Sacral insufficiency fractures are a risk of massive bleeding during sacrectomy: patient series

BACKGROUND Sacrectomy carries significant risk of bleeding; however, specific risk factors, apart from medical comorbidities and tumor type, for this life-threatening complication remain unclear. This study describes two cases of massive bleeding, including one death during sacrectomy attributable to adherence of the internal iliac vein (IIV) and its neuroforaminal tributaries from sacral insufficiency fractures. OBSERVATIONS The authors presented two cases involving patients who received sacrectomy for a chordoma and experienced massive bleeding from the IIV due to adherence of the IIV and its neuroforaminal tributaries around sacral insufficiency fractures. They assessed their institution’s previous two decades’ experience of sacrectomies to determine risk factors for massive bleeding and performed anatomical dissection of 20 hemipelvises, which revealed the close proximity of the IIV to the sacral foraminae and the consistency of neuroforaminal tributaries arising from the foraminae. LESSONS Sacral insufficiency fractures may cause scarring that adheres to the IIV and its neuroforaminal tributaries, which risks massive bleeding during sacrectomy.

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Establishment and validation of a nomogram model for aseptic loosening after tumor prosthetic replacement around the knee: a retrospective analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1423-3 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Hao-ran Zhang ◽

Feng Wang ◽

Xiong-gang Yang ◽

Ming-you Xu ◽

Rui-qi Qiao ◽

...

Keyword(s):

Risk Factors ◽

Aseptic Loosening ◽

Cox Regression ◽

Univariate Analysis ◽

Significant Risk ◽

Stem Length ◽

Tumor Type ◽

Prosthetic Replacement ◽

Tumor Site ◽

Motion Mode

Abstract Background Aseptic loosening has become the main cause of prosthetic failure in medium- to long-term follow-up. The objective of this study was to establish and validate a nomogram model for aseptic loosening after tumor prosthetic replacement around knee. Methods We collected data on patients who underwent tumor prosthetic replacements. The following risk factors were analyzed: tumor site, stem length, resection length, prosthetic motion mode, sex, age, extra-cortical grafting, custom or modular, stem diameter, stem material, tumor type, activity intensity, and BMI. We used univariate and multivariate Cox regression for analysis. Finally, the significant risk factors were used to establish the nomogram model. Results The stem length, resection length, tumor site, and prosthetic motion mode showed a tendency to be related to aseptic loosening, according to the univariate analysis. Multivariate analysis showed that the tumor site, stem length, and prosthetic motion mode were independent risk factors. The internal validation indicated that the nomogram model had acceptable predictive accuracy. Conclusions A nomogram model was developed for predicting the prosthetic survival rate without aseptic loosening. Patients with distal femoral tumors and those who are applied with fixed hinge and short-stem prostheses are more likely to be exposed to aseptic loosening.

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Bilateral internal iliac artery ligation: the procedure of choice in life threatening postpartum haemorrhage

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203524 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3607

Author(s):

Sameer P. Darawade ◽

Arti A. Wagle ◽

Sneha Trivedi ◽

Saloni Manwani

Keyword(s):

Postoperative Complications ◽

Iliac Artery ◽

Internal Iliac Artery ◽

Iliac Vein ◽

Artery Ligation ◽

Vein Thrombosis ◽

Internal Iliac Artery Ligation ◽

Internal Iliac ◽

Life Threatening ◽

Vein Injury

Background: The present study was to assess the indication and study the intraoperative and postoperative complications of bilateral internal iliac artery ligation. Aim of this study was to evaluate the effectiveness of internal iliac artery ligation in arresting postpartum haemorrhage.Methods: This is a retrospective study carried out between January 2015 to December 2018 at Shrimati Kashibai Navale Medical College and General Hospital, Pune. This study included 48 patients with life-threatening PPH. Bilateral internal iliac artery ligation was done by anterior approach in 7 patients and by posterior approach in 41 patients.Results: Intraoperative and postoperative complications were noted in all patients. Of the total patients, 10 required massive blood transfusion and 12 underwent obstetrical hysterectomies (n=12; 25%). Internal iliac vein injury was seen in 1 patient (n=1; 2.08%) and external vein thrombosis was noted in 3 patients (n=3; 6.25%). Maternal mortality was observed in 1 patient due to DIC on day 9 (n=1; 2.08%). The uterine salvage rate was 75%.Conclusions: Internal iliac artery ligation (IIAL) safe, rapid, effective, time tested method of controlling bleeding from genital tract.

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Embolization for massive bleeding due to spontaneous left external iliac vein rupture: report of a successful case

CVIR Endovascular ◽

10.1186/s42155-021-00219-5 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Eijun Sueyoshi ◽

Ichiro Sakamoto ◽

Masataka Uetani

Keyword(s):

Spontaneous Rupture ◽

Hypovolemic Shock ◽

Balloon Catheter ◽

Vena Cava ◽

Iliac Vein ◽

Massive Bleeding ◽

Invasive Approach ◽

External Iliac Vein ◽

Successful Case ◽

Life Threatening

Abstract Background Spontaneous rupture of the iliac vein has rarely been reported. Its associated hypovolemic shock-related symptoms and signs, including syncope and hypotension, have been observed in most of these cases. Successful transcatheter venous embolization for massive bleeding due to spontaneous rupture of the external iliac vein was herein reported. Case presentation An 82-year-old female patient developed sudden left lower abdominal and back pain. Immediately, she lost consciousness and went into shock. CT images of her abdomen revealed a huge retroperitoneal hematoma, with leakage of contrast medium in the hematoma in the left flank. These findings suggested left external iliac vein rupture. Open surgery was considered; however, since the patient’s condition may have deteriorated further due to the time needed to prepare for surgery, including general anesthesia, transcatheter venous embolization of the left iliac vein was selected. A 5.2-Fr compliant balloon catheter (nominal diameter of 10 mm) was inflated at the distal site of the external iliac vein to reduce extravasation. N-butyl-2-cyanoacrylate (NBCA) was mixed with Lipiodol at a ratio of 1:2. The left Iliac vein was filled and completely embolized with the NBCA/Lipiodol mixture (total injected volume, 5 mL) using a 1.8-Fr microcatheter. After embolization, the patient quickly. An inferior vena cava filter was placed 1 day after embolization. Conclusion Spontaneous rupture of the iliac vein is a very rare and lethal condition. Transcatheter venous embolization may control potentially life-threatening bleeding. Rapid bleeding control in a critical condition is facilitated by this minimally invasive approach.

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Risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery during cesarean section

British Journal of Radiology ◽

10.1259/bjr.20190127 ◽

2019 ◽

Vol 92 (1102) ◽

pp. 20190127

Author(s):

Hiroyuki Tokue ◽

Azusa Tokue ◽

Yoshito Tsushima ◽

Takeshi Kameda

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Iliac Artery ◽

Internal Iliac Artery ◽

Placenta Previa ◽

Massive Bleeding ◽

Balloon Occlusion ◽

Round Ligament ◽

Internal Iliac ◽

Angiographic Findings

Objective: We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section. Methods: We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups. Results: 20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time (p < 0.001), hysterectomy (p < 0.001), post-operative hospital stay (p < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, p < 0.01]. Conclusion: The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section. Advances in knowledge: Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.

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Drug interactions in ambulatory cancer patients receiving cancer-directed therapy

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.6129 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 6129-6129 ◽

Cited By ~ 2

Author(s):

R. P. Riechelmann ◽

L. Wang ◽

I. F. Tannock ◽

M. K. Krzyzanowska

Keyword(s):

Risk Factors ◽

Drug Interactions ◽

Cancer Patients ◽

Scientific Evidence ◽

Significant Risk ◽

Median Number ◽

Cancer Type ◽

Solid Malignancies ◽

Life Threatening ◽

Treatment Intent

6129 Background: Cancer patients (pts) are susceptible to drug interactions (DI) because they receive multiple medications. Here we evaluate the epidemiology of potential DI in cancer patients. Methods: Ambulatory, adult pts with solid malignancies who were receiving antineoplastic treatment completed a questionnaire about drugs taken in the previous month. Drug Interactions Facts software was used to screen for potential DI and to classify them in terms of severity (major, moderate and minor, where major is a life-threatening interaction) and level of scientific evidence (1 to 5, with 1 being the highest level). Summary statistics and logistic regression were used to describe the results. Results: Between Sept -Dec 2005, 183 pts completed the questionnaire: median age was 61 (range 26–88), and 114 (62%) were women. Cancer sites included breast 63 (35%), gastrointestinal 45 (25%), and genitourinary 36 (20%). Treatment intent was palliative in 139 (60%). Most pts (76%) were receiving chemotherapy; 111 (66%) had at least one co-morbid condition, and 72 (47%) had abnormal liver and/or renal function. The median number of drugs per pt was 5 (range 0–16). Among the 183 pts, 131 potential DI were identified of which 65 (50%) were due to pharmacokinetic interactions. Sixteen (12%) of all potential DI were major, 94 (72%) were moderate, and 21 (16%) were minor. Fourteen (11%), 54 (41%), 5 (4%), 42 (32%), and 16 (12%) were supported by levels 1,2,3,4,5 of evidence respectively. Most potential DI involved non-chemotherapy agents such as warfarin, antihypertensives, and anti-inflammatory drugs. In multivariate analyses, number of comorbidities (p= .0001), number of drugs (p= .005), and cancer type (p= .03) were significant risk factors for DI. Conclusion: PotentialDI are common in oncology, and usually involve non-chemotherapeutic drugs. Risk factors for potential DI include comorbid illness, number of medications and type of cancer. Oncologists should be aware of such an important issue. No significant financial relationships to disclose.

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Sacral Insufficiency Fractures: a Review of Risk Factors, Clinical Presentation, and Management

Current Pain and Headache Reports ◽

10.1007/s11916-020-0848-z ◽

2020 ◽

Vol 24 (3) ◽

Cited By ~ 3

Author(s):

Ivan Urits ◽

Vwaire Orhurhu ◽

Jessica Callan ◽

Nishita V. Maganty ◽

Sara Pousti ◽

...

Keyword(s):

Risk Factors ◽

Clinical Presentation ◽

Insufficiency Fractures ◽

Sacral Insufficiency Fractures

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Iatrogenic bleeding during flexible bronchoscopy: risk factors, prophylactic measures and management

ERJ Open Research ◽

10.1183/23120541.00084-2016 ◽

2017 ◽

Vol 3 (2) ◽

pp. 00084-2016 ◽

Cited By ~ 16

Author(s):

Maurizio Bernasconi ◽

Coenraad F.N. Koegelenberg ◽

Angela Koutsokera ◽

Adam Ogna ◽

Alessio Casutt ◽

...

Keyword(s):

Risk Factors ◽

Massive Bleeding ◽

Flexible Bronchoscopy ◽

Haemodynamic Instability ◽

First Line ◽

Trendelenburg Position ◽

Prophylactic Measures ◽

Dependent Position ◽

Life Threatening ◽

Resuscitation Team

Significant iatrogenic bleeding during flexible bronchoscopy is fortunately rare and usually self-limiting. Life-threatening bleeding, however, can occur, especially after conventional or cryoprobe-assisted transbronchial biopsy. The aim of this review is to provide the practising pulmonologist with a concise overview of the incidence, severity and risk factors for bleeding, to provide sensible advice on prophylactic measures and to suggest a plan of action in the case of significant bleeding. Bronchoscopy units should have a standardised approach and plan of action in the case of life-threatening haemorrhage. Wedging the bronchoscope in the bleeding segment, turning the patient in an anti-Trendelenburg position and onto the side in order for the bleeding lung to be in the dependent position, installing vasoconstrictors and using a tamponade balloon early are the recommended first-line strategies. Involving a resuscitation team should be considered early in the case of massive bleeding, desaturation and haemodynamic instability.

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Risk Factors for Sacral Insufficiency Fractures in Cervical Cancer After Whole Pelvic Radiation Therapy

Anticancer Research ◽

10.21873/anticanres.13120 ◽

2018 ◽

Vol 39 (1) ◽

pp. 361-367 ◽

Cited By ~ 2

Author(s):

MASAKUNI SAKAGUCHI ◽

TOSHIYA MAEBAYASHI ◽

TAKUYA AIZAWA ◽

NAOYA ISHIBASHI

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Radiation Therapy ◽

Insufficiency Fractures ◽

Pelvic Radiation ◽

Sacral Insufficiency Fractures

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Antenatal diagnostic aspects of placenta percreta and its influence on the perinatal outcome: a clinical case and literature review

Acta medica Lituanica ◽

10.6001/actamedica.v23i4.3423 ◽

2017 ◽

Vol 23 (4) ◽

pp. 219-226 ◽

Cited By ~ 1

Author(s):

Jelena Volochovič ◽

Diana Ramašauskaitė ◽

Ramunė Šimkevičiūtė

Keyword(s):

Clinical Case ◽

Placenta Previa ◽

Massive Bleeding ◽

Placenta Percreta ◽

Optimal Care ◽

Iliac Arteries ◽

Internal Iliac ◽

Life Threatening ◽

Caesarean Hysterectomy ◽

Internal Iliac Arteries

Background. Placenta percreta is a very rare, but extremely life-threatening obstetrical pathology for the mother and the child, especially in the cases when it is not diagnosed before the birth and when it results in massive bleeding and a dramatic deterioration of condition. It is extremely important to diagnose this pathology as early as possible and plan further optimal care of patients in order to minimize life-threatening complications. Case report. The paper presents an illustrated clinical case of placenta percreta determined before the birth. Features of visual diagnostics are discussed. A 32-year-old pregnant woman with a history of two caesarean deliveries arrived at the tertiary level hospital at 22 weeks of gestation due to abdomen pain. Placenta previa was diagnosed and ultrasound, magnetic resonance imaging suggesting placenta percreta were seen. On the 32nd week, the planned caesarean hysterectomy was performed. The balloon catheters to occlude the internal iliac arteries and minimize bleeding during the surgery were used. Conclusions. Antenatal diagnosis of placenta percreta is especially important. Methods of visual diagnostics are complementary. The optimal surgical approach during caesarean hysterectomy remains controversial. In the case of the slow oozing without a clearly identified source of bleeding after hysterectomy and internal iliac arteries balloons deflation, ligation of one of the internal iliac arteriescan be reasonable to avoid residual haemorrhage and relaparotomy.

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