scholarly journals Surgical Embolectomy In Massive Acute Pulmonary Embolism: Our Experience

2015 ◽  
Vol 12 (2) ◽  
pp. 83-86
Author(s):  
SV Nemirova ◽  
AP Medvedev ◽  
VV Pichugin ◽  
Krishna Bhandari
Keyword(s):  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Vein Thrombosis ◽  
Medical Academy ◽  
Surgical Embolectomy ◽  
Hospital Deaths ◽  
State Medical Academy ◽  
Deep Vein ◽  
Mean Time

Background and Aims: Pulmonary embolism (PE) is the leading cause of hospital deaths among the non-surgical patients. Our aim was to evaluate the efficacy of surgical embolectomy in massive acute PE.Methods: It was a single centre, prospective study conducted between January 2007 and August 2013 in Specialized Cardiovascular Surgical Hospital of Nizhny Nizhny Novgorod State Medical Academy Nizhny Novgorod, Russia. One hundred and seventy five patients were diagnosed as PE. Only 77 patients were diagnosed as massive pulmonary embolism and were included in this study. Surgical embolectomy was performed without cardiopulmonary bypass through thoracotomy approach only in the involved pulmonary artery. Right atriotomy and evacuation of embolus was done, in cases of right ventricle thrombus.Results: Seventy-seven patients with acute massive PE underwent surgical embolectomy. Four (5.1%) patients died before discharge. Mean time of ICU stay was 70.1±11.0 hours. During six months of follow up after the embolotomy. Eleven (14%) patients had deep vein thrombosis, two had sub-massive PE. During 6 months of follow up 62 patients (81%) had no further episode of venous thrombloembolism.Conclusions: Our study showed surgical embolectomy can be done with good clinical outcome with acceptable mortality rate.Nepalese Heart Journal 2015;12(2):83-86

Temporary caval filter in the prevention of pulmonary embolism during delivery and postpartum

2005 ◽  
Vol 20 (4) ◽  
pp. 183-189
Author(s):  
G Pagliariccio ◽  
L Carbonari ◽  
C Grilli Cicilioni ◽  
A Angelini ◽  
E Gatta ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Lower Limbs ◽  
X Ray ◽  
Vein Thrombosis ◽  
Caval Filter ◽  
Prophylactic Use ◽  
The Right ◽  
Deep Vein ◽  
Mean Time

Objectives: The treatment of deep vein thrombosis (DVT) of the lower limbs during pregnancy remains controversial. There are a lot of problems related to anticoagulant therapy for the safety of the fetus; the use of caval filters rarely appears in the literature and it is not yet codified. So the choice of the right treatment is often difficult. The authors review their experience with a prophylactic use of a temporary caval filter for patients with proximal DVT of the last period of pregnancy, in order to avoid the inherent risk of major pulmonary embolism during delivery and postpartum. Methods: Ten women with proximal DVT were treated. The diagnosis was performed by Doppler ultrasonography (DU) and magnetic resonance (MR). At the end of pregnancy, a temporary caval filter (eight Prolyser and two Tempofilter) was percutaneously inserted under X-ray control. The patients were then subjected to a planned caesarean section. After 15 days, all filters were removed after a phlebography to check the absence of clots. Results: The mean time of X-ray exposure was about 1 min and 30 s. None of the patients suffered a major pulmonary embolism. All fetuses were born without problems or malformations. There were no complications related to the filters. No caval thrombosis or filters clots were found at the phlebography. The follow-up registered no pulmonary embolism episodes. Conclusions: The use of a temporary caval filter in pregnancy is safe and does not introduce any additional risk. It could be suggested for pregnant patients with proximal DVT beginning in the last period of pregnancy.

scholarly journals Anticoagulant therapies for acute venous thromboembolism: a comparison between those discharged directly from the emergency department versus hospital in two Canadian cities

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022063 ◽  
Author(s):  
Tammy J Bungard ◽  
Bruce Ritchie ◽  
Jennifer Bolt ◽  
William M Semchuk
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Severity Index ◽  
Vein Thrombosis ◽  
Risk Patients ◽  
Acute Venous Thromboembolism ◽  
Record Review ◽  
Deep Vein

ObjectiveTo compare the characteristics/management of acute venous thromboembolism (VTE) for patients either discharged directly from the emergency department (ED) or hospitalised throughout a year within two urban cities in Canada.DesignRetrospective medical record review.SettingHospitals in Edmonton, Alberta (n=4) and Regina, Saskatchewan (n=2) from April 2014 to March 2015.ParticipantsAll patients discharged from the ED or hospital with acute deep vein thrombosis or pulmonary embolism (PE). Those having another indication for anticoagulant therapy, pregnant/breast feeding or anticipated lifespan <3 months were excluded.Primary and secondary outcomesPrimarily, to compare proportion of patients receiving traditional therapy (parenteral anticoagulant±warfarin) relative to a direct oral anticoagulant (DOAC) between the two cohorts. Secondarily, to assess differences with therapy selected based on clot burden and follow-up plans postdischarge.Results387 (25.2%) and 665 (72.5%) patients from the ED and hospital cohorts, respectively, were included. Compared with the ED cohort, those hospitalised were older (57.3 and 64.5 years; p<0.0001), more likely to have PE (35.7% vs 83.8%) with a simplified Pulmonary Embolism Severity Index (sPESI) ≥1 (31.2% vs 65.2%), cancer (14.7% and 22.3%; p=0.003) and pulmonary disease (10.1% and 20.6%; p<0.0001). For the ED and hospital cohorts, similar proportions of patients were prescribed traditional therapies (72.6% and 71.1%) and a DOAC (25.8% and 27.4%, respectively). For the ED cohort, DOAC use was similar between those with a sPESI score of 0 and ≥1 (35.1% and 34.9%, p=0.98) whereas for those hospitalised lower risk patients were more likely to receive a DOAC (31.4% and 23.8%, p<0.055). Follow-up was most common with family physicians for those hospitalised (51.5%), while specialists/VTE clinic was most common for those directly discharged from the ED (50.6%).ConclusionsTraditional and DOAC therapies were proportionately similar between the ED and hospitalised cohorts, despite clear differences in patient populations and follow-up patterns in the community.

scholarly journals Detection of Deep Vein Thrombosis by Follow-up Indirect Computed Tomography Venography after Pulmonary Embolism

2018 ◽  
Vol 81 (1) ◽  
pp. 49
Author(s):  
Hye Jin Lee ◽  
Seung-Ick Cha ◽  
Kyung-Min Shin ◽  
Jae-Kwang Lim ◽  
Seung-Soo Yoo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Computed Tomography Venography

MynxGrip for Closure of Antegrade Puncture After Peripheral Interventions With Same-Day Discharge

2017 ◽  
Vol 51 (2) ◽  
pp. 67-71 ◽  
Author(s):  
Maciej J. Pruski ◽  
Aleksandra M. Blachut ◽  
Magda Konkolewska ◽  
Adam Janas ◽  
Eugeniusz Hrycek ◽  
...  
Keyword(s):  
Closure Device ◽  
Device Failure ◽  
Vein Thrombosis ◽  
Same Day Discharge ◽  
Small Abscess ◽  
Antegrade Puncture ◽  
The Mean ◽  
Deep Vein ◽  
Mean Time

Background: This was the first prospective study to assess the safety and efficiency of MynxGrip vascular closure device (VCD) in peripheral interventions with antegrade access. Methods and Results: We enrolled 66 consecutive patients from 1 center. All patients were discharged home on the day of procedure and were observed for adverse events at 1 and 30 days of follow-up. No major complications were observed. The rate of minor complications (conversion to manual or mechanical compression) was 7.6%. Postdischarge, 3% of patients experienced minor complications—small abscess, ipsilateral deep vein thrombosis. In 1 patient, a second VCD was deployed after device failure. The derived device failure rate was 5.9%. No patients required hospitalization. No late bleeding and no hematomas >6 cm were noted. The mean time to discharge was 4 hours and 5 minutes. Conclusion: The MynxGrip was safe and effective in sealing access sites after antegrade femoral artery puncture with same-day discharge.

The risk of recurrent venous thromboembolism in patients with unprovoked symptomatic deep vein thrombosis and asymptomatic pulmonary embolism

2006 ◽  
Vol 95 (03) ◽  
pp. 562-566 ◽  
Author(s):  
Gema Díaz ◽  
Elena Marín ◽  
Rafael Vidal ◽  
Antonio Sueiro ◽  
Roger Yusen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Lower Extremity ◽  
Vitamin K Antagonist ◽  
First Episode ◽  
Oral Vitamin ◽  
Antagonist Therapy ◽  
Vein Thrombosis ◽  
Recurrent Venous Thromboembolism ◽  
Deep Vein

SummaryPatients with a first episode of symptomatic pulmonary embolism (PE) havea higher risk of recurrent venous thromboembolism (VTE) than patients with a first episode of proximal lower extremity deep vein thrombosis (DVT). Patients with symptomatic DVT and silent PE may havea different risk of VTE recurrence than patients that have symptomatic DVT without PE. Therefore, it was the aim of this prospective cohort study to compare the risk of recurrent symptomaticVTE in patients with proximal lower extremity DVT and silent PE to the risk in patients that only have proximal lower extremity DVT. Ninty-one consecutive outpatients presenting to the emergency department of a university hospital subsequently hospitalised with a first episode of unprovoked symptomatic proximal lower extremity DVT, and without new pulmonary symptoms were included. Standard initial treatment consisted of intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin for 5–7 days, overlapped with oral vitamin-K antagonist therapy, with long-term oral vitamin-K antagonist therapy (goal INR 2.5 [2.0–3.0]). Study endpoints were: symptomatic recurrent DVT, new PE, and recurrent PE, evaluated by standard objective testing. At enrolment, 28 of 91 (31%) patients with DVT had silent PE. In the patients with DVT and silent PE, there were 3 VTE recurrences during 20 person-years of follow-up, while there were no VTE recurrences during 61 person-years of follow-up in the patients with isolated DVT. The Kaplan-Meier estimated VTE recurrence rate at 1 year after the diagnosis of DVT was 11% (95% CI: 2–28%) for patients with symptomatic DVT and silent PE, compared to 0% in patients with isolated symptomatic DVT (p = 0.0045). In patients with a first episode of unprovoked symptomatic acute proximal lower extremity DVT, the risk of recurrent VTE was significantly higher in those with silent PE compared to those without PE.

scholarly journals Bleeding and recurrent VTE with apixaban vs warfarin as outpatient treatment: time-course and subgroup analyses

2020 ◽  
Vol 4 (2) ◽  
pp. 432-439 ◽  
Author(s):  
Derek Weycker ◽  
Gail DeVecchis Wygant ◽  
Jennifer D. Guo ◽  
Theodore Lee ◽  
Xuemei Luo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Outpatient Treatment ◽  
Time Points ◽  
Vein Thrombosis ◽  
Study Population ◽  
Recurrent Vte ◽  
Deep Vein ◽  
Bridge Therapy

Abstract In the phase 3 trial Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-Line Therapy, apixaban was noninferior to enoxaparin, overlapped and followed by warfarin, in the treatment of venous thromboembolism (VTE) with significantly less bleeding; in a real-world evaluation, risks for bleeding and recurrent VTE were lower with apixaban vs warfarin plus parenteral anticoagulant (PAC) bridge therapy. The present study extends this research by comparing outcomes over time and within selected subgroups. A retrospective observational cohort design and 4 US private health care claims databases were used. Study population included patients who initiated outpatient treatment with apixaban or warfarin (plus PAC bridge therapy) for VTE. Major bleeding, clinically relevant nonmajor (CRNM) bleeding, and recurrent VTE were compared during the 180-day follow-up period, at selected follow-up time points (days 21, 90, 180), and within subgroups (pulmonary embolism [PE] with or without deep vein thrombosis [DVT], DVT only, provoked VTE, unprovoked VTE) using multivariable shared frailty models. Study population consisted of 20 561 apixaban patients and 35 080 warfarin patients; baseline characteristics were comparable. Overall, at selected follow-up time points, and within the aforementioned subgroups, adjusted risks were lower among apixaban vs warfarin patients: major bleeding, by 27% to 39%, CRNM bleeding, by 17% to 28%, and recurrent VTE, by 25% to 39% (all P ≤ .01). In this real-world study of VTE patients, risks of bleeding and recurrent VTE were lower among apixaban (vs warfarin) patients during the 180-day follow-up period, at selected follow-up time points, and within subgroups defined by index VTE episode.

Endovenous laser ablation of varicose veins with the 1470 nm diode laser using a radial fiber – 1-year follow-up

2013 ◽  
Vol 30 (2) ◽  
pp. 86-90 ◽  
Author(s):  
E von Hodenberg ◽  
C Zerweck ◽  
M Knittel ◽  
T Zeller ◽  
T Schwarz
Keyword(s):  
Pulmonary Embolism ◽  
Diode Laser ◽  
Varicose Veins ◽  
Endovenous Laser Ablation ◽  
Vein Thrombosis ◽  
Saphenous Veins ◽  
Superficial Vein Thrombosis ◽  
Radial Fiber ◽  
Deep Vein

Background: Endovenous laser ablation is one of the most accepted treatment options for insufficient great and small saphenous veins. The aim of this study was to investigate the long-term efficacy and safety of the radial fiber (ELVeS-radial kit™) for the 1470 nm diode laser in a 1-year follow-up. Methods: A total of 308 lower limbs with primary insufficiency of great and small saphenous veins or insufficient tributaries were included in the prospective observational cohort study. The primary efficacy endpoint of the study was ultrasonographic proven elimination of venous reflux after at least 1 year. Secondary efficacy and further safety end points after 1 year were as follows: (1) sonographic exclusion of recanalization of the treated vein segments, (2) deep vein thrombosis, clinical pulmonary embolism or superficial vein thrombosis as defined by objective testing, (3) death from any cause, (4) persistent clinical complaints such as pain and paresthesia, (5) recurrent varicose veins. Patient satisfaction was assessed using a CIVIQ-2 questionnaire after 1 year. Results: Follow-up could be completed in 91.2% of the patients. Excellent efficacy numbers with 99.6% occlusion of the treated varicose veins as elimination of reflux could be demonstrated. After 1 year, 96% of the treated veins disappeared completely sonographically; one recanalization was observed. No deep vein thrombosis or pulmonary embolism occurred, three superficial vein thrombosis were diagnosed in follow-up examinations. Four patients died, not related to pulmonary embolism. No persistent pain or paresthesia occurred in the follow-up. Recurrent varicose veins were diagnosed in 10 patients (2.81%). Conclusion: One-year follow-up showed that endovenous laser treatment of varicose veins with 1470 nm diode laser using the radial fiber is highly effective, also regarding in a 1-year follow-up.

scholarly journals Clinical Outcome of Acute Pulmonary Embolectomy Taken as to be the First Line Treatment for Massive and Submassive Pulmonary Embolism: Experience from One Single Center in China

2020 ◽  
Author(s):  
Wang QiMin ◽  
Chen Liangwan ◽  
Chen Daozhong ◽  
Qiu Hanfan ◽  
Huang Zhongyao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Single Center ◽  
First Line ◽  
Pulmonary Embolectomy ◽  
Submassive Pulmonary Embolism ◽  
Surgical Embolectomy ◽  
First Line Treatment

Abstract Backgroud: Acute pulmonary embolism (PE) is one of the most critical cardiovascular disease. The treatment for PE depends on the severity of disease including anticoagulation, systemic thrombolysis, surgical embolectomy,and catheter embolectomy. The indication of surgical pulmonary embolectomy is still controvery. Although there have been more favourable reports of the of surgical embolectomy (SE) over past decades, SE has still been used as a resort or rescue treatment for acute massive PE with significant hemodynamically unstable or present with cardiogenic shock or patients whose thrombolysis failed，therefore the high mortality of pulmonary surgical embolectomy was still reported. SE has not yet been accepted broadly as initial therapy in the algorithm for massive and submassive PE.Objective : The purpose of this study is to evaluate the early and midterm outcome of surgical pulmonary embolectomy which was taken as the first line therapy for acute central major pulmonary embolism in one single center in ChinaMethods: A retrospective review of patients who underwent surgical pulmonary embolectomy for acute pulmonary embolectomy was conducted from July of 2005 to Sept of 2019 at a single heart center in China. Patients with chronic thrombus or thrombendrterectomy were excluded.The risk factors for morbidity and mortality of the surgical pulmonary embolectomy were reviewed, The institutional echocardiographic database was searched for follow-up studies to compare markers of right ventricular function.Results: A total of 41 patients were included for the study, 17 cases (41.5%) had submassive PE and 24 (58.5%) had massive pulmonary embolism required preoperative positive inotropic treatment. Mean cardiopulmonary bypass time was 103.2±48.9 minutes, and 10 patients (24.4.%) underwent procedures without aortic cross-clamping. Ventilatory support time was 80.6±21.3hours. ICU stay was 4.51±3.23 days. Hospital stay was 12.8±6.4days. There was operative mortality 3 (7.32%) for massive pulmonary embolism and no death case of submassive pulmonary embolism. For massive PE patients, if the first choice treatment was surgical embolectomy, the mortality was low,only 2.56%, even though there were 2 cases suffered from cardiac arrest preoperatively. However, if 2 cases who received systemic thromblysis firstly were included in the datus,the mortality rate of SE increased to 12.5%. All cases had echocardiography results available for follow-up at discharge,and 30 cases at three months, only 10 cases at one years after surgical embolectomy. There were no death event related with recurrent PE in the follow-up,but 3 patents died of cerebral incranal bleeding, gastric cancer and gastric cancer at 1 year,3 years and 8 years after surgical embolectomy respectively.Conclusions: In this small retrospective single center experience, SE presented with low mortality rate when it was rendered as the first line treatment in selected patients for massive and submassive acute pulmonary embolism. SE should play the the same role as ST in the treatment algorithm for acute PE. Echocardiographic showed right ventricular function was improved in the early and midterm follow- up term

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