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PubMed2006

Reperfusion pulmonary edema after the removal of hepatocellular carcinoma embolus.

To report a non-fatal case of reperfusion pulmonary edema (RPE) after the removal of a hepatocellular carcinoma embolus, which had caused an acute obstruction of the tricuspid valve and pulmonary vasculature during a hepatic lobectomy. Pulmonary embolism caused by hepatocellular carcinoma embolus is extremely rare, and, in the present case, it was associated with unusual clinical features. A 69-year-old ASA II woman with hepatocellular carcinoma was presented for an elective left hepatic lobectomy. During the surgery, the tumor embolus was dislodged from the interior of the lumen of the inferior vena cava (IVC), which then drifted into the tricuspid valve area and pulmonary vasculature. The patient showed the specific signs of acute pulmonary embolism, such as a reduction in end-tidal carbon dioxide, an increase in central venous pressure, and a decrease in arterial pressure. The patient exhibited the symptoms for about 10 minutes. After this period, however, cardiovascular variables became relatively stable, even during a mechanical obstruction due to cross-clamping the pulmonary artery for embolectomy. After several hours of pulmonary embolectomy, the patient experienced an episode of RPE. The ventilatory supports for the treatment of RPE were successful, and the patient recovered without any complications. The patient's case in the present study demonstrates that pulmonary embolism may occur as a result of a hepatocellular carcinoma extending into the IVC during operative management. The anesthesiologist should be careful of the possibilities of RPE after removal of the tumor embolus.

Aged↗
PubMed1986

Venous thromboembolism to the heart. A case report and review of treatment.

Venous thromboembolism to the heart is a rare and often fatal condition that is now being recognized more frequently owing to the widespread use of two-dimensional echocardiography. Death may be due to embolic obstruction of the tricuspid or the pulmonary valves, or to further migration of the embolus to the pulmonary arteries. The incidence of early recurrent pulmonary embolism is high. When used as primary treatment, medical treatment (anticoagulation or fibrinolytic therapy) failed in eight of 13 reported cases. Only one of eight patients died when surgical embolectomy was undertaken. We believe that an echocardiographic diagnosis of venous thromboembolism to the heart is sufficient evidence to warrant urgent surgical embolectomy. An undue delay in definitive treatment is often fatal.

Aged↗
PubMed1999

Thrombolytic treatment of type A right atrial thrombi: description of three cases and review of the literature.

Type-A right atrial thrombosis is characterized by echocardiographic detection of mobile worm-shaped thromboemboli in the right atrium, with a high propensity to embolic dislocation into the pulmonary circulation. This type of thrombus is associated with a very high mortality rate that exceeds 60% in untreated patients. Surgical embolectomy has been proposed as the treatment of choice, but the availability of an experienced surgical staff and the patients' eligibility for surgical treatment cannot be taken for granted. Efficacy of systemic thrombolysis for treatment of type-A right atrial thrombosis has repeatedly been reported during the past few years, with early mortality rates comparable to those of surgical approach. The major advantages of thrombolysis would be ease of administration and independence of patient's hemodynamic status. Our experience confirms these impressions and argues in favor of the routine use of systemic thrombolysis in the presence of a type-A right atrial thrombus, while reserving surgical embolectomy for patients with formal contraindications to thrombolysis.

Aged↗
PubMed1976

Arterial embolism in the upper limb.

Upper extremity embolectomy was carried out in 20 patients. Two patients died postoperatively of their primary disease. Of the remaining 18 patients 10 had embolectomy performed within 12 hours after the onset of symptoms, 8 of these had excellent results and 2 had fair results. Eight patients were embolectomized after 12 hours, 2 had excellent results, 2 had fair results, 2 poor results and 2 had the forearm amputated.

Adult↗
PubMed1975

[Cardio-respiratory assistance with the extracorporeal membrane oxygenator for massive pulmonary embolism].

A 39 year old pneumectomized patient presents a massive pulmonary embolism, dies within 3 hours and is supported inefficiently by cardiac massage with recurrent mydriasis during 2 hours. At that time, under extracorporeal cardiopulmonary bypass with a membrane oxygenator, the cardiac activity recovers immediatly due to right decompression and coronary perfusion. The patient is conscious within 5 hours. The cardiopulmonary bypass with a membrane oxygenator appears to be the best therapy when the cardiac massage fails to restitute a normal myocardial function. No embolectomy was performed. The patient died when the bypass was stopped after 48 hours. We conclude that the prolonged peripheral extracorporeal bypass followed by embolectomy is the best therapy of pulmonary embolism.

Adult↗
PubMedDate not supplied

[Arterial embolisms of the lower extremities].

INTRODUCTION: Embolism is one of the most frequent causes of lower limbs acute arterial occlusion [1]. Of the total number of peripheral embolism 56% of cases involve lower limbs arteries [2]. Inadequate and late treatment of the lower limbs embolism is associated with high morbidity and mortality rate. The aim of this paper was to study the aetiology of lower limbs embolism and to detect factors influencing early and late results after the operative treatment. PATIENTS AND METHODS: The study included 204 patients with 224 lower limbs embolism, treated surgically at the Institute of Cardiovascular Diseases of the Clinical Centre of Serbia in Belgrade in the period between 1993 and 1997. There were 107 (52.2%) female and 97 (47.8%) male patients. Thirty two (14.3%) patients were younger than 50 years, 64 (28.6%) were between 51 and 65, 101 (45.1%) between 66-75, while 27 patients (12.1%), were older than 75. Twenty (8.9%) patients were admitted less than 6 hours before the operation, 79 (33.3%) between 6 and 24 hours, and 125 (55.8%) more than 24 hours before the operation (Table 1). One hundred (53.6%) patients had motor and 133 (59.4%) sensor paralysis on admission. Table 2 shows arterial localization of the lower limbs embolism. The popliteal artery was involved in most cases. During the operation transfemoral arterial approach was used in 132 (58.9%) cases, while transpopliteal in 92 (41.1%) cases. Fourteen cases required bypass surgery, 43 fasciotomy, 2 intraoperative streptokinase and 4 intraoperative angiography. All patients were controlled using physical and CW Doppler ultrasonographic examinations immediately after the operation, and then one, six and 12 months, as well as every year. RESULTS: In 173 (84.4%) patients cardiac causes of embolism were found, in 8 (3.9%) noncardiac, while in 8 (3.9%) the cause could not be established. Of all cardiac causes absolute arrhythmia was most frequent. Table 3 and Table 4 show the aetiology of the lower limb embolism. The early amputation rate was 23 (10.3%) cases, while limb salvage was recorded in 174 (77.7%) patients. Of all saved limbs complete recovery was noted in 162 (72.4%) cases and peroneal nerve paresis in 12 (5.3%) cases. The early postoperative mortality rate was 27 (12.0%). Table 5 shows early results of embolectomy. The early results (limb salvage, complete recovery, rethrombosis, early reoperations, amputations rate, morbidity and mortality rate) of embolectomy were statistically significant: worse in cases when the embolus was located in the abdominal aorta and popliteal artery; in cases with a long time interval before the operation as well as in patients with sensor-motoric paralysis on admission (Tables 6-8). Of the total number of patients in 87 (56.5%) cases a late control examination was carried out. Forty nine (31.8%) patients died before the late control, while 18 (11.7%) did not come to control examination. Late recidivation of embolism was found in 3 cases. In these patients the cause could not be found, and they were treated by anticoagulant drugs.

Aged↗
PubMedDate not supplied

Treatment of superior mesenteric artery embolism with a fibrinolytic agent: case report and literature review.

Successful treatment of superior mesenteric artery embolism depends on an aggressive approach in patients at risk for mesenteric ischemia. This approach favors an early diagnosis and permits the reestablishment of arterial flow within an appropriate time, with prevention of vasospasm and control of organic insufficiencies. We report here a case of superior mesenteric artery embolism in which arterial flow was reestablished by selective intra-arterial infusion of streptokinase. The literature has reported 18 similar cases thus far. This procedure could be an alternative to embolectomy in selected patients, i.e., patients with an early diagnosis, no evidence of intestinal necrosis and with partial occlusion and/or occlusion of secondary branches of the superior mesenteric artery. Frequent arteriographies and intensive care are necessary in this approach. The patient should be continuously monitored because of the possibility of treatment failure and the need for embolectomy.

Drug Therapy, Combination↗
PubMed1976

Changing clinical trends in patients with peripheral arterial emboli.

One hundred and twenty-four patients treated by Fogarty balloon catheter embolectomy from 1964 through 1973 were reviewed and compared to an earlier series of 82 patients treated by direct extraction during the interval from 1948 to 1963. In patients undergoing embolectomy, the incidence of rheumatic heart disease (RHD) declined from 55 to 27 percent, and that of arteriosclerotic heart disease (ASHD) rose from 39 to 55 percent. The operative mortality rate of those with RHD was unchanged and that of patients with ASHD declined from 74 to 36 percent. This was attributed, in part, to the lesser degree of operative stress entailed by the Fogarty catheter and the local anesthesia. Limb salvage was 82 percent when ischemic symptoms were less than 24 hours in duration and 66 percent when such symptoms were more than 24 hours in duration. The amputation rate for the entire group was 22 percent. The low 2 year survival of patients with ASHD and of amputees was ascribed to the wide extent of their atherosclerotic cardiovascular disease. This was emphasized by the fact that 44 percent of late deaths were due to myocardial infarction.

Adult↗
PubMed2003

[Intensive care management of acute pulmonary thromboembolism].

Three patients with acute pulmonary thromboembolism, who had fallen into cardiopulmonary arrest or severe respiratory failure, were treated and saved in our intensive care unit. Two patients were resuscitated with percutaneous cardiopulmonary support device. Two patients underwent surgical embolectomy and we carefully applied positive pressure ventilation to prevent postoperative reperfusion pulmonary edema. Early diagnosis and treatment are essential for saving critically ill patients with acute pulmonary embolism. However, cardiopulmonary resuscitation is often difficult and unsuccessful. Therefore prophylaxis is strongly recommended especially in patients with known risk factors of venous thrombosis. Since reperfusion pulmonary edema is a serious complication after surgical pulmonary embolectomy, careful postoperative respiratory care is needed.

Acute Disease↗
PubMed2003

[Surgical treatment of peripheral vascular injuries after cardiac catheterization].

OBJECTIVE: Diagnostic and therapeutic cardiac interventions have being performed in expanding numbers during last years. Forty-two cases with peripheral vascular injuries requiring surgical therapy after 64.911 cardiac interventions in our center between 1985 and 2002 were evaluated retrospectively. METHODS: Thirty-three of vascular injuries (78.6%) occurred after angiography/catheterization, and the remaining vascular injuries (21.4%) occurred after angioplasty/stent procedures. There were 12 female (28.6%) and 30 male (71.4%). The mean age was 51.3+/-4.1 years. The localization of the arterial injuries were femoral region in 37 cases (88.1%) and brachial region in 5 cases (11.9%). The complications were recorded as arterial thrombosis in 19 cases, pseudoaneurysm in 14 cases, hematoma in 5 cases, arteriovenous fistula in 2 cases, deformed stent stuck in 2 cases. Arterial injuries were treated by performing embolectomy in 16 cases, embolectomy and saphenous patch plasty in 3 cases, resection of pseudoaneurysm and PTFE patch plasty in 1 case, draining of hematoma and primary repair in 5 cases, primary repair of femoral arteriovenous fistula in 2 cases and removal of the deformed stent from femoral artery in 2 cases. RESULTS: The incidence of vascular complications was significantly higher in brachial interventions when compared with femoral interventions (p<0.0001). The postoperative morbidity was found as 14.3% in our cases. CONCLUSION: The early diagnosis and treatment are very important in peripheral vascular complications after cardiac interventions; otherwise, delay can cause loss of related extremity.

Adolescent↗
PubMed1992

[Angioscopy in peripheral vascular surgery].

At Saint-Luc's Hospital of Montreal, between January 1, 1990 and February 1, 1991, 47 angioscopic procedures were done in 43 patients submitted to peripheral vascular reconstructions. The purpose of the study was to evaluate the role of angioscopy during those procedures. The operations were as follows: twenty femoropopliteal bypasses done with reversed saphenous vein, 15 done with in situ saphenous veins and 10 done with synthetic grafts. Two patients had popliteal embolectomies. Seventeen percent of the cases showed technical problems with the use of controlled angioscopy and were subsequently corrected. Three residual valves and one unsuspected venous stenosis were found in 15 in situ grafts, for a total of 27% correctible defects. In the reversed saphenous group, one case of venous sclerosis and one case of anastomotic stenosis were found for a total of 10%. For the synthetic grafts group we found an intimal flap distal to the anastomosis in one case (10%). Finally, we found a significant residual clot in one case (50%) after embolectomy. The technique of angioscopy is simple, the equipment reliable, and the learning period is short. Angioscopy is a very useful approach and should be readily available in the armamentarium of every vascular surgeon.

Adult↗
PubMed1992

Surgery for massive pulmonary embolism.

Pulmonary embolectomies were performed in 30 patients from January 1973 until December 1991 in the University Hospital of Leuven. There was an 80% hospital survival. The late follow-up showed no recurrent pulmonary emboli. The preoperative haemodynamic status was the most important predictor for survival. Patients, under cardiopulmonary resuscitation or in profound cardiogenic shock before surgery, had a survival of only 50% while all other patients survived. Angiography, performed in only 23% of the cases, remained the most important diagnostic tool until the advent of transthoracic and transoesophageal echocardiography. Thrombolysis is an acceptable alternative in the stable patient, but pulmonary embolectomy is life-saving in the haemodynamically unstable patient and when thrombolysis is contraindicated.

Adult↗
PubMed1992

[Shotgun pellet embolus in the cerebral circulation via the internal carotid artery in the neck; a case report].

A 57-year-old hunter was shot accidentally and admitted to our hospital without any neurological deficits. Plain X-ray films of the neck revealed the presence of several shotgun pellets, one of which was thought to be in the vicinity of the right internal carotid artery at the C1 level. One week later, while surgical removal of pellets was being performed under fluoroscopic control, the pellet entered into the lumen of the artery and migrated to the intracranial vessels. Right carotid angiogram revealed that the pellet occluded in the right angular artery about 1.5cm distal from its outlet. Although embolectomy was performed, we could not get a patency of the vessel. CT scan taken 3 days after operation showed the occurrence of massive cerebral edema. Angiogram taken 2 weeks after confirmed occlusion of the vessel. The patient was discharged with left lower quadrantanopsia one month after the operation. In the literature, 20 similar cases have been hitherto reported and briefly reviewed. Of these 20, 6 cases died of cerebral infarction. We believe that embolectomy is warranted as soon as possible when patients show a condition building up to a stroke.

Carotid Artery, Internal↗
PubMed2005

Peripheral ischemia caused by paradoxical embolization: an underestimated problem?

Although a patent foramen ovale (PFO) is often found in younger patients with transient ischemic attacks or stroke, paradoxical embolization through PFO is rarely considered as a cause of acute limb ischemia. We report a single-center experience of 5 consecutive patients with limb-threatening ischemia due to paradoxical embolization within a one-year period. All patients were treated by catheter thrombectomy and long-term oral anticoagulation after surgery. The fact that the 5 embolectomies made up 10% of all embolectomies performed in our center during this time interval may indicate that the role of paradoxical embolization is still underestimated in peripheral embolic disease.

Aged↗
PubMed2005

[Modern approach to treatment in pulmonary thromboembolism].

Pulmonary embolism (PE) and deep vein thrombosis (DVT), respectively venous thromboembolism (VIE), are relatively frequent diseases. Appropriate management of PE includes risk stratification, preventive and primary therapy. Appearance of the disease ranges from mild to severe, and rapid and accurate risk stratification is extremely important. So appropriate management can range from prevention of recurent PE with anticoagulant therapy alone in low risk patients, to clot disolution or embolectomy in high risk patients. Preventive therapy prevents recurent VTE including anticoagulant therapy with heparin (low molecular weight heparin-LWM or unfr actional UFH), direct thrombin inhibitors (DTI) or oral anticoagulants. Primary therapy includes thrombolitic therapy or embolectomy (catheter or surgical). Prevention DVT and VTE includes mechanical and pharmacological measures in internal medicine, in general, cancer and orthopedics surgery.

Humans↗
PubMed1991

[Acute arterial neoplastic embolism after pneumonectomy for primary bronchial cancer. Clinical and therapeutic consequences apropos of a case].

We report a case illustrating the therapeutic consequences of an intravenous metastasis to the left superior pulmonary vein following resection of a voluminous primary lung carcinoma. Arterial spread of malignant cells occurred because the size of the tumor did not allow immediate clamping of the left superior pulmonary vein. The embolism was situated at the aortic bifurcation and lower limb ischemia persisted despite also emergency embolectomy. Distal (lower popliteal) embolectomy was also unsuccessful, and lower limb amputation was inevitable. This case illustrates the problems encountered in surgical treatment of pulmonary vein invasion by lung carcinoma and the role of adjuvant chemotherapy and radiotherapy.

Acute Disease↗
PubMed1991

[Acute neoplastic arterial embolism after pneumonectomy for primary bronchial cancer. Clinical and therapeutic consequences apropos of a case].

We report a case illustrating the therapeutic consequences of an intravenous metastasis to the left superior pulmonary vein following resection of a voluminous primary lung carcinoma. Arterial spread of malignant cells occurred because the size of the tumor did not allow immediate clamping of the left superior pulmonary vein. The embolism was situated at the aortic bifurcation and lower limb ischemia persisted despite also emergency embolectomy. Distal (lower popliteal) embolectomy was also unsuccessful, and lower limb amputation was inevitable. This case illustrates the problems encountered in surgical treatment of pulmonary vein invasion by lung carcinoma and the role of adjuvant chemotherapy and radiotherapy.

Acute Disease↗
PubMed1991

[Embolic occlusion of arteries of the upper extremity].

Ninety-nine patients underwent embolectomy of upper extremity arteries; in 12% of the cases reoperation and in 4% amputation was necessary. Thrombosis is the cause of reocclusion of the brachial artery, based on endothelial lesions of the axillary passing into the brachial artery. At autopsy studies these andothelial lesions were verified by histological and electron-microscopical examinations in a high percentage. Therefore embolectomies should be performed very carefully by means of thin fogarty catheters. Postoperative anticoagulant therapy seems to improve the survival rate.

Adult↗