PURPOSE: To assess the efficacy of temporary vena cava filters in patients undergoing ultrahigh-dose streptokinase thrombolysis for iliocaval thrombosis and to determine therapy success and filter and therapy complications. METHODS: Forty-five patients were studied regarding extension and characteristics of thrombosis, duration, success, and complications of thrombolysis therapy, filter type, access route, pulmonary embolisms, and filter complications. RESULTS: Complete recanalization was achieved in 57% of cases. Filters were inserted predominantly via a transbrachial route. One fatal pulmonary embolism (2%) occurred 1 day after starting thrombolysis. No other pulmonary embolism was noted. Other complications were induced by thrombolysis alone (n = 12), thrombolysis and filter (n = 9), and filter alone (n = 11). CONCLUSION: Fatal pulmonary embolisms as a complication of ultrahigh-dose treatment of pelvic or caval thrombosis can not safely be prevented by the temporary vena cava filters currently available. Filter design needs to be improved.

Adolescent↗

PubMedDate not supplied

Multivisceral transplantation for abdominal malignancy: indication, technique, and results in three patients.

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Abdominal Neoplasms↗

PubMedDate not supplied

Clinical experience with temporary vena caval filters.

PURPOSE: To look at the benefits and complications of different vena caval filters inserted prophylactically. Three temporarily implantable caval filter systems were used in 67 patients. MATERIALS AND METHODS: Twelve Cook filters (six transjugular, six transfemoral), 11 Angiocor filters (one transjugular, 10 transbrachial), and 44 Antheor filters (three transjugular, four transfemoral, 37 transbrachial) were successfully implanted. In known iliac vein or caval thrombosis, the prophylactic filters were placed during thrombolytic therapy in 46 cases, surgery in 17 cases, thrombosis in pregnancy in three cases, and high-dose heparinization without lysis in one case. RESULTS: One patient had a fatal pulmonary embolism during treatment; seven thrombi were detected in the filter. Other complications were caused either by the underlying therapy alone (one fatal outcome of abdominal aorta aneurysmal surgery, two cases of cerebral hemorrhage, two cases of retroperitoneal hematomas, two cases of streptokinase fever reactions, one compartment syndrome, two cases of macrohematuria), by the combination of therapy and caval filter implantation (three cases of groin hematomas, three cases of arm hematomas), or by filter implantation alone (two cases of subclavian vein thrombosis, one catheter infection, one dislocation, one air embolism, one basket rupture). The bleeding complications were related to the aggressive thrombolytic therapy and would have occurred without filter implantation. CONCLUSION: Because temporary caval filters have no long-term complications per se, their use seems sensible as long as there are stringent indications, including the presence of iliac vein or caval thrombosis and risk of thrombus mobilization. The Antheor filter system was the most convenient system for implantation.

Adolescent↗

PubMedDate not supplied

[Significance of transverse forefoot stabilization in the treatment of hallux valgus. Comparative study of clinical/radiologic short-term results].

72 feet of 56 patients were treated by Brandes operation, modified by using a distally attached capsular-periosteal flap from 1984 till 1986 at the Orthopedic Clinic of the University of Vienna. On 41 of these feet an additional cerclage fibreuse according to Lelievre was done. This group had a significantly better correction of the hallux valgus angle with 17 degrees as compared to 8 degrees in the group without cerclage fibreuse. The correction of the intermetatarsal angle was also significantly better with 5 degrees as compared to 1 degree. Only through cerclage fibreuse was it possible to stabilize the sesamoids in the transversal as well as in the longitudinal direction. We found no improvement of subjective well-feeling after the cerclage fibreuse, but a significantly better correction and mobility in the metatarsal-sesamoid joint and the metatarsal-phalangeal joint.

Adult↗