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PubMed1982

Strut fracture and disc embolization of a Björk-Shiley mitral valve prosthesis: localization of embolized disc by computerized axial tomography.

The case of a patient who survived strut fracture and embolization of a Björk-Shiley mitral prosthetic disc is presented. Prompt surgical treatment was directly responsible for survival. In addition, computerized axial tomography of the abdomen aided in localizing and retrieving the embolized disc, which was lodged at the origin of the superior mesenteric artery. A review of similar case reports from the literature supports our conclusions that the development of acute heart failure and absent or muffled prosthetic heart sounds in a patient with a Björk-Shiley prosthetic heart valve inserted prior to 1978 should raise the possibility of valve dysfunction and lead to early reoperation.

Adult↗

PubMed1976

Massive pulmonary embolism permitting paradoxical systemic arterial embolism: successful surgical management.

The case of a young woman, receiving oral contraceptives, who developed massive pulmonary embolism producing circulatory collapse and paradoxical arterial embolism through a patent foramen ovale is documented.. Limb viability was threatened. Emergency management included removal of arterial and pulmonary emboli, surgical closure of the patent foramen ovale, inferior caval partitioning, ovarian vein ligation, and short-term anticoagulation. Recovery was rapid and complete.

Adult↗

PubMed1999

Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)

BACKGROUND: Pulmonary embolism (PE) remains poorly understood. Rates of clinical outcomes such as death and recurrence vary widely among trials. We therefore established the International Cooperative Pulmonary Embolism Registry (ICOPER), with the aim of identifying factors associated with death. METHODS: 2454 consecutive eligible patients with acute PE were registered from 52 hospitals in seven countries in Europe and North America. The primary outcome measure was all-cause mortality at 3 months. The prognostic effect of baseline factors on survival was assessed with multivariate analyses. FINDINGS: 2110 (86.0%) patients had PE proven by necropsy, high-probability lung scan, pulmonary angiography, or venous ultrasonography plus high clinical suspicion; ICOPER accepted without independent review diagnoses and interpretation of imaging provided by participating centres; 3-month follow-up was completed in 98.0% of patients. The overall crude mortality rate at 3 months was 17.4% (426 of 2454 deaths, including 52 patients lost to follow-up): 179 of 397 (45.1%) deaths were ascribed to PE and 70 of 397 (17.6%) to cancer, and no information on the cause of death was available for 29 patients. After exclusion of 61 patients in whom PE was first discovered at necropsy, the mortality rate at 3 months was 15.3% (365 of 2393 deaths). On multiple-regression modelling, age over 70 years (hazard ratio 1.6 [95% CI 1.1-2.3]), cancer (2.3 [1.5-3.5]), congestive heart failure (2.4 [1.5-3.7]), chronic obstructive pulmonary disease (1.8 [1.2-2.7]), systolic arterial hypotension (2.9 [1.7-5.0]), tachypnoea (2.0 [1.2-3.2]), and right-ventricular hypokinesis on echocardiography (2.0 [1.3-2.9]) were identified as significant prognostic factors. INTERPRETATION: PE remains an important clinical problem with a high mortality rate. Data from ICOPER provide rates and highlight adverse prognostic categories that will help in planning of future trials of high-risk PE patients.

Acute Disease↗

PubMed2000

Availability of diagnostic facilities in the Netherlands for patients with suspected pulmonary embolism. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localisation of Pulmonary Embolism.

Pulmonary embolism remains a complex diagnostic problem. Although accurate and cost-effective, the 'Dutch consensus' strategy is not widely applied. We assessed the availability and investment plans of the different facilities used in this strategy. Furthermore, the current and future availability of new diagnostic modalities was investigated. A questionnaire was sent to all Dutch hospitals. The questionnaire contained separate sections with questions for the hospital management and the medical practitioners at the departments of radiology, nuclear medicine, internal medicine and pulmonology. Five hundred and eighty-four questionnaires were sent out (response rate 68%). Forty-three percent of the hospitals had no nuclear medicine facility, 11% had no pulmonary angiography facility, and 59% had no spiral CT scan (SCTA). Forty-six percent of the responding hospitals had a nuclear medicine facility; and 5% used Technegas for ventilation studies. Strategies with SCTA were available in about 27% of the hospitals. Due to future investments this number will increase to approximately 55%. Strategies with Technegas were available in 2.4% of the hospitals, this number might increase to 25% if Technegas is proven accurate. The 'Dutch consensus' strategy is available in two-thirds of the hospitals. All other strategies were less feasible. Several equivalent strategies for diagnosing pulmonary embolism should be developed. These strategies should be accurate, widely available and accepted.

Algorithms↗

PubMed2002

Online automated detection of cerebral embolic signals from a variety of embolic sources.

A major limitation of embolic signal (ES) detection by transcranial Doppler ultrasound is the lack of a reliable automated system. The performance of an automated system needs to be evaluated for different embolic sources on consecutively acquired typical data. We evaluated a new online frequency filtering approach in a total of 565 h of data containing 925 ES from four groups of patients: post carotid endarterectomy (postCEA), symptomatic carotid stenosis (SCS), asymptomatic carotid stenosis (ACS) and atrial fibrillation (AF). The following sensitivities and specificities were achieved: postCEA = sensitivity 95.8%, specificity 88.2%; SCS = sensitivity 98.4%, specificity 88.6%; ACS = sensitivity 85.7%, specificity 13.0%; AF = sensitivity 54.8%, specificity 7.0%. This online automated system performed similarly to the human expert in the postCEA and SCS groups, but less well in patients with AF and ACS. The low ratio of ES to normal data in patients with ACS may have contributed to the lower specificity; further evaluation with a higher number of ES is required. Refinement of the algorithm is required to improve its sensitivity for AF data.

Aged↗

PubMed2000

Pulmonary embolism complicated by patent foramen ovale and paradoxical embolization.

We present the case of a 74-year-old male with chest pain, dyspnea, and syncope secondary to an acute pulmonary embolism complicated by a patent foramen ovale with straddling thrombus and paradoxical embolization. We review the literature with specific focus on the pathogenesis and acute treatment of this life-threatening occurrence.

Aged↗

PubMed1998

Nonadhesive liquid embolic agent: role of its components in histologic changes in embolized arteries.

RATIONALE AND OBJECTIVES: The authors evaluated the safety and efficacy of a nonadhesive liquid embolic material and the role of its components in histologic changes in embolized arteries. MATERIALS AND METHODS: A Eudragit-E mixture (Rohm Chemische Fabrik, Darmstadt, Germany) was made of a cationic copolymer (Eudragit-E) dissolved in an equal volume of absolute ethanol and iopamidol. The Eudragit-E mixture, an ethanol-iopamidol mixture, and an iopamidol-saline mixture were injected into 12 rabbit renal arteries each. Three rabbits from each group were followed up for 1 day, 1 week, 1 month, and 3 months, at which time they were sacrificed. Kidneys were removed for histologic examination. RESULTS: The Eudragit-E mixture occluded all renal arteries without difficulty: the arteries did not recanalize. Histologically, acute vasculitis was caused by both the Eudragit-E and ethanol-iopamidol mixtures, but not by the iopamidol-saline mixture. Small infarctions were elicited with the ethanol-iopamidol mixture but not with the iopamidol-saline mixture. CONCLUSION: The Eudragit-E mixture is effective and easy to handle. Fifty percent ethanol may play a role in vessel occlusion with Eudragit-E mixture and in acute vasculitis.

Animals↗

PubMed2001

Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism.

A 41-year-old multigravida presented at 32 weeks of gestation with polyhydramnios and an anencephalic fetus. Abnormal bleeding as a result of disseminated intravascular coagulation complicated an emergency Caesarean section for severe abdominal pain thought to be due to uterine rupture. Massive transfusion with blood products was necessary and the abdomen packed to control bleeding. The patient was transferred to the intensive care unit where she made a slow but complete recovery. Amniotic fluid embolism with atypical presentation of isolated coagulopathy is the likely diagnosis in this case. The case serves to demonstrate that amniotic fluid embolism may present with symptoms and signs other than the classical pattern of dyspnoea, cyanosis and hypotension.

Adult↗

PubMed1978

Which embolic material is best suited for which embolization procedure?

Various embolization cases are described, and these require certain embolization materials. In our experience Gelfoam particles are very well suited for gastrointestinal tract lesions. Ivalon shavings gave excellent results in congenital arteriovenous malformations with permanent occlusions. Bristle brushes are a new device for larger artery occlusion. Stainless steel coils in combination with silk tufts proved thrombosis of large AV fistuals or of aneurysms particularly of the splenic artery.

Abdominal Injuries↗

PubMed1993

Spectral characteristics of embolic heart sounds detected by precordial Doppler ultrasound during venous air embolism in dogs.

We have studied the frequency spectrum of embolic heart sounds as detected by precordial Doppler ultrasound after injecting air 0.01-0.1 ml into the external jugular vein of anaesthetized dogs (n = 7). At volumes of 0.05 ml and greater, there was a significant increase in both the maximum frequency of the spectrum and the power of those high frequency components to greater than control values. Both changes correlated significantly with the volume of air injected (P < 0.05). With repeated injections of air at 5-min intervals, there was a small increase in the high frequency components in the control signal between injections (P < 0.05). We conclude that such spectral changes could be used to quantify the volume of air in transit through the heart, and to reflect the short-term history of venous air embolism.

Animals↗

PubMed2003

Embolization with autologous fibroblast-attached platinum coils in canine carotid artery aneurysms: histopathological differences from plain coil embolization.

PURPOSE: This study was designed to evaluate the effect of autologous fibroblast-attached platinum coils on the promotion of intra-aneurysmal thrombus organization. MATERIALS AND METHODS: Sidewall aneurysms were surgically created at common carotid arteries bilaterally in 5 dogs. Fibroblasts were obtained from the skins of the dogs and cultured and attached to unmodified platinum coils in a 5-day coculture. In each animal, one aneurysm was embolized with fibroblast-attached platinum coils (study group) and the other with plain platinum coils of the same size (control group). RESULTS: All aneurysms were partially occluded; the mean occlusion rate was 67%. The histologic analyses performed 2 weeks after the embolization showed more advanced organization of intra-aneurysmal thrombus in the study group than in the control group (80% versus 53%, P = 0.02). Overgrowth of the organizing tissue and parent artery stenosis did not occur. CONCLUSION: Our results suggest that autologous fibroblasts delivered with platinum coils could promote the organization of intra-aneurysmal thrombus. Although further research is needed, especially on the potential complications, endovascular treatment using autologous fibroblasts may be applied to aneurysm treatment.

Aneurysm↗

PubMed2003

Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial.

PURPOSE: Uterine artery embolization (UAE) is gaining popularity as an alternative to hysterectomy for the treatment of fibroids. Although minimally invasive treatments such as UAE offer the potential of fewer complications, shorter hospital stay, and quicker recovery than surgery, there have been few published data on tolerance and recovery in patients undergoing UAE. MATERIALS AND METHODS: This was a multicenter prospective single-arm clinical treatment trial involving the practices of 11 interventional radiologists in eight Ontario university-affiliated and community hospitals. Between November 1998 and November 2000, 555 women underwent UAE for symptomatic uterine fibroids. Follow-up included ultrasound examinations and telephone interviews. UAE was performed under conscious sedation. Polyvinyl alcohol particles (355-500 micro m) were the primary embolic agent, and the procedural endpoint involved stasis in the uterine arteries. Pain protocols included antiinflammatory medications and narcotics and a planned overnight hospital admission. Tolerance and recovery were measured by patient-reported pain intensity (10-point numeric rating and five-point descriptor scale), hospital length of stay (LOS), and time until return to work. RESULTS: Intraprocedural pain was reported by 30% of patients and postprocedural pain was reported by 92% of patients (mean pain rating +/- SD, 7.0 +/- 2.47). The mean hospital LOS was 1.3 nights. Postprocedural pain was the most common indication for an LOS greater than 1 night (18%) or 2 nights (5%). Return visits to the hospital (10%) and readmissions (3%) were primarily for pain. The overall postprocedural complication rate was 8.0% (95% CI: 5.9%-10.6%). Of the 44 complications, 32 (73%) were pain-related. The mean recovery time after UAE was 13.1 days (median, 10.0 d). CONCLUSION: The majority of patients had a 1-night LOS after UAE and recovered within 2 weeks. Postprocedural pain varied considerably and was the major indication for extended hospital stay and recovery.

Adolescent↗

PubMed1983

Transcatheter embolization of hepatocellular carcinoma: assessment of efficacy in cases of resection following embolization.

In 8 cases of hepatocellular carcinoma, hepatectomy was performed after hepatic artery embolization with Gelfoam. Complete necrosis of the tumor was found in 4 of these cases. Compared with the tumors that showed incomplete necrosis, the tumor in the complete necrosis group were small, thickly encapsulated, and located at sites remote from collateral circulation. Angiography and computed tomography after embolization accurately demonstrated tumor necrosis or continued viability, as confirmed by examination of resected specimens.

Aged↗

PubMed2005

Clinicians' response to radiologists' reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT.

OBJECTIVE: The purpose of our study was to investigate clinician response and patient outcome associated with the radiologist's report of isolated subsegmental pulmonary emboli (ISSPE) or indeterminate or inconclusive results on MDCT for venous thromboembolism. MATERIALS AND METHODS: All patients were examined using 8- or 16-MDCT. Reported findings on combined CT pulmonary angiography and CT venography of 1,435 consecutive patients were analyzed retrospectively. The charts of patients of interest with ISSPE or with indeterminate or inconclusive pulmonary embolism results were analyzed for clinician response and recurrent symptoms of venous thromboembolism in both treated and untreated patients during the following 3 months. RESULTS: We studied 207 patients of interest, and follow-up was available on 192 (92.8%) (67 ISSPEs, 125 inconclusive). Of the 192 patients, 25 (37%) of 67 patients with ISSPE and 108 (86%) of 125 patients with inconclusive results did not receive anticoagulation. Two patients with ISSPE and two patients with inconclusive results returned with new symptoms suggesting recurrent venous thromboembolism, but no venous thromboembolism was found. Thirteen (10%) of 133 untreated patients died without clinical evidence of recurrent venous thromboembolism. In 61 patients who received anticoagulation (42/67 [63%] ISSPE and 17/125 [14%] inconclusive), five patients returned with venous thromboembolism symptoms. None had recurrent emboli. Two (3%) of 61 patients who received anticoagulation died of other diseases. CONCLUSION: Patients with ISSPE more commonly received anticoagulation than not. In the patients who did not receive anticoagulation, no recurrent pulmonary embolism was identified on follow-up. In most patients with inconclusive findings on CT pulmonary angiography, clinicians chose to withhold anticoagulation without additional imaging workup. No adverse effects of this clinical decision were uncovered.

Angiography↗

PubMed2005

[Uterine artery embolization using gelatin sponge in a miniature pig: a study of arterial size and the distribution of embolic materials].

Uterine artery embolization using gelatin sponge particles was performed in a miniature pig, and the distribution of the particles was investigated. The particles spread in the cervix and proximal portion of the left horn. Histological study revealed embolic material in both the myometrium and endometrium. Several particles were found even in arteries smaller than 100 microm in diameter in the endometrium. Further studies should address the risks of gelatin sponge particles in the peripheral arteries of the uterine endometrium, as they may induce inflammatory processes and evoke complications including infection and menopause.

Animals↗

PubMed1989

[Usefulness of partial splenic embolization (PSE) in hepatocellular carcinomas showing a risk of gastrointestinal bleeding after transcatheter arterial embolization (TAE)].

We have examined 103 patients with a hepatocellular carcinoma (HCC) who were treated by transcatheter arterial embolization (TAE) with a partial splenic embolization (PSE) (n = 5) or without a PSE (n = 98). It was found that gastrointestinal (GI) bleeding after TAE occurred in 10 (10.2%) out of the 98 TAE patients and within 10 days after the TAE. In these GI bleeding after TAE patients, the platelet counts were significantly low and marked splenomegaly was seen. It also was found that there was a risk of GI bleeding after TAE in cases showing thrombocytopenia (less than 50,000/microliters) and marked splenomegaly with a splenic index of more than 50. In 5 patients with a high risk of GI bleeding, for whom a PSE was performed, the platelet counts were markedly increased even four weeks after the TAE. The survival rate of TAE patients given a PSE was significantly higher than in TAE patients manifesting a risk of GI bleeding. From these results, it would seem that TAE patients given a PSE is the better therapy for HCC patients manifesting a risk of GI bleeding.

Carcinoma, Hepatocellular↗

PubMed1989

[The hemodynamics of the lung circulation of minipigs after experimentally-caused Sedlarik's pulmonary embolism. III. Sedlarik's embolization of the lung circulation by electrically-activated blood].

Pulmonary embolisms of different clinical degree of severity can be produced by means of the pulmonary embolism model according to Sedlarik by application of electrically activated blood as a thrombogenic substance. An unambiguous influence of the size and the consistency of the thrombus exists concerning the severity of the hemodynamic changes. However, the hemodynamics seems to adapt to the changed conditions of the circulation, because a tendency to normalization was observed in short-term experiments. The morphologic changes after embolisation are more typical for the severity of the clinical picture in this acute phase than the hemodynamics. A testing of the animal model in long-term experiments seem to be ingenious for that reason.

Animals↗

PubMedDate not supplied

Experimental study of hepatic artery embolization: evaluation of various embolic materials.

Transcatheter arterial embolization was performed in a group of rabbits bearing VX2 tumor in the liver by injecting gelatin sponge (GS) with or without an anticancer agent (ACA) or Lipiodol with or without ACA. The antitumor effects as evaluated by tumor size and histological examination revealed that GS with or without ACA was most effective, followed in order by Lipiodol-ACA, aqueous solution of ACA and Lipiodol alone. On the other hand, severe normal tissue damage (necrosis of the liver and gallbladder) with elevation of plasma GOT, GPT, and LDH levels was more commonly observed in GS with or without ACA. Pharmacological analysis of plasma and tissue revealed that the antitumor effect of Lipiodol-ACA was due to prolonged release of ACA in addition to the embolization effect of Lipiodol, while the chemotherapeutic role of ACA was of little importance in GS-ACA.

Alanine Transaminase↗