Articles: patients.
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Multidiscip Resp Med · Feb 2013
Case ReportsSuccessful management of warfarin-exacerbated diffuse alveolar hemorrhage using an extracorporeal membrane oxygenation.
Although diffuse alveolar hemorrhage complicating warfarin therapy is rare, it generally has a worsening clinical course and can be a life threatening condition. A 56-year-old male who had undergone a pulmonary lobectomy for lung cancer 2 years before had received warfarin for about 5 months due to pulmonary vein thrombosis. The patient presented with severe dyspnea and had prolonged anticoagulation values. ⋯ The reversal of anticoagulation was initiated, and extracorporeal membrane oxygenation was performed for refractory respiratory failure that did not improve despite maximal mechanical ventilatory support. The diffuse alveolar infiltrations resolved after 5 days, and we successfully weaned off both extracorporeal membrane oxygenation and mechanical ventilation. Herein we report the detailed course of a case that was successfully treated with extracorporeal membrane oxygenation as a bridge-to-recovery for warfarin- exacerbated diffuse alveolar hemorrhage.
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The promising results of the Solitaire Flow Restoration (FR) With the Intention for Thrombectomy (SWIFT) trial recently led toFood and Drug Administration (FDA) approval of theSolitaire FR stent retriever device for recanalization of cerebral vessels in patients with acute ischemic stroke. ⋯ Our study shows that a variety of other endovascular approaches are used in conjunction with Solitaire FR in actual practice in the United States.Early postmarket results suggest that Solitaire FR is an effective tool for endovascular treatment of acute ischemic stroke.
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BACKGROUND AND IMPORTANCE:: Spinal extradural arteriovenous fistula (SEDAVF) with parenchymal drainage (Type A) is a rare clinical entity that causes venous congestive myelopathy. Treatment includes endovascular and open microsurgical interventions. We reviewed the clinical records of patients treated for a Type-A SEDAVF to evaluate the feasibility of our treatment strategy. ⋯ Overall, all patients stabilized or improved neurologically and experienced no recurrence. To treat a Type-A SEDAVF, either TVE or microsurgical intradural drainer occlusion can be used for satisfactory long-term results with minimal surgical risks. For a case with multiple intradural draining veins, detachment of the venous lake should be considered.
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Preoperative embolization of meningiomas remains contentious, with persisting uncertainty over the safety and efficacy of this adjunctive technique. ⋯ The complication rate was 3.7%. No relationship between the embolic agent and the degree of devascularization was observed. Achieving a complete devascularization resulted in a lower blood transfusion requirement, considered an indirect measure of operative blood loss. This series demonstrates that pre-operative meningiomaembolization is safe and may reduce operative blood loss. We present distal intratumoral injection of liquid embolic as a safe and effective alternative to more established particle embolization techniques.
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Ethylene vinyl alcohol co-polymer (Onyx) is widely used for the embolization of arteriovenous malformations of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs when compared to traditional catheter-based techniques. ⋯ The balloon microcatheters showed excellent navigability, and there were no problems with retrieval or with the repeated inflation and deflation of the balloons. A proximal Onyx plug, which is crucial in many AVM embolizations, was not necessary with this technique. Additionally, fluoroscopy and procedural times seemed lower with this technique compared to conventional embolization methods.