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At least 1,531 records · Page 85Linked to original sources
PubMed1991

[Successful treatment of a fulminant pulmonary embolism using a high-dose bolus injection of urokinase during cardiopulmonary resuscitation].

Experience has shown that the bolus injection of streptokinase during resuscitation in case of fulminant pulmonary embolism considerably improves the prognosis. In the case presented here a 64-year old female patient with a fulminant pulmonary embolism was injected with 2 x 1,000,000 I.U. urokinase after 20 minutes of unsuccessful cardiopulmonary resuscitation. Ten minutes after the second injection the circulation could be stabilised by drugs only. The patient survived without any lasting damage. The mechanism of fibrinolysis during resuscitation is discussed. It is also possible to check the diagnosis during resuscitation using echocardiography or angiography. However, treatment must usually start immediately only on clinical diagnosis. Resuscitation in the case of a pulmonary embolism can even be successful after much longer than one hour. Contra-indications must be ignored in such cases. Side effects, which are usually haemorrhages, can as a rule be treated. In our opinion urokinase should be given by preference in the bolus injection during resuscitation. The exception to this is the primary operation during resuscitation. Pulmonary embolectomy is also possible after unsuccessful fibrinolysis.

Female↗
PubMed1985

Treatment of heparin-associated thrombocytopenia and thrombosis with low molecular weight heparin (CY 216).

This report concerns 34 cases of heparin-associated thrombocytopenia in which standard heparin has been systematically replaced by LMW heparin CY 216 Choay. There were 21 women and 13 men, mean age, 69 years. Twenty-six of the 34 cases had thrombotic complications. All of the patients were treated by standard heparin of porcine mucosal origin, in most cases for prevention of deep vein thrombosis and pulmonary embolism. Twenty-six cases occurred along with orthopedic and traumatologic surgery (especially for total hip replacement, 15 cases). Four cases involved vascular surgery and three involved medical thrombotic disease. Standard heparin treatment was always replaced by LMW heparin CY 216. Initial doses were 0.30 ml three times daily, later increased to obtain global hypocoagulability. Surgical procedures (embolectomy and vena cava filter) were carried out when necessary. Five patients had thrombolytic treatment (urokinase) in conjunction with LMW heparin. The overall results were 31 recoveries, but with seven severe sequelae (three amputations and four hemiplegias) most often attributable to the first ischemic attack, and three deaths. For the last 16 patients, indirect platelet aggregation tests were performed (control platelet-rich plasma plus patient platelet-poor plasma plus LMW heparin): nine cases had negative tests, with nine recoveries and seven cases had positive tests, with five recoveries and two deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1997

Trapped thrombus in a patent foramen ovale.

We report two cases of impending paradoxical embolism through a patent foramen ovale. A 73-year-old male had recurrent pulmonary embolism and a large thrombus trapped in a patent foramen ovale. The other patient, a 70-year-old male had septic mediastinitis after prior bypass surgery and a large thrombus lodged in a patent foramen ovale. Cardiac embolectomy and closure of the foramen ovale was performed in both cases because of impending paradoxical embolism. In addition pulmonary thromboendarterectomy was performed to relieve pulmonary hypertension. Therapeutical options are discussed.

Aged↗
PubMed1997

Cardiac hydatid cyst causing massive pulmonary embolism.

Cardiac hydatid cyst is a rare parasitic disease. Since it may be associated with fatal complications, early diagnosis and treatment of a cardiac hydatid cyst is very important. We present a case with hydatid cyst localized in the right atrium and bilaterally in the lungs, and embolized pulmonary arteries bilaterally. The right atrial cyst localized on the interatrial septum was removed using cardiopulmonary bypass and the cyst in the right pulmonary artery was extracted by an embolectomy catheter. The patient died of pulmonary hypertension and pulmonary insufficiency three months postoperatively.

Adult↗
PubMed1998

[Local fibrinolysis of peripheral arterial occlusions].

PURPOSE: Since their discovery more than 60 years ago fibrinolytic agents have shown their therapeutical efficiency in myocardial infarction and other thromboembolic disorders in clinical studies. Local catheter fibrinolysis as an alternative to surgical embolectomy was established in the mid eighties. Fibrin-specific agents such as rt-PA and pulse-spray fibrinolysis as a new catheter technology were developed in order to improve the efficiency of local fibrinolysis and to minimize complications such as bleeding. The purpose of this paper is to review the historical and recent developments of fibrinolytic agents and catheter technologies, and to describe the methods, indications, and complications of local fibrinolysis.

Arterial Occlusive Diseases↗
PubMed1994

Primary pulmonary-artery sarcoma. Report of a case with complete resection and graft replacement, and review of 47 surgically treated cases reported in the literature.

A case of pulmonary leiomyosarcoma originating in the left pulmonary artery stem in a 28-year-old Japanese man is reported. The patient complained of recurrent hemoptysis. The diagnosis was made at exploratory thoracotomy. Two days following thoracotomy, under cardio-pulmonary bypass, the upper one-third of the pulmonary trunk and part of the right pulmonary artery stem were resected and left pneumonectomy was performed. A Dacron prosthetic 23 mm composite graft was inserted to replace the pulmonary trunk and a portion of the right pulmonary artery. Postoperative course was uneventful. The patient died about 8 months after surgery because of right lung metastases. In our review of surgically treated forty-eight cases, complete resection was performed in 11, incomplete resection in 23, and embolectomy in 6, whereas 8 were unresectable. A localisation often not allowing adequate resection of the tumor or the advanced stage of the tumor at surgery are considered the main causes of the poor prognosis of the pulmonary sarcoma.

Adult↗
PubMed1991

Possibilities of interventional ultrasound (IVUS) in intraoperative diagnostics and quality control in peripheral vascular surgery.

The IVUS system allows for a complete, only slightly invasive assessment of the femoral, pelvic and abdominal vessels in cross-section within the framework of intraoperative diagnostics and quality control. This method provides clear information concerning the vascular walls and internal structure. In our experience so far, it provides an ideal form of intraoperative control in cases of venous thrombectomy, embolectomy in the abdominal and pelvic vessels, following half-closed and open thromboendarterectomy and after intraoperatively performed angioplastic interventions.

Embolism↗
PubMed1987

Advances in vascular endoscopy.

In reconstructive vascular surgery several intraoperative investigations are in use to check-up and secure full blood flow restoration (angiography, ultra-sound, electro-magnetic flowmeter etc.). In the last years endoscopical lumen control, introduced 1969 in clinical praxis, could be remarkably simplified and improved. For vascular endoscopy three technical prerequisites are necessary: a) temporary interruption of blood flow using clamps or balloon catheters, b) replacement of the blood by a transparent medium via pressure controlled saline perfusion, c) availability of suitable special endoscopes. The main application of vascular endoscopy includes: a) semi-closed thromboendarterectomy (aorto-iliac or femoropopliteal), b) arterial embolectomy, c) lumen control of inserted grafts including the anastomosis and the distal run-off vessels, d) venous thrombectomy. The availability of small-calibre endoscopes (external diameter: 1.7-2.7 mm) enables the extension of lumen control to small vessel areas such as the tibial and coronary arteries. Compared with angiography vascular endoscopy offers several convincing advantages such as a more reliable three dimensional lumen control, easy performance, saving time and the avoidance of any additional X-ray exposure. Technical faults or overlooked concomitant vascular lesions can be diagnosed and corrected immediately.

Angiography↗
PubMed1985

[Indications for the intra-arterial infusion of urokinase in the treatment of acute intestinal ischemia in patients with heart disease].

The poor prognosis of acute mesenteric artery occlusion can be improved by reaching a rapid angiographic diagnosis and by instituting treatment at an early stage. In addition to operative embolectomy, success may be expected from the use of urokinase infused super-selectively into the superior mesenteric artery. This treatment is only likely to be successful if it is carried out within ten hours of the onset of clinical signs and symptoms. In patients with heart disease, angiography is recommended as soon as there is any suspicion of mesenteric occlusion, in order to confirm the diagnosis, localise the embolus and decide on the form of treatment. Urokinase treatment can be successful for embolic occlusion of the main branches or peripheral branches of the superior mesenteric artery. However, complete occlusion of the main superior mesenteric artery should be treated operatively. A contra-indication to urokinase therapy is occlusion due to infected emboli from an endocarditis.

Acute Disease↗
PubMed1991

Complications of preoperative balloon test occlusion of the internal carotid arteries: experience in 300 cases.

Treatment of some tumors and aneurysms of the skull base may require internal carotid artery (ICA) sacrifice. Preoperatively to determine the dependence of the cerebral blood flow on a particular vessel, we perform a balloon test occlusion (BTO) by temporarily occluding the vessel in an awake patient. During occlusion, clinical evaluations and cerebral blood flow measurements are assessed. We have performed 300 BTOs. Eleven patients (3.7%) have had complications. Six (2%) were asymptomatic dissections. Five (1.7%) had neurologic deficits that persisted beyond the test period. Of these five, one was back to baseline in less than 24 hours, one recovered completely in a week, and one (0.33%) had a minimal but persistent dysphasia. These latter three cases are unexplained but might have resulted from unrecognized dissections or embolic events. Finally, one patient with a persistent deficit required energency surgery for reasons unrelated to the BTO and was therefore difficult to assess, and one required emergency middle cerebral artery embolectomy and repair of the dissection. The preoperative knowledge of carotid dependence in cases in which the ICA is at risk is essential, since vascular grafts or alternative surgical approaches are necessary in patients unable to tolerate carotid sacrifice. Since approximately 15 to 20% of the population falls into this category, a preoperative BTO appears justified.

Journal Article↗
PubMed1992

[Malignant fibrous histiocytoma of the aorta].

Upper gastrointestinal bleeding occurred in a 64-year-old woman who was being treated with 1,000 mg acetylsalicylic acid and three times 5,000 IU heparin daily previous to a planned embolectomy because of occlusion of a lower leg artery. Radiology demonstrated multiple areas of osteolysis of the left thorax which were interpreted as recurrence of carcinoma of the breast, treated by mastectomy and radiotherapy 15 years previously. Acute renal failure, recurring severe back and abdominal pain, paraplegia of both legs and finally death from circulatory failure were explained as having been caused by multiple embolisation in the course of arteriosclerosis or a paraneoplastic increase in clotting activity. Autopsy revealed complete occlusion of the descending thoracic aorta by a malignant fibrous histiocytoma which had been the site of multiple emboli of thrombotic material and tumour tissue to spleen, kidneys, liver, intestinal segments, spinal cord and the artery to the left lower leg. Adrenal metastasis and osteolysis of the ribs were due to the histiocytoma and not the previously known carcinoma of the breast.

Aorta, Thoracic↗
PubMed1991

[An idiopathic floating left-ventricular thrombus].

Four weeks after appendicectomy a 28-year-old man developed dragging pains in the left calf. Left popliteal, posterior tibial and dorsalis pedis arteries could not be palpated. Angiography revealed an embolic occlusion of the left superior femoral artery at the level of the adductor canal. Echocardiography demonstrated a pedunculated left ventricular thrombus, 3.5 x 2.0 cm, as a possible source of the embolus. After successful trifurcation embolectomy and saphenous vein patch-plasty acenocoumarol, 4 mg/d and heparin, 3 x 7500 IU/d were administered. Because the thrombus failed to shrink, systemic thrombolysis, initially 750,000 IU streptokinase and 3000 IU heparin i.v., was begun. After five days the thrombus diameter had decreased to 0.7 cm. But because thrombus movement had increased, streptokinase was replaced by 70 IU/d ancrod i.v. The thrombus completely disappeared within two weeks. The patient was symptom-free during the period of anticoagulation with acenocoumarol. Six months later echocardiography confirmed the absence of thrombus in the left ventricle.

Acenocoumarol↗
PubMed1990

[Systemic lysotherapy using recombinant tissue plasminogen activator for fulminant pulmonary embolism].

A 44-year-old woman sustained massive pulmonary embolization from a deep leg-vein thrombosis. She was given 70 mg recombinant tissue plasminogen activator (rt-PA) by continuous intravenous drip over two hours. Before this treatment perfusion scintigraphy had demonstrated complete absence of flow in the right lung due to embolic occlusion of the central hilar vessels. In addition there were several segmental filling defects in the left lung. Even during the two-hour infusion the circulatory state began to improve, as did echo- and electrocardiographic signs of acute right heart strain. Correspondingly there was a rapid raise in arterial pO2. Another scintigraphy after 48 hours revealed almost complete reperfusion of the right lung and the left lung segments. This case demonstrates that infusion of rt-PA can be an effective and relatively risk-free method of treating haemodynamically significant massive lung embolism, even in comparison with selective or systemic thrombolysis with urokinase or streptase or with surgical embolectomy.

Adult↗
PubMed1990

[Transmetatarsal border zone amputation in arterial blood supply disorders].

Transmetatarsal amputations (TA) were performed in 32 patients (22 men, 10 women; mean age 64 [40-91] years) with occlusive arterial disease. Previous revascularization procedures (bypass, thrombendarterectomy, embolectomy) had been performed in 26 patients. Surgical results of TA after one year were good in 16, satisfactory in seven, and unsatisfactory in nine. Further amputations became necessary after a mean of 52 (4-221) days in four of the six patients without and five of 26 with previous revascularization. Follow-up examination 1-6 years after discharge found that six had died, 16 were able to walk and fully rehabilitated, while in ten walking was limited and they required help in walking.

Adult↗
PubMed1986

[Percutaneous aspiration thromboembolectomy: an additional transluminal angioplasty method].

Percutaneous aspiration-thromboembolectomy is a simple method for removal of thrombo-embolic material of diverse origin. It is highly effective with small material outlay. As a third angioplasty method it has considerably improved the success rates of balloon dilatation and local lysis treatment with urokinase or streptokinase. The procedure was used alone or in combination on 71 occasions involving 69 limbs in 66 patients. An angiographically demonstrable success was seen in 96% and clinical improvement in 91.6%. Local lysis treatment with streptokinase or urokinase was shortened, less hazardous and, because of removal of non-lysable material, more successful. Embolectomy with the Fogarty catheter remains the method of choice for treating emboli arising from the heart in vessels of the aorto-iliac system. For smaller vessels below the inguinal ligament, however, we consider the new, lesser invasive method to be an alternative to vessel surgery.

Adult↗
PubMed1980

[Local streptokinase treatment in acute pulmonary embolism with shock (author's transl)].

Streptokinase (290 000 U/2 h) was directly infused under angiographic control into the predominantly affected right pulmonary artery in a 71-year-old patient with acute pulmonary embolism and persistent shock. This led to immediate complete remission of shock symptoms and lasting stabilisation of the patient. If, as this case demonstrates, embolectomy is not possible and high-dose intravenous streptokinase is contraindicated, localised use of streptokinase in low dosage offers a possibility for treatment of life-threatening pulmonary embolism.

Aged↗
PubMed1997

A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire.

BACKGROUND: Low-molecular-weight heparin appears to be at least as effective and safe as standard, unfractionated heparin for the treatment of deep-vein thrombosis, but only limited data are available on the use of low-molecular-weight heparin to treat acute symptomatic pulmonary embolism. METHODS: We randomly assigned 612 patients with symptomatic pulmonary embolism who did not require thrombolytic therapy or embolectomy to either subcutaneous low-molecular-weight heparin (tinzaparin) given once daily in a fixed dose or adjusted-dose, intravenous unfractionated heparin. Oral anticoagulant therapy was begun between the first and the third day and was given for at least three months. We compared the treatments at day 8 and day 90 with respect to a combined end point of recurrent thromboembolism, major bleeding, and death. RESULTS: In the first eight days of treatment, 9 of 308 patients assigned to receive unfractionated heparin (2.9 percent) reached at least one of the end points, as compared,with 9 of 304 patients assigned to low-molecular-weight heparin (3.0 percent; absolute difference, 0.1 percentage point; 95 percent confidence interval, -2.7 to 2.6). By day 90, 22 patients assigned to unfractionated heparin (7.1 percent) and 18 patients assigned to low-molecular-weight heparin (5.9 percent) had reached at least one end point (P=0.54; absolute difference, 1.2 percentage points; 95 percent confidence interval, -2.7 to 5.1). The risk of major bleeding was similar in the two treatment groups throughout the study. CONCLUSIONS: Under the conditions of this study, initial subcutaneous therapy with the low-molecular-weight heparin tinzaparin appeared to be as effective and safe as intravenous unfractionated heparin in patients with acute pulmonary embolism.

Acute Disease↗