scholarly journals Mechanical thrombectomy of COVID-19 DVT with congenital heart disease leading to phlegmasia cerulea dolens: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Neema Jamshidi ◽  
Weiyi Tan ◽  
Dingle Foote ◽  
Leigh Reardon ◽  
Gentian Lluri ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Elevated Risk ◽  
Flow Dynamics ◽  
Single Session ◽  
Case Presentation ◽  
Left Lower Extremity ◽  
Therapeutic Anticoagulation ◽  
Independent Risk Factors ◽  
Fontan Physiology ◽  
Phlegmasia Cerulea Dolens

Abstract Background COVID-19 and Fontan physiology have each been associated with an elevated risk of venous thromboembolism (VTE), however little is known about the risks and potential consequences of having both. Case presentation A 51 year old male with tricuspid atresia status post Fontan and extracardiac Glenn shunt, atrial flutter, and sinus sick syndrome presented with phlegmasia cerulea dolens (PCD) of the left lower extremity in spite of supratherapeutic INR in the context of symptomatic COVID-10 pneumonia. He was treated with single session, catheter directed mechanical thrombectomy that was well-tolerated. Conclusions This report of acute PCD despite therapeutic anticoagulation with a Vitamin K antagonist, managed with emergent mechanical thrombectomy, calls to attention the importance of altered flow dynamics in COVID positive patients with Fontan circulation that may compound these independent risk factors for developing deep venous thrombosis with the potential for even higher morbidity.

scholarly journals Spontaneous Iliac Vein Rupture Due to May-Thurner Syndrome and Its Staged Management

2019 ◽  
Vol 53 (4) ◽  
pp. 348-350
Author(s):  
Michael Ingram ◽  
Julia Miladore ◽  
Alok Gupta ◽  
John Maijub ◽  
Keisin Wang ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Mechanical Thrombectomy ◽  
Vena Cava ◽  
Iliac Vein ◽  
Internal Iliac Vein ◽  
Left Lower Extremity ◽  
Therapeutic Anticoagulation ◽  
Internal Iliac ◽  
Staged Approach

We present a case of a 58-year-old otherwise healthy women who presented with left lower extremity deep venous thrombosis and was found to have pulmonary embolism along with a ruptured left internal iliac vein. Our patient was hemodynamically stable upon presentation; therefore, a staged approach was undertaken. Initially, an inferior vena cava filter was placed and the patient was slowly advanced to therapeutic anticoagulation and subsequently discharged. She then returned 2 weeks after discharge for venogram, mechanical thrombectomy, and stenting. At 1-year follow-up in clinic, she was found to have patent stents and resolution of symptoms.

scholarly journals Fatal deep venous thrombosis and pulmonary embolism secondary to melioidosis in China: case report and literature review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hua Wu ◽  
Dongliang Huang ◽  
Biao Wu ◽  
Mengjie Pan ◽  
Binghuai Lu
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Fatal Case ◽  
Therapeutic Interventions ◽  
Case Presentation ◽  
Reduce Mortality Rate ◽  
Left Lower Extremity ◽  
Appropriate Treatment ◽  
History Of

Abstract Background Burkholderia pseudomallei is a gram-negative bacterium and the causative pathogen of melioidosis, which manifests a variety ranges of infection symptoms. However, deep venous thrombosis (DVT) and pulmonary embolism (PE) secondary to bacteremic melioidosis are rarely documented in the literature. Herein, we reported a fatal case of melioidosis combined with DVT and PE. Case presentation A 54-year-old male construction worker and farmer with a history of diabetes was febrile, painful in left thigh, swelling in left lower limb, with chest tightness and shortness of breath for 4 days. He was later diagnosed as DVT of left lower extremity and PE. The culture of his blood, sputum and bone marrow samples grew B. pseudomallei. The subject was administrated with antibiotics (levofloxacin, cefoperazone/tazobactam, and imipenem) according to antimicrobial susceptibility testing and low molecular heparin for venous thrombosis. However, even after appropriate treatment, the patient deteriorated rapidly, and died 2 weeks after admission. Conclusions This study enhanced awareness of the risk of B. pseudomallei bloodstream infection in those with diabetes. If a patient has predisposing factors of melioidosis, when DVT is suspected, active investigation and multiple therapeutic interventions should be implemented immediately to reduce mortality rate.

scholarly journals Surgical procedure of segmentectomy as a possible cause of postoperative cerebral embolism: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Peirui Chen ◽  
Qiusha Qing ◽  
Mingqiang Diao ◽  
Xiaokang Sun ◽  
Junrong Yang ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Surgical Procedure ◽  
Mechanical Thrombectomy ◽  
Early Postoperative Period ◽  
Cerebral Embolism ◽  
Case Presentation ◽  
Early Symptom ◽  
Life Threatening ◽  
Pulmonary Vein Stump ◽  
Possible Cause

Abstract Background Cerebral embolism after lobectomy is a life-threatening complication during the early postoperative period. However, it is unclear if cerebral embolism can develop after segmentectomy. Case presentation We experienced a case of a 37-year-old man who demonstrated early symptom of acute ischemic stroke in early postoperative period after right upper posterior segmentectomy and performed intra-arterial mechanical thrombectomy (IAMT) successfully. Conclusions Long and irregular pulmonary vein stump (PVS) and endothelial injury caused by surgical procedure may lead to cerebral embolism after segmentectomy. We believe that doing preoperative pulmonary vascular assessment and using appropriate surgical procedure may reduce the rate of cerebral embolism.

scholarly journals Management of Phlegmasia Cerulea Dolens Caused by a Giant Leiomyoma

2021 ◽  
Author(s):  
Elisabeth Ekkel ◽  
Tara Chandran ◽  
Ryan Qasawa ◽  
Michael Trpkovski ◽  
Sachinder Hans
Keyword(s):  
Uterine Leiomyoma ◽  
Inferior Vena ◽  
Mechanical Thrombectomy ◽  
Vena Cava ◽  
Iliac Vein ◽  
Young Female ◽  
Common Iliac Vein ◽  
Venous Obstruction ◽  
Recurrent Thrombosis ◽  
Phlegmasia Cerulea Dolens

Abstract This case is of a young female with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent mechanical thrombectomy to temporize the condition until she could be evaluated by gynecology-oncologist to remove the cause of venous obstruction. Prior to hysterectomy, suprarenal inferior vena cava filter was placed. Less than 12 hours post hysterectomy she developed recurrent thrombosis involving the left common and external iliac veins. She underwent repeat mechanical thrombectomy with wall stent placement in the left common iliac vein with resolution of her symptoms.

scholarly journals Surgical Procedure of Segmentectomy as a Possible Cause of Postoperative Cerebral embolism: A Case Report

2020 ◽  
Author(s):  
Peirui Chen ◽  
Qiushan Qing ◽  
Mingqiang Diao ◽  
Xiaokang Sun ◽  
Junrong Yang ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Surgical Procedure ◽  
Mechanical Thrombectomy ◽  
Early Postoperative Period ◽  
Cerebral Embolism ◽  
Case Presentation ◽  
Early Symptom ◽  
Life Threatening ◽  
Pulmonary Vein Stump ◽  
Possible Cause

Abstract Background: Cerebral embolism after lobectomy is a life-threatening complication during the early postoperative period. However, it is unclear if cerebral embolism can develop after segmentectomy. Case Presentation: We experienced a case of a 37-year-old man who demonstrated early symptom of acute ischemic stroke in early postoperative period after right upper posterior segmentectomy and performed intra-arterial mechanical thrombectomy (IAMT) successfully.Conclusions: long and irregular pulmonary vein stump (PVS) and endothelial injury caused by surgical procedure may lead to cerebral embolism after segmentectomy. We believe that doing preoperative pulmonary vascular assessment and using appropriate surgical procedure may reduce the rate of cerebral embolism.

Dual and Balloon-Assisted AngioJet Thrombectomy for Iliofemoral Deep Venous Thrombosis

2018 ◽  
Author(s):  
Zubin Irani ◽  
Sara Zhao
Keyword(s):  
Pulmonary Embolism ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Mechanical Thrombectomy ◽  
Post Thrombotic Syndrome ◽  
Thrombus Removal ◽  
Phlegmasia Cerulea Dolens ◽  
Extremity Veins

Lower extremity deep venous thrombosis (DVT) may be complicated by pulmonary embolism, post-thrombotic syndrome, and phlegmasia cerulea dolens. Due to these complications, the American Venous Forum now recommends thrombus removal for large or symptomatic thrombus burden. The AngioJet Solent Proxy and Omni thrombectomy sets are indicated for use in iliofemoral and lower extremity veins with a diameter ≥3 mm. The device has quickly become a preferred device among the available mechanical thrombectomy options. The AngioJet system has been demonstrated as both efficacious and safe as a method of thrombectomy in lower extremity DVT. This chapter discusses two techniques to utilize the AngioJet device in iliofemoral DVT.

scholarly journals Carotid approach to anterior circulation thromboembolectomy in an adult with failing fontan physiology: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caroline Eden ◽  
Hugo Clifford ◽  
Arthur Wang ◽  
Asif Mohammed ◽  
Peter Yim
Keyword(s):  
Anesthetic Management ◽  
Pressure Control ◽  
Double Outlet Right Ventricle ◽  
Anterior Circulation ◽  
Case Presentation ◽  
Airway Control ◽  
Physiological Alterations ◽  
Cardiopulmonary Monitoring ◽  
Fontan Physiology ◽  
Failing Fontan

Abstract Background Anesthetic management of an adult with failing Fontan physiology is complicated given inherent anatomical and physiological alterations. Neurosurgical interventions including thromboembolectomy may be particularly challenging given importance of blood pressure control and cerebral perfusion. Case Presentation We describe a 29 year old patient born with double outlet right ventricle (DORV) with mitral valve atresia who after multi-staged surgeries earlier in life, presented with failing Fontan physiology. She was admitted to the hospital almost 29 years after her initial surgeries to undergo workup for a dual heart and liver transplant in the context of a failing Fontan with elevated end diastolic pressures, NYHA III heart failure symptoms, and liver cirrhosis from congestive hepatopathy. During the workup in the context of holding anticoagulation for invasive procedures, she developed a middle cerebral artery (MCA) stroke requiring a thromboembolectomy via left carotid artery approach. Discussion and Conclusions This case posed many challenges to the anesthesiologist including airway control, hemodynamic and cardiopulmonary monitoring, evaluation of perfusion, vascular access, and management of anticoagulation in an adult patient in heart and liver failure with Fontan physiology undergoing thromboembolectomy for MCA embolic stroke.

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