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Vascular surgery
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Treatment. If limb clinically viable and arterial embolus suspected, embolectomy +/- completion angiogram.If limb viable and thrombosis suspected, angiography, intra-arterial thrombolysis (streptokinase or tPA; takes 4–24 hours to dissolve thrombus), angioplasty, balloon catheter thrombectomy, reconstructive surgery +/- fasciotomies (for compartment syndrome), are possible therapeutic options.
Gangrene of the Toes
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
The common causes of gangrene of the toes are: Atherosclerosis.Arterial embolism.Thromboangiitis obliterans (Buerger's disease).Collagen vascular disease (SLE, polyarteritis nodosa, rheumatoid arthritis, etc.).
Acute Mesenteric Ischemia
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Knowing the etiology of AMI plays a key role in patient management and outcomes. It is important to acknowledge two important studies with differences in etiologies for AMI. In a classical analysis by Endean (2001), AMI was diagnosed in 170 patients. The most common etiology was nonthrombotic (60%), followed by thrombotic (34%), and indeterminate (6%). In the thrombotic cohort, arterial embolism accounted for 38%, arterial thrombosis for 36%, and venous thrombosis for 26%. This is in contrast to a more recent study of 107 patients with AMI by Alhan et al. (2012) where the most common etiology was documented to be mesenteric arterial thrombosis (63.6%), followed by arterial embolism (26%), and nonocclusive mesenteric ischemia (10.2%). Although differences in etiologies exist based on current literature, it is important to remember the difference in outcomes based on origin of AMI, as demonstrated by Schoots et al. (2004), who performed a quantitative analysis of data derived from 45 observational studies containing 3692 patients. They were able to identify that survival after AMI varied between the different etiological subsets. The authors concluded that the mortality rate after surgical treatment of arterial embolism and venous thrombosis has improved over the years, whereas that after surgery for arterial thrombosis and nonocclusive ischemia remained poor.
Implantable loop recorders in patients with atrial fibrillation
Published in Expert Review of Cardiovascular Therapy, 2022
Arjun N. Sharma, William F. McIntyre, Stephanie T. Nguyen, Adrian Baranchuk
Among current literature, only the LOOP study compared ILRs to usual care with a randomized control trial (RCT) design [67]. Among 6004 individuals aged 70–90 years who had at least one AF risk factor, ILR monitoring led to AF diagnosis in 31.8% compared to 12.2% of individuals randomized to the control group of usual care. This resulted in an increase in anticoagulation initiation (29.7% versus 13.1%) but did not result in a significant decrease in stroke or systemic arterial embolism during the mean follow-up period of 64.5 months. These findings have limited the practice of ILR screening and suggested that the relationship between ILR-detected AF burden and stroke risk remains unclear [68]. Data is still needed to clarify the threshold of AF warranting anticoagulation and will likely guide future AF screening. This opinion is reflected in the United States Preventive Services Task Force guidelines, which found that current evidence is insufficient to recommend AF screening by any modality [69]. Despite these limitations ILRs remain useful in research settings where the desired outcome is AF detection only rather than stroke prevention.
Comparison of predictive value of risk scores for gastrointestinal bleeding in antiplatelet therapy
Published in Platelets, 2022
Mei-na Lv, Xiao-chun Zheng, Shao-jun Jiang, Hong-qin Zhang, Fang-Da Xu, Ting-Ting Wu, Wen-Jun Chen, Jin-hua Zhang
With the increased aging of the population, the prevalence of cardiovascular and cerebrovascular diseases is increasing year by year. According to the survey, there are currently about 290 million patients with cardiovascular and cerebrovascular diseases in China, accounting for about 21% of the total population [1,2], and the standardized incidence of stroke among residents aged 40–74 has increased by an average of 8.3% per year [3]. Antiplatelet drugs are one of the important drugs for the prevention and treatment of cardiovascular and cerebrovascular diseases. The use of antiplatelet drugs is also increasing year by year in China. For example, the amount of clopidogrel used in 2018 increased by 1.89 times compared with 2013 [4]. Oral antiplatelet drugs mainly include aspirin, clopidogrel, ticagrelor, cilostazol, and prasugrel. These drugs are widely used to prevent or treat thrombosis and reduce the risk of embolism events, including non-cardiogenic stroke, coronary heart disease, and lower extremity arterial embolism [5–7].
The current status of thermal ablation in the management of T1b renal masses
Published in International Journal of Hyperthermia, 2019
BT Welch, PH Shah, RH Thompson, TD Atwell
Particularly related to cryoablation of larger tumors, significant bleeding can result due to the use of multiple applicators and/or central placement of the applicators [13,36]. Cracking of the iceball, presumably due to differential expansion/contraction of tissue during dynamic temperature fluctuations, may also occur and result in significant hemorrhage [37,38]. Accordingly, prophylactic selective renal artery embolization should be considered to minimize this risk of bleeding. In one small study, patients treated with such embolization had smaller post-procedural hematomas compared to those who did not have such treatment [39]. Embolization should also be considered prior to ablation in those patients with need for aggressive anticoagulation following ablation (e.g. recent coronary stent placement or arterial embolus). Peri-procedural arterial blood pressure monitoring is helpful for real-time assessment of patient hemodynamics to help differentiate normal post-procedural bleeding from that warranting urgent intervention. Close observation following treatment, often including brief hospitalization, is warranted particularly for frail patients.