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Surgical therapy of venous malformation combined with embolo-/sclerotherapy: How much and when?
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Truncular type. The truncular type of VMs can involve the epifascial, marginal vein (see Chapter 41), which can be treated by surgery, endoluminal laser ablation, or radiofrequency ablation. The subfascial form, e.g., the sciatic vein or the accessory femoral vein (Figures 38.4 and 38.5), can be treated by interventional catheter techniques or by surgery. The control phlebography in this case after partial resection of the accessory vein and resection of the aneurysmal vein segment demonstrated malformations with aneurysms of the femoral vein that required further treatment. In this particular case, the inferior vena cava filter was placed for prophylaxis given that the patient had a history of pulmonary embolisms prior to aneurysm resection.
Venous disorders
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The management of DVT has in the past been focused upon reducing the risk of pulmonary embolus. Patients who are confirmed to have a DVT on duplex imaging should be rapidly anticoagulated with a ‘treatment dose’ of subcutaneous LMWH. Patients with significant renal impairment should be commenced on intravenous unfractionated heparin. Patients who have a sensitivity towards heparinoids, such as those with heparin-induced thrombocytopenia, should commence on another anticoagulant, such as fondaparinux (an indirect factor Xa inhibitor) or bivalirudin (a direct thrombin inhibitor). This will achieve rapid anticoagulation and reduce the risk of embolisation. Typically, patients will then commence on warfarin for at least 3 months (or longer depending upon the persistence of risk factors or in recurrent cases). Patients who cannot be safely anticoagulated (usually due to bleeding risks) should be considered for a temporary inferior vena cava filter, until either they are safe to be anticoagulated or the risk of embolisation has subsided and the filter may be retrieved. Patients with active cancer typically remain on a LMWH. There is a range of newer or ‘novel’ anticoagulants (NOACs). These oral agents either directly inhibit factor Xa (rivaroxaban and apixaban) or thrombin (dabigatran). Work is ongoing to explore their place within patient management.
Venous thrombo- embolism – treatment
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
Continuous infusion rather than bolus or pulse-spray infusion is usually recommended for treating DV T. Low doses have been found to be as effective as higher doses with fewer complications. Typical treatments can involve several visits to the interventional suite over several days. Treatment might release clot fragments as pulmonary emboli, but an inferior vena cava filter is usually not required because ongoing lysis minimizes any damage they may cause.
Clozapine associated pulmonary embolism: systematic review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
A total of 34 cases of PE associated with clozapine from 24 articles were included in the final analysis (see Table 1). The mean age of patients was 43.21 years with male predominance (63.63%, n = 21/33). The mean dosage of clozapine was 281.45 mg per day. There was a large variation in data on duration of clozapine use and development of PE. Duration ranged from few days to many years. Respiratory distress was the most common presenting complaint (55.55%, n = 15/27) followed by concurrent respiratory distress and chest pain both in five patients. Three patients presented with syncope while one presented with worsening of somatic symptoms and was diagnosed with PE. Three patients presented with sudden death, and PE was diagnosed on autopsy. In article by Hagg et al [4] PE was diagnosed in five patients on autopsy and one patient on CT of chest. No additional details on clinical presentation were available. Treatment of PE was mentioned in 20 patients. Anticoagulation was the mainstay of treatment in 80% (n = 16/20). Two patients were treated with Tissue plasminogen activator (TPA), and one patient was treated with only Inferior Vena Cava filter placement. In a case reported by Yang et al [5] patient developed massive PE. TPA therapy was refused by family, and the patient died. Mortality rate in our review was 36.36% (n = 12/33). Fate of clozapine after PE episode in patients who survived was available in 18 patients. Clozapine was discontinued in 14 patients. In four patients clozapine was continued. The details of the four patients in which clozapine was continued are discussed below.
Central Venous Catheter as a Novel Approach to Postoperative Thrombolysis in Patients with Acute Iliofemoral Deep Venous Thrombosis
Published in Clinical and Experimental Hypertension, 2023
Biyun Teng, Fenghe Li, Xuehu Wang, Hao Tian, Yu Zhao, Qiu Zeng
All procedures were done in the supine position and performed under conscious sedation with local anesthesia. The choice of anesthetic agent was determined by the surgeons. According to Chinese national guidelines (25), a retrievable inferior vena cava filter (IVCF) was routinely placed below the bilateral renal veins and above the opening of the iliac vein through a femoral venipuncture angiogram after ascertaining the patency of the inferior vena cava in the beginning of the procedure to prevent PE development. Angiography was done to rule out any deviation in the position of the filter. Afterward, the long sheath was left in place for subsequent use.
Risk factors for venous thromboembolism (VTE) recurrences in Thai patients without cancer
Published in Hematology, 2019
Panchalee Satpanich, Ponlapat Rojnuckarin
The majority of patients were initially treated by subcutaneous low molecular weight heparin (LMWH, 67.2%) or intravenous unfractionated heparin (20.2%). Thrombolytic therapy, surgical thrombectomy and inferior vena cava filter were used in 9 (4.5%), 3 (1.5%) and 1 (0.5%) patients, respectively. For long-term therapy, warfarin was used in 97.5%, followed by direct oral anticoagulants (1.5%) and LMWH (1%). The median duration of anticoagulants was 12 months (interquartile range [IQR]: 6.0, 35.3).