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PubMedDate not supplied

Endoluminal recanalization in a patient with phlegmasia cerulea dolens using a multimodality approach-a case report.

Phlegmasia cerulea dolens is a limb-threatening form of deep venous thrombosis and should be treated aggressively. The authors report a patient who presented with iliocaval and femoral deep venous thrombosis and posed an additional therapeutic challenge based on a recent history of heparin-induced thrombocytopenia. Catheter-directed pharmacologic thrombolysis and balloon venoplasty were applied in treatment. The direct thrombin inhibitor argatroban was used in place of heparin for concurrent anticoagulation. This multimodality endovascular approach (chemical and mechanical interventions) was successful in relieving the venous occlusion and salvaging the limb, while maintaining appropriate treatment for heparin-induced thrombocytopenia.

Anticoagulants↗
PubMed2006

Recanalization of obstructed cerebrospinal fluid ventricular catheters using ultrasonic cavitation.

OBJECTIVE: Fifty percent of implanted cerebrospinal fluid (CSF) shunts fail within 2 years, primarily because of obstruction of the proximal catheter. Percutaneous techniques to reduce the morbidity of shunt revision are being developed. The authors describe the development of a device that uses ultrasonic cavitation to unblock ventricular catheters. METHODS: In collaboration with Cybersonics, Inc. (Erie, PA), we designed, built, and tested a system that produces low-frequency ultrasound (20-28 kHz). Extensional ultrasonic waves are transmitted along a tapered wire (final diameter, approximately 0.8 mm) to the tip, where cavitation is produced in a highly localized region. An in vitro model of sheep choroid plexus occluding typical ventricular catheters was developed. The device was safety tested in vivo in rat and pig brains by introducing the device into shunt catheters inserted during simulated shunt surgery. A clinical safety trial using the device to attempt to remove blocked and adherent ventricular catheters has commenced. RESULTS: In the sheep choroid plexus model, at least 90% of the occluded holes were unblocked in a few minutes, restoring normal flow. There was no adverse effect of the device within shunt catheters inserted into live animal brains. Four patients have undergone treatment with the device at open CSF shunt surgery without adverse effect, and the device seems effective at unblocking and freeing the occluded catheters. CONCLUSION: Ultrasonic cavitation produced at the end of a fine wire that is introduced percutaneously into a CSF shunt promises to be a useful technique for minimally invasive proximal ventricular CSF shunt catheter revision.

Animals↗
PubMedDate not supplied

Endoluminal recanalization in a patient with phlegmasia cerulea dolens using a multimodality approach.

Phlegmasia cerulea dolens, a rare complication of deep venous thrombosis, has traditionally been difficult to treat. The patient described in this report posed additional therapeutic challenges based on a history of heparin-induced thrombocytopenia. She presented with severe leg pain and swelling, and a venogram showed occlusion of both her inferior vena cava and right iliac vein. The use of a multimodality approach, both chemical and mechanical, was successful in removing the venous occlusion, thereby preventing further complications, such as circulatory shock, postphlebitic syndrome, and venous gangrene.

Catheterization↗
PubMed2002

Clinical course, timing of rupture and relationship with coronary recanalization therapy in 77 patients with ventricular free wall rupture following acute myocardial infarction.

This study aimed to analyze the clinical course, timing of rupture and relationship with percutaneous coronary intervention (PCI) in patients with cardiac free wall rupture (FWR) following acute myocardial infarction (AMI). FWR was observed in 77 (2.3%) of 3, 284 patients with AMI in our CCU over 28 years. 47 (61.0%) cases were male and mean of age was 69.8 year old. Rupture occurred on Day 1 of infarction in 46 patients (59.7%). 22 cases (28.6%) had cardiogenic shock before FWR. 10 cases (13.0%) had double rupture preceded by ventricular septal perforation (VSP). 25 cases (32.5%) were treated with thrombolytic agents, and only 10 cases (13.0%) had percutaneous coronary intervention (PCI). Before 1981, when PCI was not indicated, incidence of FWR was 2.7%. After 1988 (the era of PCI), the incidence decreased to 1.1%. FWR and the era showed a significant negative correlation (r=0.519: P=0.0056). Rupture was abrupt in 51 cases (66.2%: abrupt type) and was gradual in 26 cases (33.8%: oozing type). The percentages of female, patients with cardiogenic shock before rupture, patients treated by thrombolytic agents and survival rate were significantly higher in the slow-onset rupture group than in the abrupt-onset rupture group. The percentage of patients treated by PCI was extremely low (7.8%) in abrupt-onset group. Of all patients, only 8 (10.4%) survived by emergency operation. One patient with abrupt type survived emergency pericardiotomy in the CCU. One patient with abrupt type and 4 patients with oozing type who had emergency operation in operation room survived. 2 patients with oozing type survived by pericardial drainage and strict blood pressure control. We conclude that early recognition and emergency surgery without thrombolytic therapy may substantially reduce mortality in oozing ruptures. Moreover, immediate and adequate reperfusion by PCI may prevent development of abrupt rupture following acute myocardial infarction.

Aged↗
PubMed2004

Endovascular recanalization of subclavian artery occlusions.

Percutaneous balloon angioplasty for subclavian stenosis achieves satisfactory procedural success rates except for total occlusion. Seven lesions in six consecutive patients who underwent stenting for subclavian total occlusion were reviewed to evaluate the feasibility and efficacy of endovascular stenting. Six lesions were treated using Palmaz stents, and one with the combination of a Palmaz and a SMART stent. Procedural success (residual stenosis < 30%) was achieved for all lesions. The only neurological complication was an embolism in a branch of the posterior cerebral artery, which resulted in homonymous hemianopsia. Follow-up angiography over 6 months after the stenting for five lesions found one in-stent re-occlusion and one ostial restenosis due to elastic recoil. No patient had any new or recurrent symptoms except for recurrent upper limb ischemia due to the case of in-stent re-occlusion during the clinical follow-up period of 1 to 52 months (mean 16.6 months). This complication was resolved by a second treatment. Our limited experience suggests that stenting can redilate even cases of angiographical total occlusion of the proximal segment of the subclavian artery.

Adolescent↗
PubMed1982

Recanalized umbilical vein in portal hypertension.

Experience with splenoportography suggests that patency of the umbilical vein occurs in about 9% of the patients with portal hypertension. A widely patent umbilical vein might serve as a decompressive portosystemic shunt. Percutaneous transhepatic portography was performed in 107 patients with cirrhosis of the liver and portal hypertension. A patent umbilical vein was found in 28 patients (26%). This finding significantly paralleled the number and size of other collateral veins, apart from gastroesophageal varices. No significant relation was found between umbilical vein patency and portal pressure, extrahepatic shunting, variceal bleeding, or ascites. It is concluded that a large patent umbilical vein does not effectively relieve portal hypertension, prevent gastroesophageal varices, or protect against variceal bleeding or ascites.

Adult↗
PubMed1984

Percutaneous recanalization of iliac artery occlusions: an alternative to surgery in the high-risk patient.

Percutaneous transluminal angioplasty was performed successfully in three patients with total occlusions involving the iliac artery. Two patients had occlusion of the external iliac artery and the third patient had occlusion of the common iliac artery. The vessels were still patent at 3-12 months after the procedure. One complication occurred involving a thrombus in the common femoral artery of the diseased leg. The thrombus was surgically removed under local anesthesia. In high-risk patients, percutaneous transluminal angioplasty of total iliac artery occlusions may represent a viable alternative to surgery.

Angioplasty, Balloon↗