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PubMed1999

Thromboembolism in the right side of the heart.

Right-sided cardiac thromboemboli, or pulmonary emboli-in-transit, represent an unusual disease process with high morbidity and mortality. We present a detailed case report and a synopsis of our experience at the University of Mississippi Medical Center between 1990 and 1997 and review the current medical literature. These thrombi and emboli may largely be subdivided into type A--a mobile, serpiginous clot that is probably a mobilized deep vein thrombus--and type B--a rather immobile clot morphologically similar to left-sided heart thrombi that may represent intracardiac thrombosis. The mainstays of therapy include surgical embolectomy and thrombolysis, but there is no clear benefit of one over the other. Treatment should be individualized according to the clot's size and morphology, likelihood of preexisting pulmonary embolism, the patient's cardiopulmonary reserve, comorbid conditions, and local expertise with treatment modalities.

Adult↗
PubMed2002

Severe erosion of lumbar vertebral body because of abdominal aortic false aneurysm: report of two cases.

STUDY DESIGN: Two cases of lumbar vertebral erosion resulting from abdominal aortic false aneurysm are reported. OBJECTIVE: To present an uncommon complication of aortic endoprosthesis causing spinal pathology. SUMMARY OF BACKGROUND DATA: Vertebral body pathologies usually are associated with fracture, osteoporotic collapse, tumor, spondylitis, or spondylodiscitis. Aortic abdominal aneurysm rarely has been reported as causing lytic lesions of the spine. METHODS: A retrospective case analysis was performed for two patients with an aorta bifurcation prosthesis and lytic lesions of the spine. False aneurysms were detected at the proximal junction of the prostheses. A biopsy of the affected vertebrae showed no infection or malignancy. Surgery was performed in both cases, and the prostheses were successfully revised. In one case, an anteroposterior spinal fusion was performed because of severe anterior bone loss. RESULTS: The back pain of both patients resolved completely after surgery. In one of the patients, an embolectomy in the right leg failed, and a below-the-knee amputation had to be performed. CONCLUSIONS: In patients with endovascular prostheses, false aneurysm should be considered when lytic lesions of vertebral bodies are differentially diagnosed because these patients can present with only spinal symptoms.

Aged↗
PubMedDate not supplied

Treatment of venous thromboembolism.

Venous thromboembolism (VTE), comprised of pulmonary embolism (PE) and deep vein thrombosis (DVT), is a disease entity with a significant morbidity and mortality. Anticoagulation, initially with intravenous heparin and followed with long term warfarin treatment is the traditional therapy for VTE. Low molecular weight heparin, (LMWH) has a greater bioavailability than unfractionated heparin and can be administered subcutaneously. LMWH has resulted in shorter hospitalizations, reduced inicidents of major bleeding complications, and has moved the treatment of VTE for selected patients to the out-patient setting. Thrombolytic therapy has been recommended in patients with life threatening PE such as those with right ventricular dysfunction or hypotension. There are advances in the technology for clot removal with catheter embolectomy and clot fragmentation. Inferior vena cava filters can be place percutaneously in patients who are at high risk for VTE or those in whom anticoagulation is contraindicated. Since VTE is often asymptomatic, prevention is the most effective means to reduce morbidity and mortality.

Anticoagulants↗
PubMed2003

Biliary ascariasis: percutaneous transhepatic management.

In a 60-year-old woman who underwent cholecystectomy and T-tube drainage for biliary ascariasis, postoperative bilirubin levels continued to increase. T-tube cholangiography revealed multiple filling defects in the bile ducts, which suggested roundworm reinfestation. Because the patient could not tolerate endoscopy, a percutaneous transhepatic approach with balloon dilatation of the ampulla of Vater and subsequent advancement of roundworms into the duodenum with an embolectomy balloon was used. The procedure was successful, with no major complications. The use of a percutaneous transhepatic treatment to advancement of roundworms into the duodenum is a feasible alternative to surgery when endoscopic extraction fails.

Ascariasis↗
PubMed2004

Early and mid-term results of totally laparoscopic surgery for aortoiliac disease: lessons learned.

The present article is the first in the literature reporting short- and medium-term results using a totally laparoscopic technique for aortoiliac disease.Forty-nine patients, 6 having an associated small aneurysm, were scheduled for totally laparoscopic surgery (TLS) for aortoiliac occlusive disease and 2 for treatment of aortic aneurysmal disease (AAA). Patients' characteristics, intraoperative, postoperative data and mid-term data were recorded.TLS was successfully completed in 45 patients. Of those patients, 41 received an aortobifemoral bypass; three, an iliofemoral bypass; and one, an aortoaortic bypass. Five patients were converted from TLS to video-assisted laparoscopic surgery using incisions varying in size from 7 cm to 11 cm. One patient underwent conversion to standard open surgery. One death occurred unrelated to the technique. Major perioperative complications related to the technique were few and presented in the early phase of the study: One intraoperative embolization to the lower limbs that needed embolectomy, and one acute aortic false aneurysm. Midterm results were favorable, demonstrating two limb graft thromboses. Hernias at trocar sites occurred in only 3.9%. The patients benefited from this procedure, which is considered definitive like its standard open counterpart. The conversion rate is lower than that reported for acute cholecystitis. Selection of patients has been less stringent during the second half of the study in term of inclusion of patients with AAA and of more TASC IV patients. Surgeons willing to learn this technique should attend dedicated courses. In the future, as this surgical innovation matures, controlled randomized studies should be initiated.

Adult↗
PubMed1979

Massive embolization of cardiac myxoma. A case report.

A case of left atrial myxoma with massive embolization in a 20-year-old woman is described. The initial clinical picture was confusing, but repeated examinations, including enzyme determinations and arteriographies, disclosed the presence of multiple arterial emboli. At embolectomy, histological investigation of embolic masses showed a picture indicating cardiac myxoma. This diagnosis was confirmed by pulmonary angiography and the tumour was removed. Postischaemic oedema of the legs necessitated decompression operations. The peripheral circulation was restored and the final result was excellent. Some aspects of the clinical presentation of this uncommon disease are discussed.

Adult↗
PubMed1989

Serum and urinary phosphate during and after prolonged muscular ischaemia in non-exercising men and women.

Serum inorganic phosphate (Pi) concentrations and urinary Pi excretions were measured in nine patients undergoing abdominal aortic bypass grafting (group I) and in nine patients undergoing lower limb arterial embolectomy (group II). In group I, serum Pi concentrations were normal until 24 h after reperfusion, when they decreased, reaching their nadir at 48 h (median Pi 0.45 mmol 1(-1). The urinary phosphate clearance relative to the creatinine clearance (Cp/Cc) increased 5 min after reperfusion reaching a maximal median value (0.454) in the 2-24-h collection period. In group II, eight patients had a normal and one had a subnormal serum Pi before reperfusion. None developed hypo- or hyperphosphataemia and the Cp/Cc remained unchanged. Daily urinary Pi excretion was higher in group I than in group II (P less than 0.03). The authors concluded that the regional muscular ischaemia in non-exercising men and women was not associated with hyperphosphataemia. The possible influence of major surgery and anaesthesia on phosphate homeostasis should be considered.

Aorta, Abdominal↗
PubMed1987

Evaluation of the usefulness of enzymatic diagnosis of myocardial infarction in patients with acute arterial occlusion of the lower extremities.

The serum activities of aspartate aminotransferase, lactate dehydrogenase, creatine kinase and estimated creatine kinase isoenzyme MB (CK-B) were investigated in 12 patients before and after revascularization of ischaemic lower extremities. All patients suffered from sudden lower limb arterial occlusion and underwent embolectomy through a small arteriotomy in the groin. The median serum activity of all four enzymes was elevated before surgery and further increased during the first 24-48 h after revascularization. Median serum activity of aspartate aminotransferase, creatine kinase and lactate dehydrogenase were continuously elevated 7 days after the operation. A high relative CK-B activity coincided in one patient with the development of electrocardiographic evidence of acute myocardial infarction. It is concluded that any of these four enzymes should be used with caution in the diagnosis of acute myocardial infarction before, during or after operation in patients who have sustained prolonged ischaemia of the lower extremities.

Acute Disease↗
PubMed2005

Anaesthetic considerations in a patient with right heart thrombi-in-transit.

This is a case report of a patient with underlying pulmonary thromboembolism who was diagnosed as having a large, mobile right heart thrombi while undergoing treatment with low-molecular weight heparin. She underwent emergency embolectomy with exploration of the right heart under a cardiopulmonary bypass (CPB). Soon after induction of anaesthesia, the patient had an episode of severe hypotension, which responded to inotropes. Large, serpiginous thrombi were found in the right atrium extending into the right ventricle and pulmonary arteries, which were evacuated. She was weaned off CPB on inotropic support and was extubated uneventfully on the 4th POD. Postoperatively, she was started on anticoagulant therapy and also underwent placement of a Greenfield inferior vena caval (IVC) filter to prevent further thromboembolic episodes.

Adult↗
PubMed1998

Spontaneous arterial thrombosis in association with pancreatic carcinoma: diagnosis and interventional management.

A 58-year-old woman presented with bilateral upper limb ischaemia. Digital subtraction angiography demonstrated upper limb arterial thrombosis, extensive on the left. This was initially treated with catheter-directed thrombolysis which cleared the thrombus on the right, although the left upper limb required supplementary surgical embolectomy. Subsequently, biopsy-proven pancreatic adenocarcinoma was detected. The upper limb arterial thrombosis appeared to be spontaneous in association with the malignancy because there was no obvious embolic source.

Adenocarcinoma↗
PubMed1993

Pulmonary hypertension due to tumor emboli: a report of three autopsy cases with morphological correlations to radiological findings.

Three cases of pulmonary hypertension caused by tumor emboli to the lungs are described. Two of the three cases had a clinical diagnosis of pulmonary thromboembolism until surgical embolectomy, and the other had a diagnosis of primary pulmonary hypertension. Autopsy disclosed chondrosarcoma, choriocarcinoma and gastric cancer as the primary tumors, respectively. Pulmonary vascular obstruction due to tumor embolism leading to pulmonary hypertension is a previously rare clinical entity, and obstructed pulmonary vessels are believed to tend to be small vessels. We compared the autopsy and radiological findings and concluded that pulmonary tumor embolism involved not only the small peripheral arteries but also the segmental and/or lobar arteries.

Adult↗
PubMed1996

Renal primitive neuroectodermal tumor: an immunohistochemical and cytogenetic analysis.

The cytogenetic and morphologic characteristics of a case with a primitive neuroectodermal tumor (PNET) arising from the left kidney in a 22 year old man are presented. The patient was detected as having a left renal mass with a tumor embolus in the inferior vena cava and multiple pulmonary metastases. A radical nephrectomy with tumor embolectomy of the inferior vena cava, along with a resection of the pulmonary nodules were performed. Histologic examination revealed a dense proliferation of small round cells with many Homer-Wright type rosettes and perivascular pseudorosettes. Immunohistochemically, the tumor cells stained strongly positive for HBA71(p30/32MIC2), a surface glycoprotein specific to PNET and Ewing's sarcoma. In addition, the tumor cells expressed several neural markers (neuron specific enolase, neurofilament, synaptophysin, and Leu-7) and vimentin, while the epithelial, muscular, and lymphocytic markers were negative in the tumor cells. Cytogenetic analysis of cultured tumor cells showed a reciprocal translocation t(11;22)(q24;q12) that is considered to be specific to PNET and Ewing's sarcoma. In conclusion, this case suggested that a karyotyping analysis is a useful diagnostic tool for renal PNET, and it may therefore be utilized to help distinguish between difficult cases of small round cell tumors and Wilms' tumor of the kidney.

Adult↗
PubMed1975

Upper limb emboli: a reappraisal.

Upper limb embolus cannot be regarded as a benign condition, with invariable recovery due to copious collateral circulation. Gangrene of the upper limb may occur, as shown in the series of cases in this report. The overall mortality rate remains considerable, because of associated cardiac disease, recurrent embolism, or both. Emboli proximal to the origin of the profunda brachii artery represent a group associated with higher risk, for which prompt embolectomy is often indicated. In embolism due to subclavian aneurysm and with thrombosis, arterial reconstruction should be undertaken, for multiple recurrence is likely. Long-term anticoagulant therapy is usually required to try to prevent recurrence of embolism if the primary source of the embolus remains.

Adolescent↗
PubMed1981

Infected ventricular septal defect.

This paper reports a case of recurrent septic pulmonary emboli resulting from bacterial endocarditis on a ventricular septal defect. This was managed by the removal of vegetations, resection of the septal leaflet of the tricuspid valve, closure of the ventricular septal defect, and pulmonary embolectomy. The literature regarding the incidence and mortality of bacterial endocarditis on ventricular septal defects, and the management of the infected tricuspid valve, is reviewed. The patient remains well two and a half years after surgery.

Adult↗
PubMed1988

Femoral false aneurysms: a recommendation for the method of repair.

False aneurysm formation is a major complication of vascular surgery. The most frequent site of anastomotic false aneurysm formation is the femoral artery. Between January 1974 and June 1986, 26 patients with 42 femoral false aneurysms were treated at the Princess Alexandra Hospital. Aneurysms developed following Dacron arterial grafting (29 aneurysms), saphenous vein grafting (10 aneurysms), umbilical vein grafting (one aneurysm) and femoral embolectomy (two aneurysms). Arterial wall failure (with intact suture and graft) was the most frequent operative finding. Ten recurrent aneurysms developed. There was a significantly greater number of recurrences when resuture or patch repair was employed than when an interposition graft was used as a repair. The development of a femoral anastomotic false aneurysm should be viewed as a total failure of that anastomosis and repair should be by replacement with an interposition graft rather than repair of the failed anastomosis by suture or patch.

Anastomosis, Surgical↗
PubMed1991

Tissue plasminogen activator and cardiopulmonary bypass for massive pulmonary embolus.

Massive pulmonary embolus resulting in cardiac arrest and doubtful cerebral status may result in indecision as to whether to proceed to pulmonary embolectomy, especially if there is continuing cardiorespiratory instability. A case is reported on the use of fibrinolysis and cardiopulmonary bypass, allowing for the cerebral status of the patient to become more clearly defined while maintaining cardiopulmonary stability and attempting to treat the underlying pathological process.

Adult↗
PubMedDate not supplied

Complications of balloon catheterization associated with aberrant cerebral arterial anatomy in a horse with guttural pouch mycosis.

A 3-year-old Quarter Horse gelding was treated for left guttural pouch mycosis by ligation and balloon catheterization of the left internal carotid artery. Catheter advancement was shorter (10 cm) than the normally reported distance (13-15 cm), but was observed endoscopically during placement as it coursed within the internal carotid artery through the guttural pouch. The horse developed a persistently abnormal respiratory pattern after catheter placement, failed to gain consciousness, developed pulmonary edema, and died 5.5 hours postoperatively. Postmortem examination revealed an aberrant left internal carotid arterial course with location of the embolectomy catheter at the junction of the basilar and caudal cerebellar arteries. Brainstem neuronal necrosis and alveolar and interstitial pulmonary edema were identified on histological examination. Angiography may be used to identify aberrant branching patterns. Failure to identify and occlude aberrant branches may result in fatal epistaxis and Brainstem lesions.

Animals↗