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Improvement following restoration of inline flow argues against comprehensive thrombus removal strategies and for selective stenting in acute symptomatic iliofemoral venous thrombosis.

OBJECTIVE: Randomized trials have demonstrated the benefit of thrombus removal strategies in iliofemoral deep venous thrombosis (IFDVT) in p … ent symptoms), was evaluated. RESULTS: Of the 69 limbs, 53 underwent pharmacomechanical/mechanical thrombectomy (PMT), whereas 16 patients underwent PMT and catheter-directed thrombolysis with restoration of inline flow in all limbs. Post-intervention VCSS improved from 6 to 2 at 24 months (P < .0001). GOS improved from 4 to 0 at 24 months (P < .0001). The VA …

Armour® Thyroid Rage - A Dangerous Mixture.

Armour® Thyroid (Forest Pharmaceuticals, LLC; affiliate of Allergan, Dublin, Ireland) is a natural porcine derivative thyroid supplement tha … iogram, which confirmed an occluded left anterior descending artery. He was treated successfully by thrombectomy and stenting of his left anterior descending artery. Evaluation for other causes of thrombosis was negative: glycosylated hemoglobin (HbA1C) 5.5%, low-density lipoprotein (LDL) 127 mg/dL, high-density lipoprotein (HDL) 33 mg/dL, hypercoagulable eval …

[How can we improve the prognosis of infrapopliteal bypasses?].

Infrapopliteal bypasses are often used for critical ischemia, in patients older than 80, in diabetics patients in 20% of cases, and patients … rove secondary patency. In cases of acute occlusions of the graft, an aggressive approach including thrombectomy, thrombolysis and distal angioplasty, can improve the patency. A global evaluation, with medical therapy, with antiplatelets, statins, diabetes control, annual evaluation of silent myocardial ischemia, and duplex scan follow-up of carotid artery dis …

Contemporary Challenges in Venous Thromboembolism: Evolving Populations and Implications for Management and Risk Stratification.

Venous thromboembolism (VTE) remains a major cause of morbidity and mortality globally. The incidence of VTE continues to increase over time, contributed to by demographic shifts and emerging risk factors, such as novel cancer treatments and exposure to gender-affirming hormonal therapies. While the introduction of direct oral anticoagulants (DOACs) revolutionized VTE management, increasing complexity in select patient cohorts has driven the need for alternative treatment strategies, including pharmacological and interventional approaches. Concurrently, contemporary patient populations have ex

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… Large-bore mechanical thrombectomy (LBMT), a minimally invasive endovascular procedure that allows aspiration of thrombus without thrombolytics, has emerged as a potential therapy for intermediate-risk PE. … Similarly, the recent STORM-PE trial evaluated computer-assisted vacuum thrombectomy with anticoagulation versus anticoagulation alone in intermediate-high risk PE, reporting superior reduction in RV/LV ratio with comparable major adverse events within 7 days [ 94 ]. …

[Treatment of a female patient with sickle-cell anemia during cardiac surgery with cardiopulmonary bypass].

A 17-year-old girl with drepanocytic (sickle-cell) anemia who was being treated with hydroxyurea and periodic blood transfusions through a Hickman-type catheter was admitted for periodic episodes of fever. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Massive right atrial thrombosis with pulmonary embolism and bacterial endocarditis were detected by computed tomography. Surgery with a beating heart and cardiopulmonary bypass was undertaken. Drepanocytic anemia in individuals homozygous for hemoglobin S is a rare condition in Spain but we are beginning to see a f

Clinical and radiographic natural history of cervical artery dissections.

BACKGROUND: Cervical artery dissection (CADsx) is a common cause of stroke in young patients, but long-term clinical and radiographic follow-up from a large population is lacking. METHODS: Epidemiologic data, treatment, recurrence, and other features were extracted from the records of all patients seen at our stroke center with confirmed CAD during a 15-year period. A subset of cases was examined to provide detailed information about vessel status. RESULTS: In all, 177 patients (mean age 44.0 +/- 11.1 years) were identified, with the male patients being older than the female patients. Almost

[Prospective monitoring of vascular access in hemodialysis by means of a multidisciplinary team].

PURPOSE: Nowadays, expert guidelines recommend the monitoring programs of the vascular access (VA) by a multidisciplinary team. MATERIAL AND METHOD: We present the experience over the last five years, of a prospective VA surveillance by a multidisciplinary team. The quality indicators reached are described as the associated factors for survival of the new VA. RESULTS: Three hundred seventeen VA have been studied, 73% were arteriovenous fistulas(AVF) and the rest were polytetrafluoroethylene (PTFE) grafts at 282 patients. The main causes of dysfunctions were elevated dynamic venous pressure (

Cardiac and great vessel thrombosis in Behçet's disease.

Behçet's disease (BD) is a chronic relapsing systemic vasculitis in which orogenital ulceration is a prominent feature. The disease affects many systems and causes hypercoagulability. We present a 27-year-old male patient who exhibited widespread great vessel thrombosis including right atrial and ventricular thrombi in the setting of right-sided infectious endocarditis and orogenital aphthous ulcerations and erythema nodosum due to BD. We reviewed the enigmatic prothrombotic state of BD, and discuss our prior experiences in this field.

Final Infarct Volume as a Surrogate End Point in Anterior Circulation ICAS-LVO Stroke: Post Hoc Secondary Analysis of RESCUE-ICAS.

BACKGROUND: Final infarct volume (FIV) on 24-hour magnetic resonance imaging is a well-established imaging biomarker linked to functional re … nly patients with anterior circulation large vessel occlusion with magnetic resonance imaging after thrombectomy were included. FIV was measured on diffusion-weighted magnetic resonance imaging performed 24 to 36 hours postthrombectomy. Infarct progression was defined as the difference between baseline computed tomography perfusion infarct volume (cerebral blo …

Demographics, Clinical Profiles, and Outcomes of Patients With Adrenal Disorders in a Tertiary Care Center: A Retrospective Study.

BACKGROUND: Adrenal masses encompass a spectrum from benign incidentalomas to malignant tumors, posing diagnostic and therapeutic challenges … a 31-year-old female with ACC and inferior vena cava thrombus, managed with open adrenalectomy and thrombectomy with renal preservation and a 35-year-old male with an aldosterone-secreting adenoma causing quadriparesis, resolved post-laparoscopic adrenalectomy. CONCLUSION: This study highlights a high prevalence of pheochromocytoma and incidentalomas in our …

Clinical and echocardiographic diagnosis, follow up and management of right-sided cardiac thrombi.

BACKGROUND: Right-sided cardiac masses are infrequent and have varied clinical presentation. The present study describes the clinical features, echocardiographic findings and management of 19 patients presenting with right-sided cardiac thrombi in a tertiary care center in north India. METHODS: This is a retrospective, single center observational study of consecutive patients over the period January 2003-2008 admitted in our emergency intensive care unit (EICU). We identified 38 patients with right-sided cardiac masses admitted to EICU diagnosed by transthoracic echocardiography of which 19 p

Left ventricular assist device implantation combined with surgical ventricular reconstruction.

Nine months after sustaining a transmural anteroseptal myocardial infarction, a 45-year-old man presented with ischemic heart disease, severe mitral valve insufficiency, New York Heart Association functional class IV congestive heart failure, and a left ventricular aneurysm. Coronary angiography revealed 3-vessel disease. Echocardiography showed severe left ventricular impairment, pronounced thrombosis in the left ventricular apex, and low myocardial reserve. To reduce the high risk of performing left ventricular and mitral valve reconstruction concurrently with revascularization, we decided t

How baseline severity affects efficacy and safety outcomes in acute ischemic stroke intervention trials.

Baseline severity of stroke may be an important predictor of efficacy and safety outcomes in acute stroke intervention trials. This summary explores definitions of baseline variables and outcomes used to measure stroke severity, efficacy, and safety. In addition, the discussion here reviews select acute ischemic stroke intravenous thrombolytic studies, such as the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study and European Cooperative Acute Stroke Studies, select neuroprotectant and endovascular clot retrieval device studies, and large cooperative databases, such as

Surgical complications after living donor liver transplantation in patients with biliary atresia: a relatively high incidence of portal vein complications.

BACKGROUND/PURPOSE: The aim of this study is to present the surgical complications in living donor liver transplantation (LDLT) for biliary atresia (BA) as a treatment for end stage liver disease. PATIENTS AND METHODS: Twenty-nine LDLTs were performed in patients with BA between October 1996 and April 2008 in Department of Pediatric Surgery at Kyushu University Hospital. The initial immunosuppression was a combination of tacrolimus and steroids. RESULTS: Twenty-eight of 29 cases with BA, who previously underwent Kasai's operation and LDLT was performed at a median age of 9.1 years (range 7 m

Deciphering mesenteric venous thrombosis: imaging and treatment.

The principal cause of a high mortality rate in mesenteric vein thrombosis (MVT) is a delay in diagnosis. Recent data indicate that the mortality rate is decreasing owing to earlier diagnosis and anticoagulation. The authors examined the treatment profile of MVT to see how the increased use of imaging and early anticoagulation has impacted this process. They retrospectively analyzed the treatment paradigm with acute MVT at one institution over a 10-year period. Twenty-three patients were identified. Data were analyzed using chi-squares and Student's t tests. Twenty-three patients (11 men and 1

Subacute Pulmonary Embolism: Insights from a National Registry of Catheter-Directed Interventions.

Background: Pulmonary embolism (PE) has classically been divided, on the basis of symptom duration, into acute (<2 weeks), subacute (2-12 we … rral and by a substantial right ventricular and pulmonary pressure load at presentation. Mechanical thrombectomy was safe and effective in this subgroup, with favourable early outcomes comparable to those of acute PE. These hypothesis-generating findings support dedicated study of the diagnosis, risk stratification and interventional management of subacute PE.

Melatonin Improves Neuroprotection and Neuroplasticity in Middle-Aged Mice Following Permanent Focal Cerebral Ischemia.

Stroke, caused by interrupted brain blood supply, predominantly affects the elderly. Epidemiological data indicate that over 70% of ischemic … ion of stroke patients (particularly older individuals) do not receive or benefit from thrombolysis/thrombectomy, leaving them with permanent arterial occlusion. In our aged mice model, pMCAO provides a stringent test of neuroprotective efficacy under conditions of sustained ischemia, which can illuminate melatonin's potential benefits in severe, unmanaged str …

Results of a Flexible Patient-Centered Approach to the Timing of Thoracic Outlet Decompression in Paget Schroetter Syndrome.

BACKGROUND: Treatment algorithms for subclavian vein (SCV) effort thrombosis (Paget-Schroetter syndrome- PSS) are multiple, ranging from thrombolysis (TL) with immediate or delayed thoracic outlet decompression (TOD) to conservative treatment with anticoagulation alone. We follow a regimen of TL/pharmacomechanical thrombectomy (PMT) followed by TOD with first rib resection, scalenectomy, venolysis, and selective venoplasty (open or endovascular) performed electively at a time convenient for the patient. Oral anticoagulants are prescribed for 3 months or longer based upon response. The aim of t…

[American Academy of Neurology, Washington, 18-25 April 2015].

CEREBROVASCULAR DISEASES: The benefit of the thrombectomy using stents retrievers in the acute stroke phase is now demonstrated when there is a proximal occlusion of an intracranial artery, whatever its mechanism. The place of the anticoagulants in the management of cervical artery dissections remains uncertain, while the benefit of the blood pressure control in the secondary prevention of deep and lobar intracerebral hemorrhages is critical. The development of cardiac MRI, prolonged cardiac monitoring and transcranial doppler seems to improve the diagnosis of cardio-embolic sources of stroke.…