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CJC Open May 2024
PubMed: 38846441
DOI: 10.1016/j.cjco.2024.01.005 -
Cureus May 2024Terminal hemorrhage, although relatively rare, presents a significant challenge in palliative care, necessitating effective management strategies to alleviate distress...
Terminal hemorrhage, although relatively rare, presents a significant challenge in palliative care, necessitating effective management strategies to alleviate distress in patients and their families. This report presents the case of a 77-year-old woman with advanced vulvar squamous cell carcinoma. The patient had ulcerated groin metastases that had affected the nerve and vasculature of her left leg. Upon clinical examination, she had a large nonhealing ulcer of 11 cm x 2 cm x 4 cm on her upper left thigh that contained slough and was oozing. After a goals of care discussion with the patient and her family, she was admitted to hospice for comfort care measures. This case highlights an unconventional use of a femoral compression device in the palliative care setting, offering a novel approach to managing terminal hemorrhage. Commonly, these devices are used for hemostasis following different procedures, such as vessel cannulation or femoral artery pseudoaneurysm repair.
PubMed: 38846207
DOI: 10.7759/cureus.59827 -
Gland Surgery May 2024The standard approach for transarterial embolization of uterine fibroids or adenomas is via the femoral artery, but this approach limits the patient's quality of life...
BACKGROUND
The standard approach for transarterial embolization of uterine fibroids or adenomas is via the femoral artery, but this approach limits the patient's quality of life and increases the risk of deep vein thrombosis in the lower extremities. We applied the distal radial approach technique for the treatment of uterine artery embolization, and aimed to explore the feasibility and safety of uterine artery chemoembolization through the distal radial approach.
METHODS
We conducted a retrospective study at The First Hospital of Jilin University from January 1, 2021 to November 30, 2023. The main inclusion criteria were: (I) uterine fibroids and adenomyosis were confirmed by preoperative imaging examination; (II) able to accurately palpate the distal radial artery pulse, and the Allen test is negative. Exclusion criteria: patients with distal radial pulses that cannot be palpated, or who are palpable but have radial arteriotomy dialysis, have a tortuous angle on preoperative radial artery ultrasound, which is not conducive to guidewire catheter passage. The primary endpoint of this study was the success rate of distal radial artery puncture. The secondary endpoints included complications and the duration of the puncture.
RESULTS
Sixteen patients were enrolled in this study, of which 8 (50%) had uterine fibroids, 5 (31.25%) had uterine adenomas, and 3 (18.75%) had both. The puncture success rate was 93.75% (15/16) and one patient who failed to puncture the distal radial artery was changed to the radial artery approach. The mean time of puncture was 21±8.54 minutes. There were no complications, including bleeding, hematoma, arterial dissection, pseudoaneurysm formation, or distal radial artery occlusion, observed.
CONCLUSIONS
Uterine artery embolization by the distal radial artery approach is safe and feasible, and should be widely promoted in uterine artery embolization.
PubMed: 38845831
DOI: 10.21037/gs-24-118 -
Vascular Specialist International Jun 2024Splenic artery embolization plays an important role in the management of various medical and surgical conditions that are non-traumatic in etiology, in addition to its...
Splenic artery embolization plays an important role in the management of various medical and surgical conditions that are non-traumatic in etiology, in addition to its well-established and widely discussed role in managing splenic trauma. In nontraumatic emergencies of catastrophic bleeding originating from the spleen or splenic artery, splenic artery embolization can be effective in achieving hemostasis as a definitive management, temporary stabilizing measure, or preoperative optimization technique. In addition to emergency clinical conditions, splenic artery embolization can be performed electively as an alternative to splenectomy for managing patients with hypersplenism. Herein, we report 6 cases of splenic artery embolization performed at our center to highlight its various indications. This article aims to demonstrate the role of splenic artery embolization in different clinical scenarios and the considerations behind the techniques employed through illustrative cases.
PubMed: 38845443
DOI: 10.5758/vsi.240030 -
Kardiologia Polska Jun 2024
From pneumonia to two cardiac surgeries: Aortic valve endocarditis complicated by aortic root abscess, atrioventricular block and postoperative left ventricular pseudoaneurysm.
PubMed: 38845434
DOI: 10.33963/v.phj.100773 -
Journal of Clinical Imaging Science 2024The great majority of patients admitted to the intensive care unit (ICU) for critical gastrointestinal bleeding (GIB) will have a predictable etiology. Once the site is...
The great majority of patients admitted to the intensive care unit (ICU) for critical gastrointestinal bleeding (GIB) will have a predictable etiology. Once the site is localized to the upper versus the lower gastrointestinal tract, the number of typically encountered etiological possibilities is quite limited. On rare occasions, the cause of GIB requiring ICU care is not one of the standard considerations, potentially leading to diagnostic and therapeutic delays. Within a short time period, three patients were admitted to our institution's medical ICU each with a different unexpected cause of GIB. All three cases generated a variety of instructive images, which are used in the present series to illustrate these conditions and the role of radiology in their evaluation and management.
PubMed: 38841309
DOI: 10.25259/JCIS_96_2023 -
Surgery Jun 2024We aimed to analyze the feasibility of endovascular treatment for brucellosis-related aorta-iliac artery pseudoaneurysm. We did a statistical analysis that among the 11...
We aimed to analyze the feasibility of endovascular treatment for brucellosis-related aorta-iliac artery pseudoaneurysm. We did a statistical analysis that among the 11 cases, the thoracic aorta was involved in 3 cases, the abdominal aorta was involved in 6 cases, and the iliac artery was involved in 2 cases. Five patients had a history of contact with cattle and sheep, 3 had a history of drinking raw milk, 10 patients had a fever before the operation, and 11 patients had positive serum agglutination test. Blood culture was positive in 2 patients. All patients were given anti-brucellosis treatment immediately after diagnosis. One died of aortic rupture 5 days after emergency endovascular gastrointestinal bleeding. Endovascular-covered stent implantation and active anti-brucellosis therapy were used to treat 10 patients. The follow-up period was 8 years without aortic complications or death for all patients. We think early diagnosis and a combination of anti-brucellosis drugs and endovascular therapy may be the first choice for treating the pseudoaneurysm caused by Brucella.
PubMed: 38839433
DOI: 10.1016/j.surg.2024.04.032 -
Annals of Vascular Surgery Jun 2024This study's objective is to describe outcomes of adult patients who underwent thoracic stent graft placement treatment for primary or recurrent aortic coarctation.
OBJECTIVE
This study's objective is to describe outcomes of adult patients who underwent thoracic stent graft placement treatment for primary or recurrent aortic coarctation.
METHODS
This is a retrospective study of 30 adult patients who underwent thoracic stent graft placement for aortic coarctation at our institution. Average age was 46.5 years, with 53.3% of patients presented with no prior treatment or repair for coarctation. Indications for repair included gradient ≥20 mm Hg with anatomic evidence of coarctation on imaging with left ventricular hypertrophy, pseudoaneurysm, aneurysm, refractory hypertension, or claudication. Stent grafts used for repair included MDT (Medtronic, Santa Rosa, CA) and GORE TAG (W. L. Gore & Associates, Flagstaff, AZ).
RESULTS
Patients were observed for a median of 979 days, with one death during the study. All patients had complete resolution of symptoms with no recurrences. TEVAR significantly reduced the gradient across the coarctation (p <0.0001). Aortic coarctation diameter significantly increased at 30-days postoperatively and continued to increase up to 5 years post-treatment. At 3+ years, aortic remodeling was observed at the coarctation site and surrounding regions. At 30 days, systolic, diastolic, and mean arterial pressure were all reduced. Systolic and diastolic blood pressure as well as MAP continued to significantly improve 1-year post-treatment.
CONCLUSIONS
Stent grafts are a safe and effective treatment for aortic coarctation. We observed a clinically significant improvement in blood pressure, and longitudinal aortic remodeling of the coarctation segment and the entire aorta that persisted over more than 3 years.
PubMed: 38838987
DOI: 10.1016/j.avsg.2024.03.009 -
CEN Case Reports Jun 2024Arterioureteral fistula represents a rare yet consequential urological complication characterized by persistent and refractory urinary tract bleeding. Its emergence...
Arterioureteral fistula represents a rare yet consequential urological complication characterized by persistent and refractory urinary tract bleeding. Its emergence typically involves aneurysm formation, presenting significant life-threatening implications. Nonetheless, its infrequency contributes to sparse documentation of incidences in post-kidney transplant recipients, thereby fostering numerous uncertainties concerning associated risks. A 67-year-old male patient, afflicted with end-stage renal failure and a history of urinary tract infection, underwent a living donor kidney transplant four months prior. Complications involving intraoperative bleeding necessitated the prolonged placement of a ureteral stent post-surgery. Subsequently, he experienced an abrupt onset of ureteral bleeding accompanied by shock, later diagnosed via contrast-enhanced computed tomography as pseudo-aneurysm formation in the right external iliac artery proximal to the allograft renal artery anastomosis, in conjunction with a fistula formation involving the donor ureter. Despite repeated attempts at intervention with covered stenting, the aneurysm persisted and proved refractory to resolution. Tragically, seven months later, the aneurysm ruptured, culminating in the demise of the patient. Our report details a case involving perioperative complications following kidney transplantation, persistent bacteriuria, and prolonged ureteral stenting, ultimately leading to the development of an arterioureteral fistula. Despite undergoing stent graft insertion as an intervention, the patient succumbed to aneurysm rupture associated with the arterioureteral fistula. This condition, though rare, can prove fatal following kidney transplantation. Consequently, future endeavors in this domain necessitate an emphasis on optimizing risk management, refining diagnostic approaches, and devising more effective therapeutic strategies to mitigate such complications.
PubMed: 38837009
DOI: 10.1007/s13730-024-00895-x -
JTCVS Techniques Apr 2024
PubMed: 38835599
DOI: 10.1016/j.xjtc.2024.02.008