The International journal of angiology : official publication of the International College of Angiology, Inc
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The use of ultrasound waves in conjunction with local thrombolysis may accelerate clot resolution and serve as an important therapeutic adjunct in the treatment of venous occlusive disease. Our goal was to provide a larger sample population over a 5-year period to evaluate our experience with the EkoSonic endovascular system (EKOS, EKOS Corporation, Bothell, WA). We suspected that ultrasound-accelerated thrombolysis (UAT) using EKOS would provide excellent thrombolysis and midterm patency rates with minimal thrombolytic complications. ⋯ In addition, our 1-year patency rates were comparable to published data using conventional catheter-directed thrombolysis. UAT provides lytic therapy by utilizing the benefits of ultrasonic waves to help augment the fibrinolytic process. Our institution currently favors the use of EKOS as the treatment of choice in patients that are appropriate thrombolytic candidates.
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We report here two cases of fibromuscular dysplasia (FMD). The first case describes an asymptomatic 75-year-old man with FMD of the right internal carotid artery. The second case reports a 17-year-old man who presented with arterial hypertension caused by FMD of the left renal artery and was subsequently successfully treated by angioplasty. ⋯ Many cases are asymptomatic and may be discovered incidentally. Percutaneous transluminal angioplasty should be used in patients with a stenosis of the renal artery causing arterial hypertension. On the contrary, conservative therapy should be chosen in patients with asymptomatic and extensive lesions of the carotid arteries.
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Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. It occurs predominantly among younger females and typically in the absence of atherosclerotic coronary artery disease. It is associated with peripartum period, connective tissue disorders, vasculitides, and extreme exertion. ⋯ SCAD is a rare cause of acute coronary syndrome. In patients with early presentation, limited disease, and ongoing symptoms, emergent cardiac catheterization with percutaneous intervention has excellent outcome. More studies are needed to establish evidence-based management guidelines.
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Pleural effusions (PE) occur frequently among patients with various types of advanced malignancies, resulting in remarkably decreased quality of life. Treatment of malignant PE includes placement of a chest tube with subsequent placement of a tunneled pleural catheter. We reviewed our experience with tunneled pleural catheter use to assess outcomes and resource utilization of this intervention. ⋯ Tunneled pleural catheter placement is a safe and effective approach to the treatment of PE. The advantages of tunneled pleural catheter placement include symptomatic relief and improved quality of life. This method allows patients to spend time at home with their family and avoid prolonged hospitalization.
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To attain satisfactory results in aortic arch surgery a reliable method of cerebral protection, avoidance of emboli, and control of hemorrhage is mandatory. Deep hypothermic circulatory arrest is the most common technique at present but gives only a limited period of protection, whereas a complicated aortic arch operation may require more time than anticipated. Therefore the selective cannulation and perfusion of the innominate artery has not been widely used until now because it is uncertain whether the left hemisphere of the brain is adequately perfused. ⋯ Only temporary neurological affections (left-sided hemiparesis) were found in two patients (9.5%). Additionally, we observed neuropsychological disturbances in one of these. Our first experience with selective cerebral perfusion via innominate artery and the attendant CATEEM monitoring for assessment of adequate bilateral cerebral perfusion suggests that this method is a useful addition to the armamentarium in complicated aortic arch surgery.