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Reperfusion of Delayed Acute Occlusive Limb Ischemia: Is It Worthwhile?  [PDF]
Mohamed A. Elsharawy, Aymen Elsaid, Ibrahim Elsharawi
World Journal of Cardiovascular Diseases (WJCD) , 2014, DOI: 10.4236/wjcd.2014.412070
Abstract: Delayed reperfusion of acute occlusive limb ischemia causes local and systemic serious consequences and is the main cause of morbidity and mortality in these patients. The aim of this study was to examine the outcome and risk factors of reperfusion injury in such cases. Patients and Methods: Retrospective review of all cases presented, to King Fahd Hospital of University, with acute occlusive limb ischemia more than 12 hours was performed between June 2004 and November 2012. Grades of ischemia, extremities, comorbidities, morbidities and mortality were recorded. Results: During the study period, 92 patients were included, 47 (51%) were embolic and the rest was thrombotic. On admission, 15 patients had grade III ischemia, 68 had grade IIb, 8 had grade IIa and 1 had grade I. Four patients died (4.3%) and 15 (16%) patients had amputation. The risk factors of amputation were age (p = 0.031), extremity (lower limb 21% vs. Upper limb 0%, p = 0.019), cause of ischemia (thrombotic 24% vs. embolic 8.5%, p = 0.049) and grade of ischemia (p = 0.001). Conclusion: Delayed reperfusion of acute occlusive ischemia carries acceptable morbidity and mortality and could be performed even in irreversible ischemia. The risk factors of amputation are age, lower limb ischemia, thrombosis and grade III ischemia.
Embolia pulmonar por cianoacrilato pos embolización de malformación arteriovenosa cerebral: Caso clínico
Fernández,Patricia; Loayza,Patricio; Sabbagh,Eduardo; Badilla,Lautaro; Rojas,David; Verschae,Gregorio; Milet,Beatriz;
Revista médica de Chile , 2004, DOI: 10.4067/S0034-98872004000400012
Abstract: arterial embolization with cyanoacrylate is commonly used for the treatment of arteriovenous malformations. we report the case of a 40 years old man who four days after an embolization with cyanoacrylate, begins with cough, bloody sputum, and right hemithorax pleuritic pain. pulmonary embolism was confirmed with chest x ray, ct scan and scyntigraphy. the patient received anticoagulation, with adequate response. the most common complications of cerebral embolization are related to central nervous system and pulmonary embolism is exceptional. considering the high number of embolization procedures done nowadays, this complication must be borne in mind (rev méd chile 2004; 132: 489-92)
Embolia pulmonar por cianoacrilato pos embolización de malformación arteriovenosa cerebral: Caso clínico Cyanoacrylate pulmonary embolism after embolization of a cerebral arteriovenous malformation: Report of one case
Patricia Fernández,Patricio Loayza,Eduardo Sabbagh,Lautaro Badilla
Revista médica de Chile , 2004,
Abstract: Arterial embolization with cyanoacrylate is commonly used for the treatment of arteriovenous malformations. We report the case of a 40 years old man who four days after an embolization with cyanoacrylate, begins with cough, bloody sputum, and right hemithorax pleuritic pain. Pulmonary embolism was confirmed with chest X ray, CT scan and scyntigraphy. The patient received anticoagulation, with adequate response. The most common complications of cerebral embolization are related to central nervous system and pulmonary embolism is exceptional. Considering the high number of embolization procedures done nowadays, this complication must be borne in mind (Rev Méd Chile 2004; 132: 489-92)
Tromboembolia coronaria múltiple como causa de infarto agudo de miocardio
Mangariello,Brenda N.; Payaslian,Miguel; Albornoz,Marcela; Miguelez,Pablo; Gos Re,Vanina; Biasco,Agustina; Mu？oz,Fabio; Salzberg,Simón; Gitelman,Patricia;
Revista argentina de cardiolog？-a , 2010,
Abstract: acute myocardial infarction caused by multiple coronary artery embolisms coronary artery embolism is a rare cause of acute coronary syndrome that is scarcely documented. only a few case reports have been published but lack of solid angiographic evidence. we describe a 32-year old man without history of cardiovascular disease with a first episode of acute myocardial infarction with angiographic evidence of multiple thromboembolisms of the coronary arteries who developed cardiogenic shock and died. we review the causes and the clinical presentations of coronary artery embolism.
Tromboembolismo venoso postoperatorio: grave riesgo prevenible
Valencia A,Wilson; Husbands Luque,Johnnie Smith;
Revista Colombiana de Anestesiología , 2010,
Abstract: postoperative deep venous thrombosis and pulmonary thromboembolism are complications which have incidence on morbimortality. many researches evidence their figures and how thromboprophylaxis can reduce these risks. different drugs and their level of protection have been evaluated, but the adherence to the published clinical practice guidelines is not optimal because of the lack of clarity in the management of patients with intermediate risk factors. the proved prevention with thromboprophylaxis forces to implement strategies to detect the patients at risk and to follow the guidelines.
Perioperative Management of Case of Gynecological Malignancy with Bilateral Deep Venous Thrombosis of Lower Limbs Along with Pulmonary Embolism  [PDF]
MK Arora, Rakesh Garg
Open Journal of Anesthesiology (OJAnes) , 2011, DOI: 10.4236/ojanes.2011.11001
Abstract: We describe the anaesthetic management of 45 year female patient with pre-existing deep venous thrombosis (DVT) and pulmonary embolism (PE) who was subsequently scheduled for an laparotomy. Before planning the surgical procedures, adequate anticoagulation must be achieved to prevent further complications of DVT, thromboembolism, and pulmonary embolism in particular. The risk of stopping the anticoagulation prior to surgery must be considered and adequately discussed with the patient and surgeons. The anaesthetic plan must be selected keeping in mind the coagulation status and the need of anticoagulation in the postoperative period.
Echocardiographic findings in pulmonary embolism: An important guide for the management of the patient  [PDF]
Ronny Cohen, Pablo Loarte, Victor Navarro, Brooks Mirrer
World Journal of Cardiovascular Diseases (WJCD) , 2012, DOI: 10.4236/wjcd.2012.23027
Abstract: Echocardiography can be used as an easy, inexpensive, devoid of complications and, for the most part, universally available tool for the risk stratification of patient with acute pulmonary embolism. Because of its low sensibility, an echocardiogram is best indicated in a patient in whom hypotension and or shock are suspected to be due to pulmonary embolism. Pertinent findings in the echocardiogram can justify the use of fibrinolytic therapy. Most common echocar-diographic findings in acute pulmonary embolism are: dilatation of the right ventricle, right ventricular dysfunction in some cases with preservation of the motility of the apex, dilatation of the inferior vena cava with lack of collapse during inspiration flattening of the interventricular septum suggesting right ventricular pressure overload and pulmonary hypertension based on the jet of tricuspid regurgitation if available.
Continuous Lumbar Plexus Catheter Removal in Postoperative Total Hip Replacement Patients Receiving Warfarin Thromboprophylaxis: A Retrospective Analysis  [PDF]
Joseph Marino,Jay Curtin,Carol Patrick,Kara Theal
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.36064
Abstract: Background and Objectives: Based on the case reports of hemorrhagic complications, recommendations for the removal of lumbar plexus catheters in anticoagulated patients were created. These guidelines are controversial as they limit the use of lumbar plexus blocks in postoperative anticoagulated patients. This study was designed to evaluate the incidence of hemorrhagic complications and coagulation status using International Normalized Ratio (INR) at the time of lumbar plexus catheter removal in patients receiving warfarin after total hip replacement. Methods: A retrospective study of 371 patients on warfarin thromboprophylaxis who received continuous lumbar plexus catheters for postoperative analgesia after total hip surgery was performed. The primary outcome measure was the incidence of bleeding complications after catheter removal; secondary outcome measures included warfarin dose, bridge therapy, incidence of deep vein thrombosis, pulmonary embolism (DVT/PE) and INR values upon catheter removal. Results: Almost all lumbar plexus catheters (93%; 344/371) were removed at 72 hours. At the time of catheter removal, mean INR was 1.99 [1.42-2.41] (p = 0.015); 67% of patients had an INR > 1.5 and half of these patients had INRs between 2.0-3.0; 5% had INR’s between 3.0-4.0. There were no adverse bleeding complications or nerve injury after the removal of catheters. Conclusions: We observed no incidence of bleeding after lumbar plexus catheter removal despite 67 % of patients demonstrating INR’s > 1.5. Our retrospective analysis illustrates the relative safety of catheter removal in anticoagulated patients and suggests that the removal of lumbar plexus catheters can be safely performed with an INR > 1.5 in patients receiving warfarin.
Continuous Lumbar Plexus Catheter Removal in Postoperative Total Hip Replacement Patients Receiving Warfarin Thromboprophylaxis: A Retrospective Analysis  [PDF]
Joseph Marino, Jay Curtin, Carol Patrick, Cristina Sison, George Koutsouras, Scott Alpert, W. Healy III, Oonagh Dowling, J. E. Chelly, Kara Theal, Renee Pekmezaris
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.36064
Abstract: Background and Objectives: Based on the case reports of hemorrhagic complications, recommendations for the removal of lumbar plexus catheters in anticoagulated patients were created. These guidelines are controversial as they limit the use of lumbar plexus blocks in postoperative anticoagulated patients. This study was designed to evaluate the incidence of hemorrhagic complications and coagulation status using International Normalized Ratio (INR) at the time of lumbar plexus catheter removal in patients receiving warfarin after total hip replacement. Methods: A retrospective study of 371 patients on warfarin thromboprophylaxis who received continuous lumbar plexus catheters for postoperative analgesia after total hip surgery was performed. The primary outcome measure was the incidence of bleeding complications after catheter removal; secondary outcome measures included warfarin dose, bridge therapy, incidence of deep vein thrombosis, pulmonary embolism (DVT/PE) and INR values upon catheter removal. Results: Almost all lumbar plexus catheters (93%; 344/371) were removed at 72 hours. At the time of catheter removal, mean INR was 1.99 [1.42-2.41] (p = 0.015); 67% of patients had an INR > 1.5 and half of these patients had INRs between 2.0-3.0; 5% had INR’s between 3.0-4.0. There were no adverse bleeding complications or nerve injury after the removal of catheters. Conclusions: We observed no incidence of bleeding after lumbar plexus catheter removal despite 67 % of patients demonstrating INR’s > 1.5. Our retrospective analysis illustrates the relative safety of catheter removal in anticoagulated patients and suggests that the removal of lumbar plexus catheters can be safely performed with an INR > 1.5 in patients receiving warfarin.
Deep Venous Thrombosis of Lower Limbs: Prevalence, Risk Factors and Treatment in Semi-Urban Areas in Senegal  [PDF]
S. J. Manga, A. Ben Haj Younes, M. Dioum, S. L. Sy, Q. Te Indafa, M. B. C. Leye
Open Journal of Internal Medicine (OJIM) , 2021, DOI: 10.4236/ojim.2021.114015
Abstract: Context and Objectives: Deep vein thrombosis (DVT) is a potentially serious affection because it can be complicated by life-threatening pulmonary embolism. Epidemiological data are scarce in Africa. The objective of this work was to describe the prevalence, risk factors and treatment of deep venous thrombosis (DVT) in Ziguinchor. Methodology: This was a retrospective study carried out at the Ziguinchor Peace Hospital from January 1, 2016 to June 30, 2020. We included in the study all patients of both sexes, aged at least 18 years and hospitalized with DVT of the lower limb confirmed by venous Doppler ultrasound. Results: A total of 64 patients were hospitalized for DVT of the lower limbs during the study, for a hospital prevalence of 3.9%. The average age of the patients was 53 years (±17.6). A female predominance was noted with an M/F sex ratio of 0.7. The main risk factors found were the age ≥ 60 years (36%) and infectious pathologies (17%). Clinical signs were dominated by lower limb pain (93.8%) and lower limb edema (92%). The lower limbs’ venous Doppler ultrasound showed a predominance of thrombosis in the left lower limb (56%). The femoral vein was the most affected in 90% of cases. The patients had all benefited from an anticoagulant treatment mainly by a low molecular weight heparin relayed from the 1st day by an antivitamin K that was acenocoumarol in 97% of the cases. The average length of hospitalization was 10 days. The complications found were pulmonary embolism (8%) and accident with anticoagulants (3%). Hospital mortality was 6%. The average cost of care was 164.000 CFA francs. Conclusion: DVT is a multifactorial pathology; its treatment requires the control of risk factors. In our study, it was more frequent in the elderly.
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