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[PMID]: 29524461
[Au] Autor:Srinivasa RN; Chick JFB; Gemmete JJ; Hage AN; Srinivasa RN
[Ad] Address:Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, 1500 East Medical Center Drivem Ann Arbor, MI 48109.
[Ti] Title:Endolymphatic Interventions for the Treatment of Chylothorax and Chylous Ascites in Neonates: Technical and Clinical Success and Complications.
[So] Source:Ann Vasc Surg;, 2018 Mar 07.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: To report the technical and clinical success of performing minimally invasive endolymphatic embolization in neonates presenting with a chylothorax or chylous ascites. MATERIALS AND METHODS: 3 neonates, 2 males and 1 female, with a mean age of 28 days (range: 19-39 days) presented with a chylothorax (2) or chylous ascites (1) which was refractory to conservative management. All 3 patients (1 previously reported) underwent intranodal lymphangiography followed by thoracic duct embolization with 1 patient undergoing additional sclerosis of the retroperitoneal abdominal lymphatics. RESULTS: Lymphangiography, thoracic duct embolization, and sclerosis of the retroperitoneal abdominal lymphatics was technically successful. The chylothorax resolved in both patients. Persistent chylous ascites was noted after treatment that resolved after surgical placement of a vicryl mesh and fibrin sealant. 1 major complication occurred with non-target embolization of glue into the lungs requiring embolectomy. CONCLUSION: Thoracic duct and retroperitoneal abdominal lymphatic embolization can be performed in neonates. Resolution of chylothorax was seen in two patients (one previously reported) following embolization, while 1 patient with chylous ascites required surgical management after endolymphatic intervention.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 3186 MEDLINE  
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[PMID]: 29503401
[Au] Autor:Funakoshi H; Matsui H; Fushimi K; Yasunaga H
[Ad] Address:Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo.
[Ti] Title:Variation in Patient Backgrounds, Practice Patterns, and Outcomes of High-Risk Pulmonary Embolism in Japan.
[So] Source:Int Heart J;, 2018 Mar 05.
[Is] ISSN:1349-3299
[Cp] Country of publication:Japan
[La] Language:eng
[Ab] Abstract:High-risk pulmonary embolism (PE) with hypotension, circulatory failure, or cardiac arrest is a rare, but life-threating condition. Many guidelines recommend that thrombolytic therapy is the first-line therapy for this condition and surgical embolectomy is an alternative treatment. However, nationwide data have been lacking on patient characteristics and practice patterns for high-risk PE in a real-world clinical setting.We defined high-risk PE patients as those who received noradrenaline and underwent surgical embolectomy or thrombolysis within one day after admission. Using a Japanese national inpatient database, we identified high-risk PE patients from July 2010 to March 2014, and divided them into patients with and without embolectomy and those with and without cardiopulmonary arrest (CPA) at admission. We examined variation in patient backgrounds, procedures, and outcomes in this population.We identified 361 patients were eligible. Among those, including 266 received thrombolysis and 95 received embolectomy. The 30-day mortality was 41.4% in 266 patients with thrombolysis, and 14 patients died in 95 patients with embolectomy. Among the thrombolysis group, 30-day mortality was 35% in 187 patients without CPA thrombolysis and was 56% in 79 patients with CPA. Among the embolectomy group, 30-day mortality was 14% in 81 patients without CPA, and 21% patients died in 14 patients with CPA.The present nationwide study showed that surgical embolectomy had a relatively low mortality. Further studies are needed to verify the comparative effectiveness of embolectomy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher
[do] DOI:10.1536/ihj.16-585

  3 / 3186 MEDLINE  
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[PMID]: 29502997
[Au] Autor:Bois MC; Eckhardt MD; Cracolici VM; Loe MJ; Ocel JJ; Edwards WD; McBane RD; Bower TC; Maleszewski JJ
[Ad] Address:Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn.
[Ti] Title:Neoplastic embolization to systemic and pulmonary arteries.
[So] Source:J Vasc Surg;, 2018 Mar 01.
[Is] ISSN:1097-6809
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Arterial neoplastic emboli are uncommon, accounting for <1% of thromboemboli in the current literature. Nonetheless, this event may be associated with significant morbidity and mortality. Herein, we report a series of 11 cases of arterial neoplastic emboli from a single tertiary care center along with a comprehensive review of the literature to date. The aim of this study was to document the incidence, clinical presentations, and complications of arterial neoplastic emboli as well as to highlight the importance of routine histologic examination of thrombectomy specimens. METHODS: Pathology archives from a single tertiary care institution were queried to identify cases of surgically resected arterial emboli containing neoplasm (1998-2014). Histopathology was reviewed for confirmation of diagnosis. Patient demographics and oncologic history were abstracted from the medical record. Comprehensive literature review documented 332 patients in 275 reports (1930-2016). RESULTS: Eleven patients (six men) with a median age of 63 years (interquartile range, 42-71 years) were identified through institutional archives. Embolism was the primary form of diagnosis in seven (64%) cases. Cardiac involvement (primary or metastasis) was present in more than half of the cohort. Comprehensive literature review revealed that pulmonary primaries were the most common anatomic origin of arterial neoplastic emboli, followed by gastrointestinal neoplasia. Cardiac involvement was present in 18% of patients, and sentinel identification of neoplasia occurred in 30% of cases. Postmortem evaluation was the primary means of diagnosis in 27%. CONCLUSIONS: This study highlights the importance of routine histopathologic evaluation of embolectomy specimens in patients with and without documented neoplasia.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher

  4 / 3186 MEDLINE  
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[PMID]: 29502772
[Au] Autor:Jolly M; Phillips J
[Ad] Address:OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, 3705 Olentangy River Road, Suite 100, Columbus, OH 43214, USA.
[Ti] Title:Pulmonary Embolism: Current Role of Catheter Treatment Options and Operative Thrombectomy.
[So] Source:Surg Clin North Am;98(2):279-292, 2018 Apr.
[Is] ISSN:1558-3171
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Pulmonary embolism remains a leading cause of death in the United States, with an estimated 180,000 deaths per year. Guideline-based treatment in most cases recommends oral anticoagulation for 3 months. However, in a small subset of patients, the "submassive, high-risk" by current nomenclature, with hemodynamic instability, more advanced therapeutic options are available. Treatment modalities to extract the thromboembolism and reduce pressure overload in the cardiopulmonary system include use of intravenous or catheter-directed thrombolytic agents, catheter-directed mechanical thrombectomy, and surgical embolectomy. This article discusses current minimally invasive and surgical methods for reducing embolic burden in patients with submassive, high-risk pulmonary embolism.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:In-Process

  5 / 3186 MEDLINE  
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[PMID]: 29428533
[Au] Autor:Jeffrey Hing JX; Ch'ng JK; Tay KH; Chong TT
[Ad] Address:Department of General Surgery, Singapore General Hospital, Singapore. Electronic address: junxian.hing@mohh.com.sg.
[Ti] Title:Greater Compliance within Instruction for Use for Concomitant Iliac Aneurysms and Adverse Aneurysm Characteristics-Initial Experience with the Nellix Endovascular Aneurysm Sealing System at a Single Institution.
[So] Source:Ann Vasc Surg;, 2018 Feb 09.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:BACKGROUND: The Nellix was introduced to Asia in 2014. Data in Asians have been sparse. Two balloon-expandable stents, each surrounded by a polymer-filled endobag, are deployed in parallel to obliterate and seal the aneurysm. This paradigm shift to treating abdominal aortic aneurysms confers advantages for certain adverse aneurysm morphology that is outside the instruction-for-use (IFU) for standard endovascular aneurysm repair (EVAR) devices. We examine outcomes of 15 Asian patients with concomitant infrarenal aortic and iliac artery aneurysms treated with the Nellix at our institution. METHOD: Between July 2014 and August 2016, 15 male patients underwent elective EVAS at a single tertiary center by the same team of vascular surgeons and interventional radiologists. Patient demographics, clinical presentations, aneurysm morphology, perioperative complications, and follow-up imaging according to the standardized protocol were studied. Preoperative CT images were analyzed using validated automatic 3-dimensional sizing software EndoSize. RESULT: The novel stent-graft deployment proves consistent and achieved a 100% technical success. Eleven patients (70%) complied within specified Nellix IFU, as compared to 20% if standard endovascular aneurysm repair (EVAR) IFU was applied. The difference is due to the presence of concurrent common iliac aneurysms (n = 5), short neck length (n = 3), and angulated necks (n = 3). Adjunct procedures included 3 open access endarterectomy with embolectomy, 1 coil embolization of internal iliac artery, 1 bilateral renal artery chimneys, and 1 proximal stent deployment. There was no conversion to open surgery. Average operative time was 133 min. Median length of stay was 4 days. Thirty-day mortality was 0%. Perioperative morbidity included exacerbation of pre-existing renal impairment (n = 6), peripheral vascular disease (n = 3), and postimplantation syndrome (n = 5). One endoleak (7%) and 2 instances of stent migration (14%) were detected. There was no complication of aneurysm or endobag rupture, limb thromboses, or fracture. CONCLUSIONS: Early data in our center are encouraging and highlight high procedural success with minimal complications despite challenging patient anatomy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180303
[Lr] Last revision date:180303
[St] Status:Publisher

  6 / 3186 MEDLINE  
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[PMID]: 29269067
[Au] Autor:Yokoya S; Hino A; Takezawa H; Katsumori T; Goto Y; Hashimoto Y; Oka H
[Ad] Address:Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan. Electronic address: yokoya@ks.kyorin-u.ac.jp.
[Ti] Title:Microsurgical Removal of Snagged Stent Retriever During Endovascular Embolectomy for Acute Ischemic Stroke.
[So] Source:World Neurosurg;111:115-118, 2018 Mar.
[Is] ISSN:1878-8769
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Catheter-based endovascular thrombectomy has gained popularity for use in patients with acute large-vessel occlusion; however, various complications have been reported. Herein, we present a unique, serious procedure-related complication. CASE DESCRIPTION: A 91-year-old woman with acute middle cerebral artery (MCA) occlusion underwent endovascular thrombectomy with a stent retriever, but the device could not be retrieved from the horizontal segment of MCA during the procedure. Subsequently, she underwent emergency craniotomy. The lodged stent was extracted with microforceps using a counter-stretch of the vessels, so as not to avulse the perforating arteries. The stent device was retrieved uneventfully through a sheath introducer that was inserted through the femoral artery. Postprocedural indocyanine green video angiography showed complete recanalization of the MCA and internal cerebral artery. CONCLUSIONS: This is a rare case in which successful open surgery was performed to retrieve a snagged stent retriever, with successful recanalization of the large cerebral artery occlusion.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180303
[Lr] Last revision date:180303
[St] Status:In-Data-Review

  7 / 3186 MEDLINE  
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[PMID]: 29304488
[Au] Autor:Ghaffari S; Sepehrvand N; Pourafkari L; Hajizadeh R; Javanshir E; Nadiri M; Nader ND
[Ad] Address:Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
[Ti] Title:Factors associated with elevated cardiac troponin levels in patients with acute pulmonary thromboembolism.
[So] Source:J Crit Care;44:383-387, 2018 Apr.
[Is] ISSN:1557-8615
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: We aimed to investigate the factors that are associated with increased cardiac troponin I (cTnI) leakage in the acute pulmonary embolism (PTE) setting and their alignment with patient outcome. METHODS: Adult patients with a diagnosis of PTE were enrolled in this prospective cohort study. The primary endpoint of interest was major adverse cardio-pulmonary events (MACPE), defined as the composite of in-hospital all-cause mortality, need for thrombolysis and mechanical ventilation and surgical embolectomy during index hospitalization. Multivariable regression analysis is used to assess factors associated with MACPE. RESULTS: 16.6% of 627 patients with acute PTE, had elevated serum cTnI. MACPE occurred in 56.7% of patients with positive cTnI and in 28.8% of patients with negative cTnI (p<0.001). Blood urea nitrogen (BUN) (OR 1.048; 1.001-1.096), alanine transaminase (ALT) (OR 1.007; 1.001-1.014), and neutrophil-lymphocyte ratio (NLR) (OR 0.829; 0.698-0.984) were independent predictors of elevated cTnI. Elevated cTnI increased the risk of MACPE 2.72 times (p<0.001). CONCLUSION: cTnI was an independent predictor of short-term outcome following an episode of PTE. BUN and ALT were directly and NLR was inversely associated with the leakage of cTnI and therefore, they could potentially serve as useful markers of risk assessment after PTE.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180228
[Lr] Last revision date:180228
[St] Status:In-Data-Review

  8 / 3186 MEDLINE  
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[PMID]: 29273536
[Au] Autor:Fugate JE; Brinjikji W; Cloft H; Kallmes DF; Rabinstein AA
[Ad] Address:Department of neurology, Mayo Clinic, 200, First St. SW, 55905 Rochester, Minnesota, USA. Electronic address: fugate.jennifer@mayo.edu.
[Ti] Title:Variability of stroke patients meeting endovascular stroke trial criteria in a non-clinical trial setting.
[So] Source:J Neuroradiol;, 2017 Dec 19.
[Is] ISSN:0150-9861
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:BACKGROUND: Five randomized trials proving the efficacy and safety of mechanical embolectomy for ischemic stroke within 8hours used differing radiological methods to select patients. We aimed to evaluate the proportion of patients in clinical practice that would meet radiological criteria for inclusion in these trials. METHODS: Retrospective study of ischemic stroke patients at a large academic medical center who were considered for endovascular stroke therapy based on confirmed intracranial large vessel occlusion from April 2010-November 2014. All patients underwent computed tomography (CT) perfusion and CT angiogram. RESULTS: Of 119 patients, median age was 69 years (IQR 57-79) and median NIHSS 18 (IQR 14-21). Most patients had ASPECTS≥6 (n=105, 88.2%). All 119 patients met radiological criteria for MR CLEAN while 105 (88.2%) met criteria for SWIFT-PRIME, 96 (80.7%) for REVASCAT, 80/116 (69.0%) for EXTEND-IA, and 74 (62.2%) for ESCAPE. About half (n=58,48.7%) were treated with IV rtPA and 66 (56%) underwent endovascular therapy. Any intracranial hemorrhage was more common in patients undergoing endovascular therapy than in those who were not (36% vs. 17%, P=0.034). The frequency of symptomatic intracranial hemorrhage (ICH) did not significantly differ between these groups (6% vs. 4%, P=0.691). CONCLUSIONS: The proportion of patients with acute stroke and large vessel occlusion presenting within 8 hours that would meet radiological criteria for endovascular stroke trials varies considerably (62-100%) in a cohort outside of clinical trials from an academic comprehensive stroke center. Thus, the radiological criteria used for candidate selection in daily practice will greatly influence the proportion of patients treated with endovascular therapy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180224
[Lr] Last revision date:180224
[St] Status:Publisher

  9 / 3186 MEDLINE  
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[PMID]: 29458084
[Au] Autor:Yuan Z; Zhou Y; Zhou X; Liao X
[Ad] Address:Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
[Ti] Title:Severe Pulmonary Embolism Secondary to Cement Embolism in the Inferior Vena Cava after Percutaneous Vertebroplasty.
[So] Source:Ann Vasc Surg;, 2018 Feb 16.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Cement pulmonary embolism (cPE) and inferior vena cava embolism (cIE) are rare but potentially life-threatening complications of percutaneous vertebroplasty (PVP). Most cPE and cIE occur simultaneously. In this case, a 65-year-old woman complained of dyspnea after PVP for 4 days. The patient's symptom and image tests manifested that the cPE was secondary to cIE. Even though the cIE was found on the first day after PVP, local surgeons treated the patient with a regular anticoagulant instead of more effective therapeutic measures. Eventually, the long cement inferior vena cava embolus broke, and was deposited in the left pulmonary embolism via systemic circulation. The patient was admitted to our hospital where we performed embolectomy by cardiopulmonary bypass (CPB), and discharged her after seven days. We report this case to show that cIE embolism is still underestimated by some spine surgeons in China, and that it may develop to severe cPE during conservation management with anticoagulation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180219
[Lr] Last revision date:180219
[St] Status:Publisher

  10 / 3186 MEDLINE  
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[PMID]: 29452460
[Au] Autor:Pasrija C; Kronfli A; Rouse M; Raithel M; Bittle GJ; Pousatis S; Ghoreishi M; Gammie JS; Griffith BP; Sanchez PG; Kon ZN
[Ad] Address:Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md. Electronic address: cpasrija@smail.umaryland.edu.
[Ti] Title:Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: A single-center experience.
[So] Source:J Thorac Cardiovasc Surg;155(3):1095-1106.e2, 2018 Mar.
[Is] ISSN:1097-685X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Ideal treatment strategies for submassive and massive pulmonary embolism remain unclear. Recent reports of surgical pulmonary embolectomy have demonstrated improved outcomes, but surgical technique and postoperative outcomes continue to be refined. The aim of this study is to describe in-hospital survival and right ventricular function after surgical pulmonary embolectomy for submassive and massive pulmonary embolism with excessive predicted mortality (≥5%). METHODS: All patients undergoing surgical pulmonary embolectomy (2011-2015) were retrospectively reviewed. Patients with pulmonary embolism were stratified as submassive, massive without arrest, and massive with arrest. Submassive was defined as normotensive with right ventricular dysfunction. Massive was defined as prolonged hypotension due to the pulmonary embolism. Preoperative demographics, intraoperative variables, and postoperative outcomes were compared. RESULTS: A total of 55 patients were identified: 28 as submassive, 18 as massive without arrest, and 9 as massive with arrest. All patients had a right ventricle/left ventricle ratio greater than 1.0. Right ventricular dysfunction decreased from moderate preoperatively to none before discharge (P < .001). In-hospital and 1-year survival were 93% and 91%, respectively, with 100% survival in the submassive group. No patients developed renal failure requiring hemodialysis at discharge or had a postoperative stroke. CONCLUSIONS: In this single institution experience, surgical pulmonary embolectomy is a safe and effective therapy to treat patients with a submassive or massive pulmonary embolism. Although survival in this study is higher than previously reported for patients treated with medical therapy alone, a prospective trial comparing surgical therapy with medical therapy is necessary to further elucidate the role of surgical pulmonary embolectomy in the treatment of pulmonary embolism.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180217
[Lr] Last revision date:180217
[St] Status:In-Data-Review


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