascularization; if not feasible, there is need for urgent retransplantation. Late thrombosis is diagnosed mostly when clinical symptoms or graft dysfunction are present, in which case the only possible therapy is retransplantation. We present a case of a young patient with late thrombosis of an aorto-hepatic bypass, in whom we successfully used thrombolytic therapy with stent-graft placement.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/métodos , Artéria Hepática/cirurgia , Hepatopatias/cirurgia , Transplante de Fígado/efeitos adversos , Trombose/cirurgia , Procedimentos Endovasculares , Humanos , Reoperação , Terapia Trombolítica , Trombose/etiologia , Trombose/terapia , Fatores de Tempo , Resultado do Tratamento
6.
Jpn J Radiol ; 37(11): 781-792, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522384

RESUMO

PURPOSE: To determine the treatment outcome and prognostic factors for survival in patients with hepatocellular carcinoma (HCC) and macrovascular tumor thrombosis (MTT). METHODS: Between January 2010 and December 2018, 66 patients diagnosed with HCC and MTT, who received specific treatment were included. Various clinical and imaging data, treatment methods, outcomes, prognostic factors, and overall survival were evaluated. Outcomes were compared with those of 24 patients treated with supportive care. RESULTS: Most patients with HCC and MTT showed disease progression (80.3%) and a low 5-year survival rate. The median survival time after treatment was 13 months (vs. supportive care group 3 months, p < 0.001). Main branch MTT (p = 0.036), extent of tumor thrombus > 1 segment (p = 0.039), presence of ascites (p = 0.009) and among treatment methods, systemic therapy alone (p = 0.007), and supportive care (p < 0.001) compared with combined local with systemic therapies were prognostic factors for poor survival. CONCLUSIONS: Although most patients with HCC and MTT showed disease progression, median survival time was significantly longer than that with supportive care. Main branch and > 1 segment involvement of MTT and presence of ascites were significant prognostic factors for poor survival. Combined local and systemic therapy over systemic therapy alone are recommended for patients with these advanced stage HCCs.


Assuntos
Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso , Carcinoma Hepatocelular/complicações , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida , Trombose/etiologia , Trombose/terapia
7.
BMJ Case Rep ; 12(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420432

RESUMO

Free-floating thrombus (FFT) in the carotid artery has been reported as a rare cause of acute ischaemic stroke. There are various treatment strategies, but higher risk of distal embolism may limit their applicability. A 77-year-old woman noticed right upper arm weakness. A CT angiogram revealed that a large floating thrombus had strayed across the carotid bifurcation, while another thrombus was present in the right axillary artery. As for the carotid FFT, in spite of anticoagulation therapy, the number of asymptomatic microthrombuses gradually increased on diffusion-weighted MRI. We performed endovascular therapy utilising two temporary occlusion balloon catheters and performed direct aspiration with a reperfusion catheter. The procedure was uneventful. We successfully performed a new endovascular technique for FFT in the carotid bifurcation. Our method is effective, minimally invasive and safe.


Assuntos
Oclusão com Balão/métodos , Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Reperfusão/instrumentação , Trombose/terapia , Idoso , Braço/irrigação sanguínea , Braço/cirurgia , Feminino , Humanos , Reperfusão/métodos
8.
Int J Med Inform ; 129: 175-183, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445252

RESUMO

OBJECTIVE: The aim of this study was to conduct an effective assessment of peripherally inserted central venous catheter (PICC)-related thrombosis based on machine learning (ML) techniques considering genotype. DESIGN: We conducted a prospective cohort study of 348 cancer patients with PICCs who were admitted to the Department of Oncology of West China Hospital, over a 1-year period, between February 1, 2016, and February 31, 2017. We obtained the clinical attributes, onset, duration, and outcome of thrombosis from electronic health records. We assigned all patients to either the training or testing set, and used four models for comparison with the currently used criteria. RESULTS: ML methods showed good efficiency in PICC-related thrombosis risk assessment (with areas under the curve of 0.7733, 0.7869, 0.7833, and 0.7717 respectively) and outperform the currently used criteria (Seeley), which did not identify any positive case. CONCLUSIONS: Our research confirmed that ML approaches are powerful tools to identify cancer patients with a high risk of PICC-related thrombosis, which outperform the currently used criteria (Seeley). Moreover, our research also offers some indications on the predictors and risk factors of PICC-related thrombosis. From our research, more-precise assessments can be performed in cancer patients with PICCs to help decide the prophylaxis and effectively lower the incidence of PICC-related thrombosis.


Assuntos
Cateterismo Periférico , Aprendizado de Máquina , Neoplasias/complicações , Trombose/terapia , Cateterismo Venoso Central , China , Hospitalização , Humanos , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Trombose/complicações
9.
Anatol J Cardiol ; 22(2): 54-59, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31375648

RESUMO

Catheter-directed intra-arterial thrombolysis (CDT) is a rational treatment method in patients with acute/subacute and even some chronic occlusions of lower extremity arteries and bypass grafts having salvageable limb ischemia. Immediate vessel patency can be achieved with an acceptable complication rate in many patients, especially those with fresh thrombus or emboli. It can be also an adjuvant treatment modality for endovascular interventions for chronic occlusions. There is no standard method of CDT including thrombolytic agent dose and technique. Selection of treatment strategy should be based on individual judgment based on viability of limb, lesion characteristics, and risks of hemorrhage.


Assuntos
Arteriopatias Oclusivas/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Terapia Trombolítica/métodos , Fibrinolíticos/administração & dosagem , Heparina/administração & dosagem , Humanos , Infusões Intra-Arteriais , Proteínas Recombinantes/uso terapêutico , Terapia Trombolítica/instrumentação , Trombose/terapia , Ativador de Plasminogênio Tecidual/uso terapêutico , Dispositivos de Acesso Vascular
10.
Vasc Endovascular Surg ; 53(7): 558-562, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327305

RESUMO

OBJECTIVE: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI. METHODS: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss. RESULTS: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts (P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group (P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system. CONCLUSION: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Isquemia/terapia , Doença Arterial Periférica/terapia , Terapia Trombolítica , Trombose/terapia , Terapia por Ultrassom , Doença Aguda , Idoso , Amputação , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Registros Eletrônicos de Saúde , Desenho de Equipamento , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Parenterais , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/instrumentação , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos , Terapia por Ultrassom/instrumentação , Dispositivos de Acesso Vascular
11.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340942

RESUMO

Right ventricular thrombus (RVT) can be life-threatening, since it has the potential to embolise and cause saddle pulmonary embolism (PE). We present a patient who initially presented with haemodynamically stable PE with evidence of RVT on echocardiogram. She was placed on heparin drip; however, she later developed cardiac arrest and died due to embolisation of RVT to the pulmonary vasculature. Although management of haemodynamically stable PE in patients with RVT is still a matter of debate, 1 given the outcome we suggest that thrombolysis or emergent embolectomy at the presentation, in this case, may have had a favourable outcome.


Assuntos
Tomada de Decisão Clínica , Parada Cardíaca/mortalidade , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Trombose/diagnóstico por imagem , Trombose/terapia , Idoso de 80 Anos ou mais , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Embolectomia/métodos , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Hemodinâmica/fisiologia , Heparina/uso terapêutico , Humanos , Embolia Pulmonar/diagnóstico por imagem
12.
Cancer Treat Res ; 179: 117-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317484

RESUMO

Central venous access devices are a critical instrument in the treatment and supportive care delivery for oncology patients. Catheter-related thrombosis (CRT) is a common complication of central venous access devices in oncology patients. Risk factors for CRT include patient-, device-, and treatment-related risk factors. Treatment of CRT is indicated to reduce symptoms, prevent catheter malfunction, prevent recurrent DVT or thromboembolic pulmonary embolism, and minimize the risk of post-thrombotic syndrome. Minimal prospective data exist on the prevention and treatment of catheter-related thromboses in cancer patients. As such recommendations largely are derived from data in the lower-extremity DVT and PE studies in cancer and non-cancer patients. Based on the available literature, primary pharmacologic prophylaxis against CRT is not recommended in cancer patients. Treatment options for CRT include catheter removal, anticoagulation, catheter-directed thrombolysis, or surgical thrombectomy. Current evidence-based guidelines recommend LMWH as the anticoagulant of choice. However, recent data showing efficacy and safety of DOACs in cancer-related VTE may be extrapolated to treatment of CRT in cancer patients. In patients with CRT, catheter removal should be pursued if continued vascular access is no longer needed, the catheter is dysfunctional, a catheter-associated infection is present, or if CRT symptoms do not resolve with anticoagulation alone. Catheter-directed thrombolysis is reserved for rare severe cases of CRT. Herein we discuss the pathophysiology, clinical presentation, diagnosis, and general management of CRT in cancer patients.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Neoplasias/complicações , Trombose/terapia , Humanos , Trombose/diagnóstico , Trombose/etiologia
13.
Cancer Treat Res ; 179: 159-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317487

RESUMO

The myeloproliferative neoplasms (MPNs) are clonal stem cell-derived diseases. This chapter focuses on the subcategory of Philadelphia (Ph) chromosome-negative classical MPNs, polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF). These MPNs are associated with both microvascular and macrovascular thrombosis, which may occur in the venous and arterial circulation. Erythrocytosis, leukocytosis, and increased JAK2V617F allele burden are known to be risk factors. In this chapter, we review the thrombotic and hemostatic manifestations of the Philadelphia (Ph) chromosome-negative classical MPNs, including the clinical manifestations, the pathophysiology, as well as management.


Assuntos
Transtornos Mieloproliferativos/complicações , Trombose , Neoplasias da Medula Óssea/complicações , Neoplasias da Medula Óssea/genética , Hemostasia/fisiologia , Humanos , Mutação , Transtornos Mieloproliferativos/genética , Transtornos Mieloproliferativos/fisiopatologia , Cromossomo Filadélfia , Policitemia Vera/complicações , Mielofibrose Primária/complicações , Trombocitemia Essencial/complicações , Trombose/diagnóstico , Trombose/etiologia , Trombose/fisiopatologia , Trombose/terapia
14.
Vasc Endovascular Surg ; 53(7): 602-605, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272299

RESUMO

INTRODUCTION: Carotid angioplasty and stenting (CAS) represents an effective procedure for treating carotid artery disease. The acute in-stent thrombosis is an extremely rare complication of CAS especially when it occurs postprocedurally during the first 24 hours. Improper antiplatelet therapy or poor response to antiplatelet medications is known to be associated with a higher risk of in-stent thrombosis during early postprocedural period following a successful intervention. MATERIAL AND METHODS: A patient who experienced acute carotid in-stent thrombosis in early postprocedural period is described. He had been taking dual antiplatelet therapy for 2 weeks before undergoing a successful CAS. Moreover, pharmacogenetics studies showed the patient to be a clopidogrel ultrarapid metabolizer, which theoretically confers hyperresponsivity to medication. Alongside the report itself, a brief literature review of relevant sources pertinent to the case has been conducted. RESULTS: According to the available literature, this is the first case report describing an ultrarapid clopidogrel metabolizer who underwent an uneventful CAS but experienced acute carotid in-stent thrombosis in early postprocedural period. A rescue procedure included an endovascular intervention consisting of thrombectomy and local alteplase application, followed by postprocedural administration of intravenous eptifibatide. At discharge, patient's dual antiplatelet therapy included ticagrelor instead of clopidogrel. CONCLUSION: Acute carotid in-stent thrombosis is a highly unexpected complication of CAS and can occur despite ultrarapid clopidogrel metabolism trait.


Assuntos
Angioplastia com Balão/instrumentação , Estenose das Carótidas/terapia , Clopidogrel/metabolismo , Citocromo P-450 CYP2C19/metabolismo , Inibidores da Agregação de Plaquetas/metabolismo , Stents , Trombose/etiologia , Doença Aguda , Administração Intravenosa , Angiografia Digital , Angioplastia com Balão/efeitos adversos , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Clopidogrel/administração & dosagem , Angiografia por Tomografia Computadorizada , Citocromo P-450 CYP2C19/genética , Substituição de Medicamentos , Eptifibatida/administração & dosagem , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Variantes Farmacogenômicos , Fenótipo , Inibidores da Agregação de Plaquetas/administração & dosagem , Fatores de Risco , Trombectomia , Trombose/diagnóstico por imagem , Trombose/terapia , Ticagrelor/administração & dosagem , Resultado do Tratamento
15.
Turk J Med Sci ; 49(4): 1179-1184, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31269784

RESUMO

Background/aim: It was aimed to describe the technical aspects and outcomes of percutaneous ultrasound-guided recanalization of thrombosed hemodialysis fistulas by thrombolytic injection. Materials and methods: A retrospective review was performed on patients with thrombosed native hemodialysis fistula who were treated using the percutaneous ultrasound-guided thrombolytic agent injection technique at the interventional radiology department. A total of 17 patients [7 women (41.2%) and 10 men (58.8%)] were included in this study. All of the data, including demographic information and clinical findings, were obtained from the patients' medical records and follow-up form of the procedure. Results: The mean fistula age was 5.6 years (range: 1­15 years). The mean diameter of the thrombosed segment was 5.53 cm (2­10 cm). Localization of the thrombi was in the aneurysmal segment at the level of needle insertion in 64.7% (n: 11) of patients, while it was on the venous side of the anastomosis in 35.3% (n: 6). The mean dose of tissue plasminogen activator (tPA) used in all of the sessions was 8.88 mg (5­17 mg). Overall technical success after all of the administrations was 100% and clinical success was 94.1%. Conclusion: Percutaneous ultrasound-guided thrombolytic injection in native hemodialysis fistulas is a rapid, practical, repeatable treatment method that is received on an outpatient basis with low risk of bleeding, and prevents unnecessary endovascular interventions or surgical operations.


Assuntos
Derivação Arteriovenosa Cirúrgica , Fibrinólise , Fibrinolíticos/uso terapêutico , Fístula , Diálise Renal , Trombose/terapia , Ativador de Plasminogênio Tecidual/uso terapêutico , Administração Cutânea , Adulto , Idoso , Aneurisma , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento , Ultrassonografia , Grau de Desobstrução Vascular
16.
BMC Cancer ; 19(1): 668, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277593

RESUMO

BACKGROUND: Recurrent hepatocellular carcinoma (HCC) with a tumor thrombus (TT) extending into the inferior vena cava (IVC)/right atrium (RA) is generally regarded as a terminal-stage condition and there is no worldwide consensus on the proper management of this situation. In the present study, we report the efficacy of hypofractionated radiotherapy (HFRT) as a salvage treatment for recurrent HCC with IVC/RA TT. METHODS: We retrospectively reviewed 75 HCC patients with an IVC/RA TT who were referred for HFRT at three institutions between 2008 and 2016. 57 cases had a TT located in the IVC (IVC group), and 18 cases had a TT located in the IVC and RA (IVC + RA group). HFRT was designed to focus on the TT with or without the primary intrahepatic tumors. RESULTS: In all cases, the TT completely disappeared (CR) in 17 patients (22.7%), 55 patients (73.3%) had a partial response (PR), and 3 patients (4.0%) had a stable disease (SD). There were no cases of progressive disease (PD). The 1-, 2-, and 3-year overall survival rates of the 75 patients were 38.7% (29/75), 13.3% (10/75) and 5.3% (4/75), respectively. The overall median survival time was 10 months. The mean survival times for the IVC group and IVC+ RA group were 13.8 ± 1.1 and 11.6 ± 2.5 months, respectively. There was no significant difference in survival between the two groups (p = 0.205). Log-rank test revealed that factors predicting poor survival were Child-Pugh B liver function classification, AFP ≥ 400 µg/L, intrahepatic multiple tumors, distant metastases, only the TT as the target, a biological effective dose (BED) < 55 Gy and no chance of further radiotherapy. CONCLUSIONS: HFRT appears to be an effective and reasonable treatment option for recurrent HCC patients with IVC/RA TT. The location of the tumor thrombus, either in IVC or in IVC and RA, is not the factor that influences the efficacy of radiotherapy or survival.


Assuntos
Carcinoma Hepatocelular/terapia , Átrios do Coração/patologia , Neoplasias Hepáticas/terapia , Hipofracionamento da Dose de Radiação , Terapia de Salvação , Trombose/terapia , Veia Cava Inferior/patologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Trombose Venosa/terapia
17.
No Shinkei Geka ; 47(7): 745-752, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31358693

RESUMO

Although the most common cause of major vessel occlusion is cardiogenic embolism(CE), atherothrombotic(AT)major vessel occlusion sometimes occur and recognize it during endovascular therapy. We evaluated the characteristics of patients with atherothrombotic major vessel occlusion who underwent endovascular therapy by comparing with them with those with cardiogenic embolism. We retrospectively evaluated 64 consecutive patients with major vessel occlusion who underwent endovascular thrombectomy between July 2014 and March 2018 in our institution. Eleven(17%)of the 64 patients were classified into the atherothombotic group based on the Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification except for artery to artery embolism. In the AT group, the proportions of patients with younger age(67±13 years old vs. 77±11 years old, p=0.048)and posterior circulation(55% vs. 8%, p=0.001)were significantly higher than in the CE group. The mean times from onset to hospital arrival and from onset to revascularization were significantly longer in the AT group than in the CE group(313±325min vs. 129±67min, p=0.008 and 468±359min vs. 280±93min, p=0.018). No significant differences in the rate of successful revascularization and favorable outcome were found between the 2 groups. More patients in the AT group than in the CE group tended to maintain their previous modified Ranking Scale score(54% vs. 24%, p=0.058). Our study shows that the patients with atherothrombotic major vessel occlusion had lower activities-of-daily living scores but attained high successful rates of revascularization and similar neurological outcome as that of multimodal endovascular therapy, as compared with the patients with cardiogenic embolism.


Assuntos
Procedimentos Endovasculares , Acidente Vascular Cerebral , Trombectomia , Trombose , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Trombose/terapia , Resultado do Tratamento
18.
Expert Rev Med Devices ; 16(7): 603-616, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31154869

RESUMO

INTRODUCTION: Blood-recirculating medical devices, such as mechanical circulatory support (MCS), extracorporeal membrane oxygenators (ECMO), and hemodialyzers, are commonly used to treat or improve quality of life in patients with cardiac, pulmonary, and renal failure, respectively. As part of their regulatory approval, guidelines for thrombosis evaluation in pre-clinical development have been established. In vitro testing evaluates a device's potential to produce thrombosis markers in static and dynamic flow loops. AREAS COVERED: This review focuses on in vitro static and dynamic models to assess thrombosis in blood-recirculating medical devices. A summary of key devices is followed by a review of molecular markers of contact activation. Current thrombosis testing guidance documents, ISO 10993-4, ASTM F-2888, and F-2382 will be discussed, followed by analysis of their application to in vitro testing models. EXPERT OPINION: In general, researchers have favored in vivo models to thoroughly evaluate thrombosis, limiting in vitro evaluation to hemolysis. In vitro studies are not standardized and it is often difficult to compare studies on similar devices. As blood-recirculating devices have advanced to include wearable and implantable artificial organs, expanded guidelines standardizing in vitro testing are needed to identify the thrombotic potential without excessive use of in vivo resources during pre-clinical development.


Assuntos
Equipamentos e Provisões , Modelos Biológicos , Trombose/diagnóstico , Materiais Biocompatíveis/farmacologia , Biomarcadores/metabolismo , Humanos , Qualidade de Vida , Trombose/terapia
19.
Bioelectromagnetics ; 40(6): 391-401, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236994

RESUMO

A vascular thrombus therapy method based on magnetic-induced vibration is presented. It is a mechanicalway of removing vascular thrombus that adopts the combined use of two concepts, namely (i) magnetic-induced vibration of magnetostrictive materials and (ii) changes in physical form of thrombus under high-frequency impact and vibration. This method has many advantages that (i) eliminate the side effects of drug treatment, (ii) reduce the complexity of traditional mechanical method, and (iii) improve the reliability of treatment. Practical results obtained from the simulations and experiments are included. They verify the proposed system and indicate that this method can effectively treat vascular thrombus and reduce patient's suffering and costs. Bioelectromagnetics. 2019;40:391-401. © 2019 Bioelectromagnetics Society.


Assuntos
Vasos Sanguíneos/metabolismo , Campos Magnéticos , Trombose/terapia , Fenômenos Biomecânicos , Simulação por Computador , Humanos , Modelos Biológicos , Vibração
20.
PLoS One ; 14(5): e0217641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150465

RESUMO

We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. The secondary endpoint was initial success of central line placement. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation (p = 0.001) and with hemodynamic instability (p <0.001) compared to the fluoroscopy-guided PICC placement. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside (p = 0.004). However, all re-inserted central lines were successful. There was no significant difference in procedure time between the three groups. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups (p = 0.038). Ultrasound-guided PICC placement by a neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Procedimentos Neurocirúrgicos/métodos , Trombose/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Unidades de Terapia Intensiva , Veias Jugulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Radiologistas , Trombose/fisiopatologia , Resultado do Tratamento , Ultrassonografia/métodos , Ultrassonografia de Intervenção/efeitos adversos
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