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Cardiovascular system
Published in David A Lisle, Imaging for Students, 2012
Deep venous thrombosis (DVT) of the leg presents clinically with local pain and tenderness accompanied by swelling. Risk factors for development of DVT include:Hospitalization and immobilizationTraumaSurgery, particularly surgery to the lower limb, or major abdominal surgeryMalignancyObesityHistory of previous DVTFactor V Leiden.
Amplatzer patent foramen ovale occluder: safety and efficacy
Published in Expert Review of Medical Devices, 2019
Raouf Madhkour, Andreas Wahl, Fabien Praz, Bernhard Meier
The device may take a couple of months to become fully covered with neo-endocardium which justifies to provide antithrombotic therapy during this period. According to the instructions for use, patients are to be treated for antithrombotic protection with acetylsalicylic acid (84 to 325 mg daily) for at least six months, with the addition of clopidogrel (75 mg/d) during the first month following implant. Due to the low thrombogenicity of the device, our regimen is simpler with usually 1 month of clopidogrel and 5 months acetylsalicylic acid (100 mg) or even more simply just a few weeks of acetylsalicylic acid. Depending on individual risk factors, such as a history of a deep venous thrombosis or a pulmonary embolism, some patients may alternatively benefit from continuation or resumption of anticoagulation therapy (e.g. warfarin or non-vitamin K dependent oral anticoagulants) to minimize the risk of recurrent thromboembolic events. Three to six months after percutaneous PFO closure, a control echocardiogram, ideally a TEE (less ideally a transthoracic echocardiogram) with bubble contrast, is performed to assess for residual shunt and to exclude thrombus on the device which is exceedingly rare with Amplatzer PFO Occluders. A transcranial Doppler examination informs reliably about residual right to left shunt but it cannot locate it to the PFO or assess for device thrombi. If complete closure is documented and no thrombus detected, antithrombotic medication can be discontinued, unless already stopped or required for another reason. In case of a residual shunt, later spontaneous closure is highly unlikely and the necessity to continue antithrombotic therapy or alternatively the implantation of a second device should be assessed. Residual shunt closure with a second device is feasible, safe, and results in complete closure in more than 80% of the cases [17,18].