scholarly journals Gastrointestinal Bleeding in Patients with SARS-CoV-2 Infection Managed by Interventional Radiology

2021 ◽  
Vol 10 (20) ◽  
pp. 4758
Author(s):  
Anna Maria Ierardi ◽  
Andrea Coppola ◽  
Silvia Tortora ◽  
Elena Valconi ◽  
Filippo Piacentino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Cardiac Disease ◽  
Distress Syndrome ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Biological Parameters ◽  
Success Rates ◽  
High Level ◽  
D Dimer

Background: This study was conducted to evaluate the technical and clinical success of trans-arterial embolization (TAE) as a treatment of gastrointestinal bleeding (GIB) in Coronavirus Disease 2019 (COVID-19) patients and to describe its safety; moreover, we describe the characteristics of these patients. Methods: Thirty-four COVID-19 hospitalized patients presented with GIB. Risk factors, drugs administered for COVID-19 infection, and clinical and biological parameters were evaluated. Furthermore, intraprocedural data and outcomes of embolization were analyzed. Results: GIB was more frequent in male. Overweight, hypertension, diabetes, previous cardiac disease, and anticoagulation preadmission (48.5%) were frequently found in our population. Previous or actual COVID Acute respiratory distress syndrome (ARDS) and a high level of D-dimer were encountered in most cases. Upper GIB was more frequent than lower GIB. Technical and clinical success rates of embolization were 88.2% and 94.1%, respectively. The complication rate was 5.9%. Conclusions: Our study highlights the most frequent characteristics of COVID-19 patients with GIB. Embolization is feasible, effective, and safe.

Risk factors for venous thromboembolism in patients with diabetes undergoing joint arthroplasty

2020 ◽  
Author(s):  
Wei Deng ◽  
Lili Huo ◽  
Qiang Yuan ◽  
Deyong Huang ◽  
Quan Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Protective Role ◽  
Pulmonary Angiography ◽  
Joint Arthroplasty ◽  
Multivariate Logistic Regression Model ◽  
Mechanical Prophylaxis ◽  
Patients With Diabetes ◽  
High Level ◽  
D Dimer

Abstract Background: Venous thromboembolism (VTE) is a significant complication after joint arthroplasty. Diabetes is related to a few changes in coagulation and fibrinolysis that may lead to thrombophilia. We aim to investigate the incidence of and risk factors for VTEs in patients with diabetes undergoing total hip (THA) or total knee anthroplasty (TKA) in a single centre in China. Methods: Patients with diabetes who underwent THA or TKA from January 2016 to December 2018 (n=400) at Beijing Jishuitan Hospital were recruited in this study. Lower limb venous Doppler ultrasound was performed before and after surgery to confirm deep venous thrombosis (DVT). Computer tomography pulmonary angiography was done to confirm pulmonary embolism (PE) for those with new postoperative DVT and typical symptoms of PE. A multivariate logistic regression model was conducted to examine factors associated with the development of postoperative VTE. Results: The overall incidence of postoperative VTE in patients with diabetes after THA or TKA was 46.8% (187 of 400). Female patients and patients undergoing TKA had higher incidence of postoperative VTE. Patients who developed postoperative VTE were older, and had higher levels of preoperative D-Dimer level and Caprini score. Increased VTE risks were associated with high level of preoperative D-Dimer (OR=2.11, 95%CI=1.35-3.30) and TKA (OR=2.29, 95%CI=1.29-4.01). Postoperative initiation of concomitant mechanical prophylaxis and low molecular weight heparin (LMWH) was protective for postoperative DVT (OR=0.56, 95%CI=0.37-0.86). Conclusions: VTE is common in patients with diabetes undergoing joint arthroplasty. Patients undergoing TKA or with a high level of preoperative D-Dimer are at a considerable risk of developing postoperative VTE. There may be a protective role of postoperative initiation of concomitant mechanical prophylaxis and LMWH for VTE.

Pulmonary Insufficiency and Respiratory Failure

2016 ◽  
Author(s):  
Bruce Chung ◽  
J. Jason Hoth
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Respiratory Failure ◽  
Cardiac Disease ◽  
Distress Syndrome ◽  
Perioperative Period ◽  
Pulmonary Insufficiency ◽  
Common Complication ◽  
Postoperative Assessment ◽  
Central Nervous System Depression

Pulmonary insufficiency is the most common complication after surgical procedures. From minor atelectasis to acute respiratory distress syndrome (ARDS), postoperative pulmonary insufficiency occurs in up to 50% of surgeries. Here we discuss the anatomy, mechanics, and pathophysiology of pulmonary insufficiency; preoperative and postoperative assessment of lung function; and treatment for pulmonary insufficiency with regard to atelectasis, pulmonary edema, and ARDS. Pulmonary insufficiency secondary to cardiac disease, thromboembolism, and central nervous system depression are discussed elsewhere. Preoperative identification of risk factors for pulmonary insufficiency and understanding the physiologic changes in the perioperative period can potentially mitigate postoperative respiratory failure.  

Pulmonary Insufficiency and Respiratory Failure

2016 ◽  
Author(s):  
Bruce Chung ◽  
J. Jason Hoth
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Respiratory Failure ◽  
Cardiac Disease ◽  
Distress Syndrome ◽  
Perioperative Period ◽  
Pulmonary Insufficiency ◽  
Common Complication ◽  
Postoperative Assessment ◽  
Central Nervous System Depression

Pulmonary insufficiency is the most common complication after surgical procedures. From minor atelectasis to acute respiratory distress syndrome (ARDS), postoperative pulmonary insufficiency occurs in up to 50% of surgeries. Here we discuss the anatomy, mechanics, and pathophysiology of pulmonary insufficiency; preoperative and postoperative assessment of lung function; and treatment for pulmonary insufficiency with regard to atelectasis, pulmonary edema, and ARDS. Pulmonary insufficiency secondary to cardiac disease, thromboembolism, and central nervous system depression are discussed elsewhere. Preoperative identification of risk factors for pulmonary insufficiency and understanding the physiologic changes in the perioperative period can potentially mitigate postoperative respiratory failure.  

scholarly journals Transarterial embolization for renal angiomyolipomas: A single centre experience in 79 patients

2017 ◽  
Vol 45 (2) ◽  
pp. 706-713 ◽  
Author(s):  
Chengen Wang ◽  
Min Yang ◽  
Xiaoqiang Tong ◽  
Jian Wang ◽  
Haitao Guan ◽  
...  
Keyword(s):  
Medical Records ◽  
Clinical Success ◽  
Tumour Size ◽  
Transarterial Embolization ◽  
Arterial Embolization ◽  
Success Rates ◽  
Single Centre Experience ◽  
Computed Tomography Scans

Objective To evaluate the long-term efficacy and safety of selective arterial embolization (SAE) in the treatment of renal angiomyolipomas (AMLs). Methods This was a retrospective review of medical records and imaging findings from patients with renal AMLs who attended our clinic and received SAE between January 2007 and January 2014. Only patents with complete medical records, preoperative computed tomography scans using typical imaging and follow-up data were included. Results A total of 79 patients were enrolled in the study. Technical and clinical success rates were 100% and 91% ( n = 72), respectively. Only two patients experienced major complications. Post-embolization syndrome (i.e. fever, abdominal pain, nausea or vomiting) was reported in 68 (86%) patients, but all symptoms were mild and resolved with conservative measures. Mean radiological and clinical follow-up periods were 16.8 and 35.9 months, respectively. In 75 (95%) patients, tumours decreased in size; mean ± SD tumour size significantly decreased from 8.4 ± 3.5 cm pre-embolization to 6.7 ± 3.0 cm post-embolization . Conclusions This study provides long-term evidence that SAE is a safe and effective method in the treatment of patients with renal AMLs.

scholarly journals Incidence and Risk Factors of Deep Vein Thrombosis in Hospitalized COVID-19 Patients

2020 ◽  
Vol 26 ◽  
pp. 107602962095321 ◽  
Author(s):  
Yuan Yu ◽  
Jie Tu ◽  
Bingxin Lei ◽  
Huaqing Shu ◽  
Xiaojing Zou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Incidence Rate ◽  
Vein Thrombosis ◽  
Number Of Patients ◽  
Proximal Extremity ◽  
High Level ◽  
Deep Vein ◽  
D Dimer ◽  
Extremity Veins

Deep vein thrombosis (DVT) is prevalent in patients with coronavirus disease 2019 (COVID-19). However, the risk factors and incidence rate of DVT remains elusive. Here, we aimed to assess the incidence rate and risk factors of DVT. All patients diagnosed with COVID-19 and performed venous ultrasound by ultrasound deparment between December 2019 and April 2020 in Wuhan Jin Yin-tan hospital were enrolled. Demographic information and clinical features were retrospectively collected. Notably, a comparison between the DVT and the non-DVT groups was explored. The incidence rate of venous thrombosis was 35.2% (50 patients out of 142). Moreover, the location of thrombus at the proximal extremity veins was 5.6% (n = 8), while at distal extremity veins was 35.2% (n = 50) of the patients. We also noted that patients with DVT exhibited a high level of D-dimer (OR 10.9 (95% CI, 3.3-36.0), P < 0.001), were admitted to the intensive care unit (OR 6.5 (95% CI, 2.1-20.3), P = 0.001), a lower usage of the anticoagulant drugs (OR 3.0 (95% CI, 1.1-7.8), P < 0.001). Finally, this study revealed that a high number of patients with COVID-19 developed DVT. This was observed particularly in critically ill patients with high D-dimer levels who required no anticoagulant medication.

scholarly journals Ultraselective transcatheter arterial embolization with small-sized microcoils for acute lower gastrointestinal bleeding

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Mitsuhiro Kinoshita ◽  
Hiroshi Kondo ◽  
Suguru Hitomi ◽  
Takuya Hara ◽  
Ryusei Zako ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Arterial Embolization ◽  
Lower Gastrointestinal Bleeding ◽  
Recurrent Bleeding ◽  
Major Complications ◽  
Vasa Recta

Abstract Purpose To evaluate the clinical outcome of ultraselective transcatheter arterial embolization (TAE) with small-sized microcoils for acute lower gastrointestinal bleeding (LGIB). Materials and methods The subjects were 17 consecutive patients (mean age, 69 years) with LGIB who were treated with ultraselective TAE using small-sized microcoils between December 2013 and December 2019. Ultraselective TAE was defined as embolization of one or both of the long or short branches of the vasa recta. The etiologies of bleeding were colonic diverticulosis in 16 patients (94%) and malignancy in one patient (6%). The bleeding foci were in the ascending colon in 11 patients (65%), transverse colon in 2 patients (12%), and sigmoid colon in 4 patients (23%). A total of 18 branches (diameter: range 0.5–1.5 mm, mean 1.1 mm) of the vasa recta in 17 patients were embolized with small-sized microcoils (size range 1–3 mm, mean combined lengths of all microcoils 7.6 cm). The mean follow-up period was 19 months (range 1–80 months). The technical and clinical success rate, recurrent bleeding rate, major complications and long-term clinical outcomes were retrospectively evaluated. Results Technical and clinical success was achieved in all patients (17/17). The rates of early recurrent bleeding (within 30 days of TAE) and major complications were 0% (0/17). Recurrent bleeding occurred in one patient at 2 months after TAE, but was stopped with conservative treatment. There were no other bleeding episodes or complications in the follow-up period. Conclusion Ultraselective TAE with small-sized microcoils is a highly effective and safe treatment modality for LGIB.

Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study

2021 ◽  
pp. 028418512110103
Author(s):  
Cheng Shi Chen ◽  
Young-Jong Cho ◽  
Ji Hoon Shin ◽  
Jeong Ho Kim ◽  
Suyoung Park ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Active Bleeding ◽  
Success Rates ◽  
Contrast Extravasation ◽  
Anterior Division

Background Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. Purpose To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. Material and Methods This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. Results The median interval between surgery and angiography was one day (range = 0–82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. Conclusions TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.

scholarly journals Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or following Pancreatic Surgery

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2733
Author(s):  
Isao Numoto ◽  
Masakatsu Tsurusaki ◽  
Teruyoshi Oda ◽  
Yukinobu Yagyu ◽  
Kazunari Ishii ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Bleeding Complications ◽  
Visceral Artery ◽  
Recurrent Bleeding ◽  
Success Rates ◽  
Embolization Treatment ◽  
Clinically Significant ◽  
Ischemic Events

Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33–80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy.

Risk factors for and influence of bloodstream infections on mortality: a 1-year prospective study in a Greek intensive-care unit

2008 ◽  
Vol 137 (5) ◽  
pp. 727-735 ◽  
Author(s):  
M. PRATIKAKI ◽  
E. PLATSOUKA ◽  
C. SOTIROPOULOU ◽  
T. VASSILAKOPOULOS ◽  
O. PANIARA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Distress Syndrome ◽  
Severity Of Illness ◽  
Bloodstream Infections ◽  
Apache Ii Score ◽  
Incidence Risk ◽  
History Of ◽  
Gram Negative Organisms ◽  
High Level

SUMMARYTo determine the incidence, risk factors for, and the influence of bloodstream infections (BSIs) on mortality of patients in intensive-care units (ICUs), prospectively collected data from all patients with a stay in an ICU >48 h, during a 1-year period, were analysed. Of 572 patients, 148 developed a total of 232 BSI episodes (incidence 16·3 episodes/1000 patient-days). Gram-negative organisms with high level of resistance to antibiotics were the most frequently isolated pathogens (157 strains, 67·8%). The severity of illness on admission, as estimated by APACHE II score (OR 1·07, 95% CI 1·04–1·1, P<0·001), the presence of acute respiratory distress syndrome (OR 3·57, 95% CI 1·92–6·64, P<0·001), and a history of diabetes mellitus (OR 2·37, 95% CI 1·36–4·11, P=0·002) were risk factors for the occurrence of BSI whereas the development of an ICU-acquired BSI was an independent risk factor for death (OR 1·76, 95% CI 1·11–2·78, P=0·015). Finally, the severity of organ dysfunction on the day of the first BSI episode, as estimated by SOFA score, and the level of serum albumin, independently affected the outcome (OR 1·44, 95% CI 1·22–1·7, P<0·001 and OR 0·47, 95% CI 0·23–0·97, P=0·04 respectively).

scholarly journals The Analysis of Risk Factors Associated with Transcatheter Arterial Embolization for Percutaneous Nephrolithotomy

2019 ◽  
Author(s):  
Hongfei Miao ◽  
Yong Chen ◽  
Peng Ye ◽  
Qingle Zeng ◽  
Huajin Pang
Keyword(s):  
Risk Factors ◽  
Percutaneous Nephrolithotomy ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Univariate Analysis ◽  
Postoperative Bleeding ◽  
Arterial Embolization ◽  
Gelatin Sponge ◽  
Bleeding Control ◽  
Embolic Material

Abstract Abstract Background: This study aimed to evaluate the risk factors of transcatheter arterial embolization (TAE) in managing haemorrhage associated with percutaneous nephrolithotomy (PCNL) to improve the surgical effect. Methods: From May 2007 to June 2018, 112 patients (31–60 years) who underwent TAE treatment for haemorrhage after PCNL were retrospectively analyzed. All patient data and embolization details were retrieved from medical records. Univariate analysis was used to identify the risk factors related to clinical outcomes. Results: Technical and clinical success rates were 100% and 93%, respectively. On angiography, we observed injury to the main artery in 1 patient, to secondary branch in 22, to tertiary branch in 58, and to both secondary and tertiary branches in 31. Embolic agents were coils (n =31), gelatin sponge (n=15), and gelatin sponge with coils/microcoils (n =66). Bleeding control failed in 8 patients. Eight patients opted for a second operation, 6 by repeat TAE and 2 by surgery. Bleeding was eventually controlled in all patients. Univariate analysis indicated that extent of transfusion, embolic material used, and injured branches were significantly associated with clinical failure. Conclusions: TAE is effective and safe in treating postoperative bleeding after PCNL. Massive transfusion, embolic material used, and injured branches were related to failure of bleeding control.

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