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Complications of percutaneous intervention for femoral, popliteal, and infrapopliteal artery occlusive disease
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Renganaden Sooppan, Christopher J. Abularrage
Ultrasound-guided thrombin injection was first described in 1998 and is now the preferred method to treat PSA.20 This technique involves visualizing the PSA neck and sac under ultrasound and directly injecting the smallest amount of thrombin into the sac away from the neck, thereby inducing thrombosis of the sac contents and occluding flow into the PSA. Ideally, a long neck with a smaller diameter is preferred to avoid spilling thrombin into the artery. Its technical success is almost instantaneous compared to almost 30 to 45 minutes of compression and the results can be seen on ultrasound in real time. The procedure is relatively safe, with a 2% rate of distal embolization reported as the most common complication.19,21 A repeat duplex is done 24 hours after the injection to verify that the pseudoaneurysm is completely thrombosed. Multilobular PSAs or patients on anticoagulation may require reinjection. Open surgical repair of a PSA is reserved for multiple failed attempts with thrombin injection.
Developmental Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James H. Tonsgard, Nikolas Mata-Machado
Pulmonary: Embolization is effective and safe.Asymptomatic lesions should be embolized.Ligation of arterial supply.Antibacterial prophylaxis at the time of dental or surgical procedures.
Secondary Hemorrhage after Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Fertility issues following uterine artery embolization are always a concern. Since patients may want fertility after myomectomy, they should be adequately counselled prior to the procedure. Takeda et al. [16] reported successful embolization of a uterine artery pseudoaneurysm in a patient who developed hemorrhage 79 days after laparoscopic myomectomy. The patient could conceive naturally following the embolization and had one spontaneous abortion followed by a successful delivery by cesarean section. Another report of successful pregnancy following embolization was made by Ito et al. [21]. The patient underwent embolization for secondary hemorrhage after hysteroscopic myomectomy 22 days following the surgery. She had two successful deliveries following the embolization. Of the eight patients who underwent embolization as reported by Takeda et al. [15], five were desirous of fertility; four of the five conceived, resulting in three live births and two spontaneous abortions. However, larger long-term follow-up studies would be required before we can consider angioembolization as a useful fertility-sparing method, and patients need to be counseled in detail about the limited evidence regarding fertility issues related to uterine artery embolization.
Specific complications associated with non-surgical rhinoplasty
Published in Journal of Cosmetic and Laser Therapy, 2020
Tuyet A. Nguyen, Shivani Reddy, Nima Gharavi
Skin and soft tissue necrosis are rare but serious complications of filler injection. It is thought that necrosis from filler injections can be caused by two mechanisms: 1) intravascular embolization through direct injection into a vessel or 2) vascular compromise from external pressure from the filler material (8). The angular, dorsal nasal, and supratrochlear arteries are particularly vulnerable to this complication, and are all possible targets in the application of filler for non-surgical rhinoplasty (9). The glabella is also a watershed area with minimal collateral circulation and small caliber vessels making it susceptible to external pressure and tamponade (10). Signs of impending necrosis include severe pain, blanching, edema, and violaceous discoloration (11–13). However, it is important to distinguish arterial from venous occlusion. While arterial occlusion is often immediately accompanied by pain and blanching, venous occlusion may not present with significant pain but demonstrates venous mottling or a livedo-like phenomenon (13). It is important to recognize features of impending necrosis to allow for early intervention and prevention of further complications.
The use of neo adjuvant single-agent vinblastine for tumour shrinkage in a highly vascular paediatric low-grade glioma
Published in British Journal of Neurosurgery, 2020
Vita Stagno, Conor Mallucci, Shivaram Avula, Barry Pizer
She underwent an image-guided craniotomy for cyst marsupialization and tumour biopsy. Histological examination of a small sample showed a LGG, with a favoured diagnosis of Pilocytic Astrocytoma (WHO Grade I) on central review. On microscopy of a small sample, the tumour showed no inherent abnormal vasculature although proliferating blood vessels were seen in a small area of surrounding white matter taken with the tumour. Although not done at diagnosis, subsequent molecular analysis of the tumour showed no BRAF v600 mutation or BRAF fusion genes. Due to the increased risk from surgery with respect to the abnormal tumour vasculature, the neuro-oncology MDT felt that she should be treated with chemotherapy in the first instance. Embolisation was felt to carry a significant risk of complications. First line chemotherapy would generally be a combination of carboplatin and vincristine. However, with respect to the association of carboplatin with myelosuppression, particularly thrombocytopenia, it was decided to treat her with an alternative chemotherapy namely vinblastine.
Construction of novel procoagulant protein targeting neuropilin-1 on tumour vasculature for tumour embolization therapy
Published in Journal of Drug Targeting, 2019
Mingyuan Zou, Malik Samiullah, Peilan Xu, Shengyu Wang, Jie He, Ting Wu, Fanghong Luo, Jianghua Yan
Tumour embolisation therapy is highly efficient. Because each vessel provides the nutrition for and facilitates removal of waste products of metabolism from, many thousands of tumour cells. Blockage or destruction of the tumour-supplying vessel may then result in thousands of downstream cells death [29–31]. Besides, in order to successfully control cancer, chemotherapeutic agents have to reach every cancer cell and lead them to be eradicated or prevented from dividing. This is difficult to achieve because even in very small tumour deposits of 1 cm3 may require to contact with up to 109 of cells. While tumour vascular targeted therapy can directly contact vascular endothelial cells. Since all solid tumours depend upon the presence of vascular supply, tumour vascular targeted therapy has a broader spectrum of treatment [32]. Most importantly, highly selective tumour vascular targeted therapy has fewer toxic side effects than traditional tumour therapy [33].