Dislodgement Of Thrombus Research Articles

Spontaneous Peripheral Arterial Microembolization

Over a seven year period 52 patients having a clinical diagnosis of spontaneous peripheral arterial microembolization were identified. Sixty-one percent of patients were female, 15% were diabetic, and 73% used tobacco chronically. A striking finding was the very high incidence of associated systemic disorders such as thrombocytosis (8), polycythemia vera (3), metastatic adenocarcinoma (3), or collagen disease requiring steroid therapy (4). Forty-nine patients had significant proximal arterial lesions as the origin of their emboli. Three patients had digital ischemia as a result of increased platelet aggregation without arterial obstruction. Forty-eight patients underwent surgical therapy. Operative mortality was 4% and overall limb salvage in survivors was 96%. The clinical syndrome of arterial microembolization may result from several pathophysiologic mechanisms including cholesterol embolization from ulcerated plaques, fibrino-platelet aggregation in patients with hematologic disorders, or dislodgement of mural thrombus in those with aneurysmal disease. We observed aortoiliac disease to be more frequent than femoral-popliteal disease, and both were amenable to surgical correction. We conclude that the genesis of arterial microembolization is multifactorial and that a variety of systemic diseases may work in concert with atherosclerotic arterial disease to produce this clinical syndrome. Prompt recognition and appropriate treatment of this disorder can yield high rates of limb salvage.

Dislodgement of a vein graft thrombus by angiographic injection of native coronary artery

A case of retrograde dislodgement of thrombus in a saphenous vein graft during injection of the native right coronary artery is presented. Attention to this previously undescribed complication may allow for timely treatment with emergency surgery or thrombolysis.

Surgical and percutaneous management of contralateral thrombus dislodgement following stent placement and dilatation of iliac artery occlusions: Technical note

Primary stenting of common iliac artery occlusions was complicated by dislodgement of occluding material to the contralateral common iliac artery in 2 of 59 patients following successful stent placement. In both patients, the complication occurred after balloon dilatation of the inserted self-expanding stent. In the first patient the embolus dislodged to the tibioperoneal trunk and required surgical embolectomy. In the second patient, percutaneous insertion of a self-expanding stent into the contralateral common iliac artery prevented distal embolization.

Transesophageal echocardiography to detect atrial clots in candidates for percutaneous transseptal mitral balloon valvuloplasty

Left atrial thrombi are common in patients with mitral stenosis. When percutaneous balloon mitral valvuloplasty is performed on such patients, there is a potential risk of thrombus dislodgment and embolization. In this study conventional transthoracic echocardiography and transesophageal echocardiography were performed for percutaneous balloon mitral valvuloplasty on 19 consecutive candidates (6 men, 13 women, 23 to 81 years old).In five patients (26%), transesophageal echocardiography revealed a left atrial thrombus; in only one of these was there a suspicion of left atrial thrombus on transthoracic echocardiography. Balloon mitral valvuloplasty was canceled in four of the five patients. Three underwent mitral valve surgery that confirmed the echocardiographic findings.Transesophageal echocardiography is better than conventional transthoracic echocardiography in detecting left atrial clots in candidates for balloon mitral valvuloplasty. Because of the potential risk of embolization, transesophageal echocardiography is recommended in all candidates for balloon mitral valvuloplasty.

Simultaneous Measurement of All Thrombosis Parameters from Native Human Blood: Usefulness in Monitoring Efficacy and Complications of Thrombolytic Therapy

The sequelae of thrombus formation, both by shear forces and by collagen fiber, the subsequent coagulation, and the dislodgement of thrombi (thrombolysis) were measured from a small volume of nonanticoagulated blood sample, by a new instrument. Addition of streptokinase (SK) or tissue-type plasminogen activator (rt-PA) to the blood sample eliminated the need for anticoagulation for thrombolysis measurement: clot lysis preceded and allowed thrombolysis to occur. The test revealed activation of platelets and coagulation by SK and rt-PA. Apart from this general trend, platelet reactivity in response to plasminogen activator showed great individual variation. Whether the greatly enhanced (42%) or prolonged hemostasis (13%), observed in different blood samples with rt-PA, could be used as a predictor of reocclusion or bleeding complications remains to be established. Thrombolysis did not occur in 12% of the samples tested. These thrombolysis models may be useful for developing new agents for the dissolution of platelet-rich thrombi. It is suggested that this technique be used for monitoring thrombolytic therapy.

Aortic degenerative changes and thrombus formation: An unusual cause of massive myocardial infarction with normal coronary arteries

More than 90% of acute transmural myocardial infarctions are associated with thrombosis of atherosclerotic coronary arterial stenoses [1,2]. However, as reported by Cheitlin et al [3], there are less common causes of myocardial infarction that occur without coronary atherosclerosis or thrombosis. These include vasospasm, coronary arteritis, trauma, luminal compromise due to accumulation of material in the arterial wall secondary to inborn errors of metabolism, anomalous origin of the coronary arteries, hematologic disorders causing in situ thrombosis, myocardial oxygen demand-supply imbalance, and coronary artery emboli. Sources of coronary emboli include infective or non-bacterial thrombotic endocarditis originating on native or prosthetic valves, atria1 or ventricular mural thrombi, tumors such as cardiac myxomas or papillary fibroelastoma of the aortic valve, and dislodgement of thrombi or atherosclerotic plaques during coronary artery bypass surgery or cardiac catheterization. We report a previously unrecognized cause of coronary artery obstruction. Elastin fragmentation and cystic medial necrosis considered by some as part of the normal aging process [4] led to mild aortic root dilatation and stress-induced fracture of a fibrous atherosclerotic plaque with exposure of a thrombogenic surface and subsequent aortic mural thrombus formation. This thrombus then occluded the left main coronary artery ostium, with subsequent partial fragmentation and embolization into the coronary circulation. The process caused massive transmural myocardial infarction, cardiogenic shock, and death in a 49-yearold black woman who had normal coronary arteries documented angiographically.

Fractured intracardiac transvenous pacemaker catheter: An unusual cause of pacemaker failure

Disruption of a permanent transvenous catheter within cardiac chambers is an unusual cause of pacemaker failure. The use of open cardiotomy for removal of the fractured catheter avoids the potential complications seen in the case reported, namely dislodgement of thrombi, and tricuspid valve damage secondary to fibrous tissue fixation of the fractured transvenous pacing catheter to the tricuspid valve. Disruption of a permanent transvenous electrode catheter can occur even if the stainless steel stylet, used for positioning, has been removed.

Studies on the Comparative Value of Intravenous Sclerosing Substances

Ochsner and Garside1 reported the results of their studies on the effect of intravenous injection of 20 different sclerosing solutions. This paper is a report of the continuation of that work, comprising a similar study of 9 additional solutions.Method. The methods used were the same as those previously employed. Eighteen dogs were used, and 4 injections were made at different levels in the veins of each leg, thus making 16 injections of a sclerosing substance in each dog. Only one drug was used for each leg, but different drugs were sometimes injected into each leg of the animal. Five-tenths cc. of each of the following solutions were injected into 16 veins:The area of injection was marked and subsequently the veins were cautiously removed under local anesthesia to prevent the dislodgement of thrombi. The more distal segments of vein were removed first.Sections were removed at the following intervals: 1/2, 1, 3, 6, 12, 24, and 48 hr., 3, 4, 6, 10, 14, 21 days, 4, 6, and 8 weeks. Thus, there were 16 secti...