RESUMEN
OBJECTIVES: Technical graft loss, usually thrombotic in nature, accounts for most of the pancreas grafts that are removed early after transplant. Although arterial and venous thrombosis can occur, the vein is predominantly affected, with estimated overall rate of thrombosis of 6% to 33%. In late diagnosis, the graft will need to be removed because thrombectomy will not restore its functionality. However, in early diagnosis, a salvage procedure should be attempted. MATERIALS AND METHODS: We conducted a retrospective, descriptive analysis of a prospective database of patients who underwent pancreas transplant from April 2008 to June 2020 at a single center. We evaluated post-transplant clinical glucose levels, imaging, treatment, and outcomes. We also performed a systematic review of publications for endovascular treatment of vascular graft thrombosis in pancreas transplant. RESULTS: In 67 pancreas transplants analyzed, 13 (19%) were diagnosed with venous thrombus. In 7 of 13 patients (54%), systemic anticoagulation was prescribed because of a non-occlusive thromboses, resulting in complete resolution for all 7 patients. Six patients (46%) required endovascular thrombectomy because of the presence of complete occlusive thrombosis; 4 of these patients (67%) needed a second procedure because of recurrence of the thrombosis. One of the 6 patients (17%) required a surgical approach, resulting in successful removal of the recurrent clot. Twelve of the 13 grafts (92%) were rescued. Graft survival at 1 year was 84%; graft survival at 3, 5, and 10 years remained at 70%. CONCLUSIONS: Pancreas vein thrombosis represents a frequent surgical complication and remains as a challenging problem. In our experience, early diagnoses and an endovascular approach combined with aggressive medical treatment and follow-up can be used for successful treatment and reduce graft loss.
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Bases de Datos Factuales , Procedimientos Endovasculares , Trasplante de Páncreas , Terapia Recuperativa , Vena Esplénica , Trombectomía , Trombosis de la Vena , Humanos , Trasplante de Páncreas/efectos adversos , Trombectomía/efectos adversos , Resultado del Tratamiento , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/cirugía , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/terapia , Estudios Retrospectivos , Procedimientos Endovasculares/efectos adversos , Factores de Riesgo , Adulto , Vena Esplénica/cirugía , Vena Esplénica/diagnóstico por imagen , Factores de Tiempo , Masculino , Femenino , Persona de Mediana Edad , RecurrenciaAsunto(s)
Implantación de Prótesis , Filtros de Vena Cava , Humanos , Resultado del Tratamiento , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Diseño de Prótesis , Factores de Riesgo , Embolia Pulmonar/prevención & control , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/terapia , Trombosis de la Vena/diagnóstico por imagen , Selección de Paciente , Toma de Decisiones ClínicasRESUMEN
The clinical risk factors and risk of developing pulmonary embolism (PE) in patients with acute isolated distal deep venous thrombosis (IDDVT) were assessed using single complete-duplex ultrasound (CDUS) imaging to reduce over-testing and over-treatment. This observational study was conducted from January 2020 to December 2022. Retrospective analysis was performed on CT pulmonary angiography (CTPA), blood coagulation markers, myocardial injury markers, blood gas analysis, and CDUS imaging of the lower extremity blood vessels of 146 patients with newly diagnosed IDDVT. Binary logistic regression was used to evaluate the relationship between these indicators and PE. After stepwise regression analysis, the predictors included in the regression model were D-dimer (DD), the sum of the thrombus length, and the maximum value of the thrombus width, with odds ratios (ORs) of 1.307 (p <0.001), 1.018 (p = 0.005), and 1.613 (p = 0.018), respectively. The combined prediction model achieved an area under the receiver operating characteristic curve (AUC) of 0.832 [95% confidence interval (CI): 0.761, 0.902]. By balancing the sensitivity and specificity of DD, combined single CDUS improves the predictive value for PE in patients with IDDVT. Key Words: Venous thrombosis, Pulmonary embolism, Ultrasonography, D-dimer, Diagnosis.
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Angiografía por Tomografía Computarizada , Productos de Degradación de Fibrina-Fibrinógeno , Embolia Pulmonar , Trombosis de la Vena , Humanos , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Femenino , Masculino , Persona de Mediana Edad , Medición de Riesgo , Estudios Retrospectivos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Factores de Riesgo , Adulto , Anciano , Curva ROC , Ultrasonografía Doppler Dúplex , Valor Predictivo de las PruebasRESUMEN
An accurate diagnosis of lower limb deep vein thrombosis (DVT) recurrence is mandatory. The diagnosis is difficult and has not been well investigated. Our objective was to define the role of clinical probability assessment, D-dimer assay, venous ultrasound and other imaging methods in the diagnosis of this condition based on a review of published data. Our review did not find any clinical prediction rule (CPR) specific to the diagnosis of DVT recurrence. D-dimer assays have not been sufficiently validated or proved effective either alone or when combined with the assessment of clinical probability or with ultrasound. The only validated ultrasound criteria are a new non-compressible vein segment and a≥2mm or>4mm increase in diameter of the common femoral or popliteal vein under compression in the transverse plane between two examinations. Limitations of these criteria include poor inter-observer agreement, non-availability of previous ultrasound reports and measurements, a high percentage of non-diagnostic ultrasound results, lack of power in diagnostic accuracy and diagnostic management studies, and lack of external validation. The analysis of venous obstruction, thrombus appearance, vein diameter and blood flow based on colour Doppler ultrasound criteria has not yet been validated in studies. Magnetic resonance direct thrombus imaging (MRDTI) is a new promising diagnostic imaging method, but is hardly accessible, costly and needs large scale validation studies. Based on this review, an update of the guidance for clinical practice is proposed for the diagnostic management of patients with clinically suspected lower limb DVT recurrence.
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Consenso , Productos de Degradación de Fibrina-Fibrinógeno , Extremidad Inferior , Valor Predictivo de las Pruebas , Recurrencia , Trombosis de la Vena , Humanos , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/diagnóstico , Extremidad Inferior/irrigación sanguínea , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Biomarcadores/sangre , Ultrasonografía Doppler en ColorRESUMEN
Lumboperitoneal shunt (LPS) has been an effective treatment of idiopathic normal pressure hydrocephalus (iNPH) but sometimes causes serious complications. Here we present the first reported case of cerebral venous thrombosis (CVT) after LPS. A 76-year-old man underwent LPS for iNPH and a week later developed weakness of the right arm and a generalized tonic-clonic seizure. Brain computed tomography and magnetic resonance imaging showed bilateral subdural hematoma (SDH) and left cortical vein thrombosis. Intravenous heparin was administered, followed by surgical evacuation of the SDH. The patient experienced gradual improvement and was subsequently discharged. It is conceivable that overdrainage of cerebrospinal fluid led to the development of both SDH and CVT. CVT is potentially fatal and should be recognized early as a possible complication after LPS to allow prompt treatment.
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Hidrocéfalo Normotenso , Trombosis Intracraneal , Trombosis de la Vena , Humanos , Masculino , Anciano , Hidrocéfalo Normotenso/cirugía , Trombosis Intracraneal/etiología , Trombosis Intracraneal/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Hematoma Subdural/etiología , Hematoma Subdural/cirugía , Hematoma Subdural/diagnóstico por imagen , Imagen por Resonancia Magnética , Heparina/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Deep venous thrombosis (DVT) after spinal surgery has recently attracted increasing attention. Patients with spinal metastases who undergo decompression with fixation are at a high risk of developing DVT. D-dimer levels indicate the risk of DVT, and the purpose of our study was to investigate D-dimer levels as a predictor of DVT perioperatively. METHODS: We prospectively evaluated 100 patients with spinal metastases. D-dimer tests were performed twice: once before surgery and one day postoperatively. DVT was diagnosed by duplex ultrasonographic assessment of both lower extremities. Pulmonary embolisms (PEs) were diagnosed using multidetector computed tomography and pulmonary angiography. Perioperative serum D-dimer levels were compared between the DVT (+) and DVT (-) groups. The cutoff value of the D-dimer level was calculated using receiver operating characteristic analysis. RESULTS: Preoperative and postoperative DVT prevalences were 8.0% (8/100) and 6.6% (6/91), respectively, and none of the patients developed PE. Before surgery, there was no significant differences in D-dimer levels between the pre-DVT (+) and pre-DVT (-) groups. After surgery, the D-dimer level one-day postoperatively for the post-DVT (+) group (17.6 ± 11.8 mg/L) was significantly higher than that of the post-DVT (-) group (5.0 ± 4.7 mg/L). The cutoff value of the postoperative D-dimer level was 9.51(mg/L), and the sensitivity and specificity for the optimum threshold were 83.3% and 89.4%, respectively. CONCLUSIONS: Our findings suggest that preoperative D-dimer level may not be a predictor of DVT. Preoperative ultrasound examinations should be routinely performed in patients with spinal metastases. Postoperative D-dimer levels greater than 9.51(mg/L) are a predictive factor for the early diagnosis of DVT after spine surgery. TRIAL REGISTRATION: Our study was registered on Chinese Clinical Trial Registry (No.ChiCTR2000029737). Registered 11 February 2020 - Retrospectively registered, https://www.chictr.org.cn/index.aspx.
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Descompresión Quirúrgica , Productos de Degradación de Fibrina-Fibrinógeno , Neoplasias de la Columna Vertebral , Trombosis de la Vena , Humanos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Femenino , Masculino , Trombosis de la Vena/sangre , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/epidemiología , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Descompresión Quirúrgica/efectos adversos , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/sangre , Adulto , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Embolia Pulmonar/sangre , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico , Valor Predictivo de las Pruebas , Biomarcadores/sangreRESUMEN
OBJECTIVE: Deep vein thrombosis (DVT) is discussed as a source of embolism for cerebral ischemia in the presence of patent foramen ovale (PFO). However, previous studies reported varying rates of DVT in stroke patients, and recommendations for screening are lacking. This study aimed to characterize patients with stroke or transient ischemic attack (TIA) and concomitant PFO and explore the rate of DVT and associated parameters. METHODS: Medical records were screened for patients with stroke or TIA and echocardiographic evidence of PFO. Concomitant DVT was identified according to compression ultrasonography of the lower limbs. A variety of demographic, clinical, and laboratory parameters, the RoPE and Wells scores were compared between patients with and without DVT. RESULTS: Three-hundred-thirty-nine patients (mean age 61.2 ± 15.4 years, 61.1% male) with stroke or TIA and PFO, treated between 01/2015 and 12/2020, were identified. Stroke and TIA patients did not differ for demographic and vascular risk factors. DVT was found in 17 cases out of 217 (7.8%) with compression ultrasonography. DVT was associated with a history of DVT, cancer, previous immobilization, calf compression pain, calf circumference difference, and a few laboratory abnormalities, e.g., increased D-dimer. A multivariate regression model with stepwise backward selection identified the Wells score (odds ratio 35.46, 95%-confidence interval 4.71-519.92) as a significant predictor for DVT. CONCLUSION: DVT is present in a relevant proportion of patients with cerebral ischemia and PFO, which needs to be considered for the individual diagnostic workup. The Wells score seems suitable for guiding additional examinations, i.e., compression ultrasonography.
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Foramen Oval Permeable , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Trombosis de la Vena , Humanos , Masculino , Femenino , Persona de Mediana Edad , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/epidemiología , Foramen Oval Permeable/diagnóstico por imagen , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/diagnóstico por imagen , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/complicaciones , Trombosis de la Vena/epidemiología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/complicaciones , Estudios Retrospectivos , Anciano , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/etiología , Factores de Riesgo , AdultoRESUMEN
Portal cavernoma thrombosis is a complication of portal cavernoma. We describe the case of a 74-year-old patient who presented to the emergency department with abdominal pain. The computed tomography scan showed a mass from the head of the pancreas to the hepatic hilum not enhanced after injection of iodinated contrast. There was no dilatation of the bile ducts. Abdominal magnetic resonance ruled out a tumour and confirmed a portal cavernoma thrombosis. In 50 % of cases the etiology of the portal cavernoma is unknown. It is often asymptomatic. It may be discovered in case of complications of portal hypertension. In rare cases the portal cavernoma can compress the bile ducts. To our knowledge, portal cavernoma thrombosis has only been described in one article. It is important to search for a thrombophilic disorder when such a complication is found. We share this case report in order to raise awareness in the medical community about this rare complication.
La thrombose de cavernome portal est une complication du cavernome porte. Nous décrivons le cas d'un patient de 74 ans qui s'est présenté aux urgences pour des douleurs abdominales. La tomodensitométrie montrait un syndrome de masse de la tête du pancréas jusqu'au hile hépatique non rehaussé après injection de produit de contraste iodé. Il n'y avait pas de dilatation des voies biliaires. Une imagerie par résonance magnétique abdominale a permis d'infirmer l'hypothèse d'une masse tumorale et d'affirmer une thrombose du cavernome porte. Dans 50 % des cas, l'étiologie du cavernome portal est inconnue. Il est souvent asymptomatique. Il peut être découvert en cas de complications à la suite d'une hypertension portale. Dans de rares cas, le cavernome portal peut comprimer les voies biliaires. À notre connaissance, la thrombose de cavernome portal n'a été décrite que dans un seul article. Il est important de rechercher un désordre thrombophilique quand une telle complication est retrouvée. Nous partageons ce cas clinique afin de sensibiliser la communauté médicale à cette rare complication.
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Vena Porta , Humanos , Anciano , Vena Porta/diagnóstico por imagen , Masculino , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/diagnóstico por imagen , Hipertensión Portal/etiología , Hipertensión Portal/complicaciones , Trombosis/etiología , Trombosis/diagnóstico por imagen , Trombosis/diagnóstico , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XAsunto(s)
Fibrosis Retroperitoneal , Vena Cava Inferior , Humanos , Fibrosis Retroperitoneal/complicaciones , Fibrosis Retroperitoneal/diagnóstico , Vena Cava Inferior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Femenino , Anciano , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagenRESUMEN
Hyperventilation-induced intracranial pressure reduction might be impaired in cerebral venous thrombosis (CVT) patients. Using transcranial Doppler, we assessed carbon dioxide-vasomotor reactivity (CO2-VMR) within 24 hours of admission in CVT patients and studied its correlation with patient outcomes. Adult moderate-severe CVT patients (participants of another large observational study) were included. CO2-VMR was calculated as the percentage change in peak flow velocities during maximal hypercapnia and hypocapnia. Outcome was assessed with the modified Rankin scale (mRS) at one - month post-discharge, dichotomized into favourable (mRS≤2) and unfavourable (mRS>2). Twenty patients' data was analysed. Impaired CO2-VMR (<70 %) was observed in 13 patients in the affected hemisphere; among them, 10 had impairments in both hemispheres. CO2-VMR correlated negatively with mRS (Rho = -0.688, p = 0.001). Odds for unfavourable outcomes were reduced by 92 % in patients with intact VMR on the ipsilateral hemisphere (Odds ratio (OR) 0.08, Confidence interval (CI) 0.006---0.636, p = 0.027) and by 94 % with VMR intact on the contralateral hemisphere (OR 0.063, CI 0.003---0.569, p = 0.03). Thus, impaired CO2-VMR in moderate to severe CVT patients is associated with unfavourable outcomes, and has the potential to prognosticate CVT patients objectively.
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Dióxido de Carbono , Trombosis Intracraneal , Ultrasonografía Doppler Transcraneal , Humanos , Masculino , Femenino , Ultrasonografía Doppler Transcraneal/métodos , Adulto , Persona de Mediana Edad , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/fisiopatología , Estudios Prospectivos , Pronóstico , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/fisiopatología , Circulación Cerebrovascular/fisiología , Anciano , Velocidad del Flujo Sanguíneo/fisiologíaAsunto(s)
Trombosis de la Vena , Humanos , Masculino , Anticoagulantes/uso terapéutico , Trombosis Intracraneal/diagnóstico , Trombosis Intracraneal/etiología , Trombosis Intracraneal/diagnóstico por imagen , Imagen por Resonancia Magnética , Síndrome , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/tratamiento farmacológico , AdolescenteRESUMEN
BACKGROUND AND PURPOSE: Cerebral venous and sinus thrombosis (CVST) leads to perfusion abnormality in the brain. Our aim was to assess perfusion abnormalities in the center and periphery of the parenchymal lesion in CVST patients and correlate with the clinical outcome. MATERIALS AND METHODS: Dynamic susceptibility contrast (DSC) perfusion imaging was performed in patients with CVST. Relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and mean transit time (MTT) values were obtained in the center and periphery of the parenchymal lesion. RESULTS: A total of 30 consecutive patients of CVST were included in the study. Parenchymal lesion was present in 21 (70%) patients. In rest 9, perfusion map was showing some abnormality although conventional MRI was normal. Mean rCBV and MTT were increasing from periphery of the lesion to the center (rCBV 69.93 ± 29.79 at periphery (PL2) to 92.49 ± 32.07 at center of the lesion and 69.19 ± 25.52 at normal appearing contralateral brain parenchyma (NABP). MTT 11.83 ± 3.76 at periphery (PL2) to 15.27 ± 5.49 at center of the lesion and 10.63 ± 3.37 at NABP). rCBV and MTT from abnormal perfusion areas from 9 patients without parenchymal abnormalities are 92.89 ± 17.76 and 15.92 ± 3.66 respectively. CONCLUSION: There is an increasing trend of MTT and rCBV from periphery to center of the parenchymal lesion. MTT is the most consistent parameter to be abnormal in patients of CVST even in patients without parenchymal lesion. Residual neurological deficit was found in patients with increased rCBV and having large hemorrhagic infarct.
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Circulación Cerebrovascular , Trombosis de los Senos Intracraneales , Humanos , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Femenino , Adulto , Masculino , Circulación Cerebrovascular/fisiología , Persona de Mediana Edad , Adulto Joven , Imagen por Resonancia Magnética/métodos , Adolescente , Angiografía por Resonancia Magnética , Encéfalo/diagnóstico por imagen , Encéfalo/irrigación sanguínea , Trombosis de la Vena/diagnóstico por imagenRESUMEN
BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for the treatment of several complications of portal hypertension (PH), including non-neoplastic portal vein thrombosis (PVT). Selection criteria for TIPS in PVT are not yet well established. Despite anecdotal, cases of thromboembolic events from paradoxical embolism due to the presence of patent foramen ovale (PFO) after TIPS placement have been reported in the literature. Therefore, we aimed at describing our experience in patients with non-neoplastic splanchnic vein thrombosis (SVT) who underwent TIPS following PFO screening. METHODS: We conducted a single-centre retrospective study, including consecutive patients who underwent TIPS for the complications of cirrhotic and non-cirrhotic portal hypertension (NCPH) and having SVT. RESULTS: Of 100 TIPS placed in patients with SVT, 85 patients were screened for PFO by bubble-contrast transthoracic echocardiography (TTE) with PFO being detected in 22 (26%) cases. PFO was more frequently detected in patients with non-cirrhotic portal hypertension (NCPH) (23% in the PFO group vs. 6% in those without PFO, p = .04) and cavernomatosis (46% in the PFO group vs. 19% in those without PFO, p = .008). Percutaneous closure was effectively performed in 11 (50%) after multidisciplinary evaluation of anatomical and clinical features. No major complications were observed following closure. CONCLUSIONS: PFO screening and treatment may be considered feasible for patients with SVT who undergo TIPS placement.
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Foramen Oval Permeable , Hipertensión Portal , Vena Porta , Derivación Portosistémica Intrahepática Transyugular , Trombosis de la Vena , Humanos , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/cirugía , Foramen Oval Permeable/diagnóstico por imagen , Estudios Retrospectivos , Hipertensión Portal/cirugía , Hipertensión Portal/etiología , Hipertensión Portal/complicaciones , Femenino , Masculino , Persona de Mediana Edad , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/cirugía , Vena Porta/cirugía , Adulto , Prevalencia , Anciano , Ecocardiografía , Circulación Esplácnica , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Resultado del TratamientoRESUMEN
A 76-year-old female with a complicated medical history presented for Watchman (Boston Scientific) placement 2 months after mitral valve transcatheter edge-to-edge repair (TEER). Preoperative workup before Watchman placement confirmed the presence of a thrombus in the left superior pulmonary vein. Post-procedure mitral valve TEER transesophageal echocardiogram showed no thrombus in the left atrium appendage or pulmonary veins. We believe the thrombus in the left superior pulmonary vein occurred secondarily due to epithelium damage during the mitral valve TEER.
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Cateterismo Cardíaco , Ecocardiografía Transesofágica , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Válvula Mitral , Venas Pulmonares , Trombosis de la Vena , Humanos , Femenino , Anciano , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/fisiopatología , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagenRESUMEN
This review explores the clinical presentation of lower extremity DVT and pulmonary embolism (PE), treatment strategies, and outcomes for venous thromboembolism (VTE) in the pediatric population. Traditional therapy for pediatric VTE was anticoagulation alone with thrombolysis and surgery reserved only in life or limb-threatening cases. Catheter-directed thrombolysis (CDT), pharmacomechanical thrombectomy (PMT) and mechanical thrombectomy (MT) have emerged as effective and safe treatment options for VTE management. Although most data are from adult studies, early pediatric studies suggest that these interventional procedures can be effective in children. The significant clinical impact of post-thrombotic syndrome (PTS) is also discussed, as PTS can lead to lifelong physical symptoms and psychosocial damage.
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Trombectomía , Terapia Trombolítica , Tromboembolia Venosa , Humanos , Niño , Terapia Trombolítica/efectos adversos , Resultado del Tratamiento , Trombectomía/efectos adversos , Tromboembolia Venosa/terapia , Tromboembolia Venosa/diagnóstico por imagen , Adolescente , Preescolar , Factores de Riesgo , Lactante , Factores de Edad , Radiografía Intervencional , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico por imagen , Femenino , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/terapia , Masculino , Recién Nacido , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Fibrinolíticos/administración & dosificación , Anticoagulantes/uso terapéuticoRESUMEN
Pediatric venous occlusions are a growing cause of morbidity and mortality, especially in hospitalized patients. Catheter-directed recanalization is a safe and effective treatment option in appropriately selected patients. Benefits of catheter directed therapies (CDTs) include the prevention of pulmonary embolism and end organ failure acutely as well as superior vena cava syndrome and post-thrombotic syndrome chronically. Timely diagnosis, recognition of underlying factors for thrombosis, and familiarity with the spectrum of tools and techniques for CDT are essential to optimizing outcomes in the acute setting. Recanalization of chronic venous occlusions can similarly provide symptomatic relief and achieve long term vessel patency. This review will detail the scope, techniques, and outcomes for CDT in the treatment of acquired systemic deep vein occlusions.
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Radiografía Intervencional , Trombosis de la Vena , Humanos , Niño , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Trombosis de la Vena/fisiopatología , Resultado del Tratamiento , Preescolar , Adolescente , Lactante , Flebografía , Grado de Desobstrucción Vascular , Factores de Edad , Factores de Riesgo , Recién Nacido , Masculino , Femenino , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Cateterismo Periférico/efectos adversos , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: The objective of this study is to compare and assess the efficacy and safety of low-molecular-weight heparin calcium (LMWH-Ca), followed by either warfarin or rivaroxaban, as treatment options for portal vein thrombosis (PVT) in patients with cirrhosis. METHODS: In this pilot study, cirrhotic (with liver function score of Child-Pugh A) patients diagnosed with PVT who were not on anticoagulant therapy received 2 weeks of subcutaneous injections of LMWH-Ca. They were then randomized to either warfarin (a full course of oral warfarin for 6 months) or rivaroxaban (a full course of oral rivaroxaban for 2 months), with 30 cases in each group. After a treatment period of up to 6 months, a comparative analysis was performed to assess the efficacy and safety of both groups. Volumetric changes in PVT were monitored dynamically using enhanced computed tomography scans before treatment at week 2 and month 6. RESULTS: There were no statistically significant differences in the clinical characteristics of the patients between the two groups. Rivaroxaban treatment reduced PVT median volume from 1.83 cm3 at week 2 to 0.0 cm3 at month 6 and prevented the worsening of PVT after 6 months of treatment with LMWH-Ca (Pâ <â 0.001). On the other hand, warfarin treatment increased PVT median volume from 1.95 cm3 at week 2 to 3.78 cm3 at month 6 (Pâ =â 0.002). None of the 30 patients in the rivaroxaban group had clinically significant gastrointestinal bleeding, while 2 of the 30 patients (7%) in the warfarin group had gastrointestinal bleeding (Pâ =â 0.317). CONCLUSION: Rivaroxaban followed by LMWH-Ca is an effective anticoagulant treatment strategy for PVT in cirrhosis.
Asunto(s)
Anticoagulantes , Heparina de Bajo-Peso-Molecular , Cirrosis Hepática , Vena Porta , Rivaroxabán , Trombosis de la Vena , Warfarina , Humanos , Proyectos Piloto , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Masculino , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversos , Rivaroxabán/uso terapéutico , Vena Porta/diagnóstico por imagen , Femenino , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/diagnóstico por imagen , Persona de Mediana Edad , Cirrosis Hepática/complicaciones , Cirrosis Hepática/tratamiento farmacológico , Warfarina/administración & dosificación , Warfarina/efectos adversos , Heparina de Bajo-Peso-Molecular/administración & dosificación , Heparina de Bajo-Peso-Molecular/uso terapéutico , Heparina de Bajo-Peso-Molecular/efectos adversos , Administración Oral , Resultado del Tratamiento , Anciano , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/administración & dosificación , Inhibidores del Factor Xa/uso terapéutico , Adulto , Inyecciones Subcutáneas , Tomografía Computarizada por Rayos X , Quimioterapia CombinadaRESUMEN
Chronic superficial venous disease, including superficial venous insufficiency, superficial venous thrombosis, and aneurysms, are prevalent conditions that affect millions of individuals worldwide. With chronic venous insufficiency specifically, the advent of office-based minimally invasive procedures in recent decades has significantly expanded access to outpatient treatment. However, as venous insufficiency is rarely life- or limb-threatening, the clinical diagnosis, diagnostic evaluation, and treatment indications should be considered carefully when recommending elective intervention. Appropriateness of care guidelines intend to aid providers and patients in the decision-making process, based on the available evidence in the scientific literature, to select the best care for the patient when treating their superficial venous disease.