Stent grafts improved patency of ruptured hemodialysis vascular accesses

This study aimed to compare stent graft with balloon tamponade for ruptured dialysis access during percutaneous transluminal angioplasty. Patients over an 8-year period (2010–2018) were identified from a database of 11,609 procedures. The primary endpoint was target lesion primary patency at 12 months. A total of 143 patients who had rupture dialysis access were enrolled, of whom 52 were salvaged by stent grafts and 91 were salvaged by balloon tamponade. The 6-month target lesion primary patency was greater in the stent graft group than in the balloon tamponade group (66.7% vs. 29.5%, P < 0.001). The benefit of stent grafts was sustained for 12 months (52.5% vs. 9.0%, P < 0.001). The stent grafts increased the median time from the index procedure to the next intervention in the ruptured area by 171 days (260 vs. 89 days) at 12 months. There was no significant difference in the access circuit patency rates at 6 months (25.5% vs. 19.8%, P = 0.203) and 12 months (12.0% vs. 5.8%, P = 0.052). The patency results of the stent grafts remained after the multivariable adjustment analysis. Compared to balloon tamponade alone, stent grafts provided superior target lesion primary patency at 6 and 12 months. The access circuit patency rates were similar.

Intrauterine Bakri balloon tamponade plus cervical cerclage for the prevention and treatment of postpartum haemorrhage in late pregnancy complicated with acute aortic dissection: Case series

In this study, a treatment method was assessed for the prevention and treatment of postpartum bleeding after combined surgery in patients having late pregnancy with the complication of acute Stanford type A aortic dissection. The clinical records of ten patients receiving treatment at the Second Xiangya Hospital of Central South University between March 2012 and March 2021 were retrospectively analysed. All patients were diagnosed with acute Stanford type A aortic dissection according to computed tomography angiography of the thoracic and abdominal aorta. Aortic valve function was assessed using two-dimensional echocardiography. All patients experienced uterine-incision delivery under systemic anaesthesia. During the operation, intrauterine Bakri balloon tamponade and cervical cerclage were performed. Postpartum bleeding was effectively controlled for all patients. The extracorporeal circulation time was 230–295 min, the postpartum 24 h bleeding volume was 500–870 mL, the volume of physiological saline injected into the balloon was 290–515 mL, and the intrauterine balloon compression time was 28–51 h. No postpartum bleeding occurred. A 42-days follow-up showed no late postpartum bleeding, poor uterine incision healing, or puerperal infection, and no uterine removal was performed. Intrauterine Bakri balloon tamponade plus cervical cerclage can effectively prevent intra- and postoperative postpartum bleeding in pregnant patients with aortic dissection.

B Lynch Suture and Intrauteribne Balloon Tamponade for Management of Severe Postpartum Hemorrhage: A Comparative Study

Objective: The aim of this study is to compare the effectiveness of intrauterine balloon tamponade and B lynch suture for management of severe postpartum hemorrhage. Study Design: Randomized Control trial Place and Duration: The study was conducted at Gynae & Obs department of Qazi Hussain Ahmad Medical Complex, Nowshera KPK for six months duration from January to 2021 to June 2021. Methods: There were one hundred and twenty patients with ages 20-45 years were presented in this study. All women had severe postpartum hemorrhage were included in this study. Demographically detailed of enrolled cases age, body mass index, gestational age and parity were recorded after taking informed written consent. Patients were equally divided into 2-groups I and II. Group I had 60 patients and received Lynch suture while in group II 60 patients received intrauterine balloon tamponade. Post-operative success rate among both groups were assessed and compared in terms of bleeding control within 10-15 minutes. SPSS 24.0 version was used to analyze the complete data. Results: In group I mean age was 29.09±2.53 years with mean BMI 25.11±7.64 kg/m2 while in group II mean age was 29.02±3.62 years with mean BMI 24.87±6.32 kg/m2. Mean gestational age in group I was 37.87±3.29 weeks and in group II mean gestational age was 38.19±6.41 weeks. Mean parity in group I was 4.03±1.19 and in group II it was 4.01±0.87. Frequency of success rate in group I was significantly higher among 54 (90%) cases as compared to group II 39 (65%) with p value < 0.05. We found that patients of group I was significantly satisfied than that of patients who received intrauterine balloon tamponade. Conclusion: In this research we concluded that lynch suture for the management of severe postpartum hemorrhage among females had higher effectiveness in terms of bleeding control within 15 minutes and with higher satisfaction among patients as compared to those females who received intrauterine balloon tamponade. Keywords: Postpartum hemorrhage, Lynch Suture, intrauterine balloon tamponade, Success Rate

Solution to Technical Difficulties of Uterine Balloon Tamponade Placement in Primary PPH Management: A Retrospective Case Series

Objective: The aim of this study was to devise and enforce a simple yet effective method of condom placement for IUBT while dealing with all the technical difficulties in a poor resource setup to control primary PPH to save life of mother. Methodology: It is a retrospective case series study that is based on the hospital data obtained from Gynecology and Obstetrics Department of Sheikh Zayed Hospital, Rahim Yar Khan for a period of 8 months (July 2019 to Feb 2020) . Patients with persistent primary PPH after medical management who were given intra-uterine balloon tamponade (IUBT) were included in this study after evaluation for possible risk factors of PPH. Sample size was kept 30 with power of test at 80% and level of significance at 5%. Statistical assessment of the variables was done and the data was analyzed with SPSS v.21. Results: The 30 female patients, included in this study, had mean age of 30.3±6.06 years ranging from 17 to 39 years. Condom IUBT was successfully placed in 28(93.3%) patients by using 4 ring forceps applied on cervix and tied together with a gauze to keep the balloon in utero in order to control bleeding of PPH while in 2(6.66%) patients; it was unsuccessful due to inexperience of the operating staff. Out of these 28 patients with successful IUBT placement, condom based intra-uterine balloon tamponade was successful in controlling bleeding of PPH in 26(92.86%) patients while in 2(7.14%) patients, bleeding was not controlled and they underwent surgical interventions. Conclusion: Condom based Intra-uterine balloon tamponade is a simple yet effective method to control bleeding in primary postpartum hemorrhage but needs positive re-enforcement in the form of awareness/training sessions for the healthcare staff. Keywords: Catheter, Post-Partum Morbidity, Condom, Intra-Uterine Balloon Tamponade, Hemorrhage, Hysterectomy

Sooner than later: a little effort may avert postpartum haemorrhage in patients with acute hepatitis E

Background: The incidence of postpartum hemorrhage (PPH) in pregnancies with hepatitis E varies from 14-42%. Management of labor and PPH in these women with acute liver injury makes it a real obstetric challenge due to associated coagulopathies and contraindication for many drugs. Prophylactic insertion of condom balloon tamponade along with active management of the third stage of labour (AMTSL) prevent primary PPH in these women. Simultaneous use of injection tranexemic acid further gives reliable results. The present study was conducted to study the effectiveness of condom balloon tamponade in preventing PPH in pregnant women with acute hepatitis E in labor.Methods: The present study was conducted in the Department of Obstetrics and Gynecology, Pt. Jawaharlal Nehru Medical (JNM) College and associated Dr. Bhim Rao Ambedkar Memorial (BRAM) Hospital, Raipur, Chhattisgarh over period of two year from September 2018 to September 2020.Results: During the study period 32 women presented with hepatitis E in labor. Condom balloon tamponade was inserted prophylactically in all hepatitis E virus (HEV) positive cases immediately after delivery of placenta along with vaginal packing, irrespective of amount of bleeding. Inspite of so many odds in the form of unscanned pregnancies, multiparity, multifetal gestation, abruption, intrauterine fetal death (IUFD), prolonged labor, deranged liver and coagulation profiles, anemia and thrombocytopenia, our study showed high effectiveness of prophylactic condom balloon tamponade by encountering only one case of PPH.Conclusions: Prophylactic condom balloon tamponade insertion just after the removal of placenta is promising in averting PPH.

Percutaneous treatment of severe retroperitoneal hematoma after percutaneous coronary intervention

We describe a patient who developed severe retroperitoneal and intraperitoneal bleeding complicating femoral arterial catheterization for Percutaneous coronary intervention. Balloon tamponade of the actively bleeding femoral artery was effective in sealing off the leakage. This management strategy for this problem emphasizing an anatomical based interventional approach if the patient does not stabilize with volume resuscitation.

Identifying Condom Catheter Component to Optimize Its Function As Intrauterine Balloon Tamponade (Iubt): A Laboratory Test

Uterine atony is the primary cause of postpartum hemorrhage worldwide. Further management for severe bleeding or limited uterotonic is the insertion of intrauterine balloon tamponade (IUBT), and a modified condom catheter is the most affordable form of IUBT. However, it has some limitations that can emerge from the component of the tools. This study aims to identify the equipment component of the condom catheter and discover potential improvements to optimize its function as IUBT. Preclinical research under laboratory environmental conditions was conducted. Five condom types, six catheter sizes, and a type of macro drip IV tubing were included in the study. The specifications of all condoms were almost similar and did not significantly differ in capacity, shape, and leakage. The condom shapes were more rounded and had a high possibility of filling the uterine space entirely if tied in the middle instead of close to the tip based on the standard. There was no significant time difference (p = 0.111; CI95% 3.31–3.52) in draining the fluid when using large catheters (nos 18F, 20F, 22F, and 24F) and removing the catheter. However, not using a catheter should consider the device's required length and mother's comfort in early mobilization. Also, further clinical studies are highly recommended.