History Of Pulmonary Embolism Research Articles

The Outcome Of Acute Heart Failure In Patients With A History Of Pulmonary Embolism, A Nationwide Analysis

The Outcome Of Acute Heart Failure In Patients With A History Of Pulmonary Embolism, A Nationwide Analysis

Predictors of Reduced Left Ventricle Global Longitudinal Strain One Year After COVID-19 Pneumonia.

Aim To identify predictors of decreased left ventricular global longitudinal strain (LV GLS) using the method of speckle-tracking in gray scale one year after COVID-19-associated pneumonia in patients without ischemic heart disease (IHD), previous pulmonary embolism (PE), peripheral thrombosis, and atrial fibrillation (AF).Material and methods The study included 156 patients from the Prospective Registry of People After COVID-19-Associated Pneumonia, with optimal visualization quality according to echocardiography (EchoCG), without IHD, AF, history of pulmonary embolism (PE), and peripheral thrombosis. The patients underwent clinical examination in the hospital during the acute period and at 3 and 12 months after discharge from the hospital. To identify earlier predictors of LV GLS impairment, clinical, laboratory, and instrumental data obtained in the hospital and at 3 months of discharge were compared based on the presence of LV GLS impairment one year after discharge (43 patients with reduced LV GLS and 113 patients with normal LV GLS). An LV GLS value ≥18% was considered reduced.Results At 3 months after discharge from the hospital, LV GLS impairment was detected in 34 (21.8%) of 156 patients, and 12 months later, in 43 (27.6%; p=0.211) of 156 patients. In contrast to the group with normal LV GLS, the majority of the group with reduced LV GLS were men (74.4% vs. 37.2%; p=0.001). In this group, body mass index (BMI) was significantly higher (29.9±4.3 kg/m2 vs. 28.1±4.5 kg/m2; p=0.011), and biological (11.6% vs. 2.7%; p=0.024) and hormonal therapy was administered more frequently (38.1% vs. 22.3%; p=0.049). The final predictive model for LV GLS impairment included male gender (odds ratio (OR), 5.65; 95% confidence interval (CI), 1.22-14.37; p <0.001), BMI (OR, 1.11; 95% CI, 1.01-1.23; p=0.040), left ventricular end-systolic volume index (LVESVI) (OR, 1.10; 95% CI, 1.01-1.22; p=0.046) and right ventricular outflow tract (RVOT) acceleration time (OR, 0.98; 95% CI, 0.95-0.99; p=0.027).Conclusion One year after COVID-19-associated pneumonia, a decrease in LV GLS was observed in 27.6% of patients without IHD, AF, history of PE, and peripheral thrombosis and was associated with male gender, increased BMI and LVESVI, and shortened RVOT acceleration time as measured 3 months after discharge from the hospital. The decrease in LV GLS one year after discharge was not associated with the severity of the disease, length of stay in the hospital, or biological and hormonal therapy.

Tranexamic Acid Is Safe in Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty.

Tranexamic acid (TXA) is increasingly utilized during total knee arthroplasty (TKA) and total hip arthroplasty (THA) to decrease blood loss; however, there are concerns with regard to potential thromboembolic complications, particularly in high-risk patients. This study sought to define a subset of patients at elevated risk for thromboembolic complications following total joint arthroplasty (TJA) and to compare postoperative outcomes between patients who received TXA and those who did not. Patients who underwent primary, elective TJA from 2015 to 2021 were identified in the Premier Healthcare Database. Patients with a history of venous thromboembolism, defined as a history of pulmonary embolism or deep vein thrombosis, were identified and formed the high-risk cohort. Patient demographic characteristics, hospital factors, patient comorbidities, antithrombotic medication use, perioperative blood transfusion, and 90-day complications were assessed and compared between patients who received TXA and those who did not. Univariate regression and multivariable regression were performed to account for potential confounders. The high-risk cohort comprised 70,759 patients who underwent TJA, of whom 46,074 (65.1%) received TXA and 24,685 (34.9%) did not. After controlling for confounding factors, patients in the TXA cohort had similar risks of pulmonary embolism (adjusted odds ratio [OR], 0.90 [95% confidence interval (CI), 0.79 to 1.02]; p = 0.097), stroke (adjusted OR, 0.97 [95% CI, 0.69 to 1.37]; p = 0.867), and myocardial infarction (adjusted OR, 0.93 [95% CI, 0.69 to 1.24]; p = 0.614) compared with patients who did not receive TXA. Patients who received TXA demonstrated decreased risks of transfusion (adjusted OR, 0.42 [95% CI, 0.38 to 0.46]; p < 0.001) and 90-day readmission (adjusted OR, 0.87 [95% CI, 0.80 to 0.94]; p < 0.001). TXA utilization was not associated with an increased risk of postoperative pulmonary embolism, stroke, or myocardial infarction in patients with a history of venous thromboembolism. Furthermore, patients who received TXA had a decreased risk of transfusion and readmission. This evidence suggests that TXA may be safely utilized among select high-risk patients. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis

Abstract Background Percutaneous pericardiocentesis (PP) belongs to life-saving procedures in cardiac tamponade, while it may also serve as diagnostic procedure in patients with recurrent pericardial effusion. Purpose The aim of the study was to evaluate the clinical characteristics and predictors of in-hospital mortality among patients subject to PP. Methods This single-center retrospective study comprised consecutive patients who underwent PP between 2011 and 2021 regardless of primary diagnosis. Among 132 456 patients screened, 208 patients were subject to PP [109 women, 52.4%; median age of 66 (58; 76) years] who underwent 231 procedures. Exclusion criteria involved data incompleteness regarding the etiology and outcome. The primary endpoint was in-hospital mortality. Results The most common indications for PP were neoplastic disease (23.1%), idiopathic effusion (14.42%), coronary artery perforation during percutaneous coronary intervention (PCI; 13.9%), viral pericarditis (11.1%), cardiac electronic device implantation (10.6%), catheter ablation (8.7%) and post-pericardiotomy syndrome (5.8%). Overall, iatrogenic cause was the most common indication for PP (41.8%). The median volume of pericardial fluid was 550 (330; 850) ml. In-hospital death was reported in 11 patients (5.3%). Univariate analysis revealed that in-hospital death was predicted by PCI-related etiology (p&amp;lt;0.0001), history of pulmonary embolism (p=0.007) and sudden cardiac arrest (p=0.032), lower pericardial drainage volume (p=0.037), right bundle branch block (p=0.007), cardiogenic shock (p=0.003), packed red blood cells transfusion (p=0.023). Logistic regression indicated that PCI-related etiology (OR 76.1, p&amp;lt;0.001), history of pulmonary embolism (OR 17.9, p=0.03) and recurrent/persistent cardiogenic shock in the course of in-hospital stay (OR 14.7, p=0.004) were independently associated with in-hospital mortality (AUC 0.895; Figure 1). Conclusion Iatrogenic etiology represents the most frequent indication for PP. PCI-related coronary perforation confers the greatest risk of in-hospital death.

Do sleeve gastrectomy and Roux-en-Y gastric bypass have different venous thromboembolism risk factors? Creation of 30-day Bariatric Hypercoagulation Score.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality after bariatric surgery, most often occurring after discharge within 30 days after surgery. To determine the risk factors associated with VTE after either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) and to develop a Bariatric Hypercoagulation Score (BHS) to predict 30-day adverse postoperative outcomes. University hospital. Using 2015-2018 data from the Metabolic and Bariatric Surgery Quality Improvement Program, a BHS was created by performing a logistic regression of "venous thromboembolism." The variables with the highest odds ratio (OR) were selected for the SG and RYGB groups. Then, the 30-day outcomes of low-risk (0-1), average-risk (2-3), and high-risk (≥4) BHS were compared. Similar risk factors for VTE were found in both the SG and RYGB groups; the highest OR was shown by history of deep vein thrombosis (SG: 3.54, RYGB: 3.05). Other related factors in both groups were history of pulmonary embolism, prolonged length of stay, Black race, and male sex. Conversely, unique risk factors such as dialysis (OR 1.81) was found in the SG group; meanwhile, prolonged operative time (OR 1.50) and age >60 years (OR 1.28) were for the RYGB group. When comparing the 30-day outcomes, BHS ≥4 had a significantly higher rate of complications (P < .001). SG and RYGB have some risk factors in common for VTE; however, dialysis was associated only with SG, and prolonged operative time and age >60 years were associated only with RYGB. BHS ≥4 showed higher 30-day adverse outcomes. The VTE-correlated variables require special consideration when assessing patients undergoing SG and RYGB.

Gender, BMI, Patient Comorbidities, and Hospital Characteristics Influence 30-Day Readmission Following Vertical Sleeve Gastrectomy.

Obesity impacts 300 million people worldwide and the number continues to increase. Laparoscopic sleeve gastrectomy (LSG) is one of several bariatric procedures offered to help these individuals achieve a healthier life. Here, we report 30-day readmission rates and risk factors for readmission after gastrectomy. We used the US Healthcare Utilization Project's Nationwide Readmission Database (NRD) from 2016 to 2019 for patients who underwent laparoscopic gastrectomy and evaluated 30-day readmission rates, comparing readmitted patients to non-readmitted patients. Confounder adjusted and unadjusted analysis were proceeded to the potential factors. The study population consisted of 235,563 patients, with a 3.0% readmission rate. Factors associated with a higher readmission rate included older age, male gender, higher BMI, Medicare as the primary payer, longer length of stay, higher total charge, higher Charlson Comorbidity Index, higher Elixhauser-Comorbidity Index, lower household income, non-elective admission type, and non-routine disposition. Additionally, larger hospital bed size, and private, invest-own hospital ownership were associated with higher readmission rates. After adjusting for confounders, several comorbidities and complications were found to be significantly associated with readmission, including ileus, abnormal weight loss, postprocedural complications of digestive system, acute posthemorrhagic anemia, and history of pulmonary embolism (all p < 0.001). Patient characteristics including age, BMI, and payment source, as well as hospital characteristics, can impact the 30-day readmission after LSG. Such factors should be considered by CMS when deciding on penalties related to readmission.

Pulmonary thromboendarterectomy in hospitalized versus elective patients with chronic thromboembolic pulmonary hypertension

ObjectiveWe sought to characterize outcomes in patients undergoing pulmonary thromboendarterectomy electively versus after acute presentation. MethodsThis is a retrospective analysis of patients who underwent pulmonary thromboendarterectomy from October 2015 to April 2022. Patients were divided into 2 groups depending on elective surgery or surgery during the same hospitalization as their presentation. ResultsIn total, 69 patients were included: 45 in the hospitalized group and 24 in the elective group. Patients in the hospitalized group were less likely to have chronic lung disease, history of pulmonary embolism and hypertension, be on anticoagulation and medication for pulmonary hypertension, and present with >1 month of respiratory symptoms. They were more likely to have worse preoperative right ventricular function. Among other demographics, risk factors for venous thromboembolism were similar between both groups. Thirteen patients in the hospitalized group required preoperative extracorporeal membrane oxygenation. There was no difference in disease classification and operative, cardiopulmonary bypass, and hypothermic circulatory arrest durations between both groups. Postoperative complications were similar between both groups, except for greater frequency of deep vein thrombosis in the hospitalized group (26.7% vs 4.2%, P = .03). In-hospital and intensive care unit length of stay were similar between both groups. Overall, in-hospital mortality was 4.3% and was similar between both groups; P = .28. ConclusionsOur series shows that pulmonary thromboendarterectomy can be safely performed in patients presenting acutely, with comparable postoperative complications and in-hospital mortality to an elective setting. Such patients present with worse right ventricular function, sometimes requiring temporary mechanical support.

The microRNA-144/451 cluster in plasma-derived microvesicles and erythrocytes in patients with history of pulmonary embolism

Chronic thromboembolic disease (CTED) and chronic thromboembolic pulmonary hypertension (CTEPH) are the complications that comprise a serious problem for patients with history of pulmonary embolism (PE). Erythrocytes, extracellular microvesicles (EMVs) and miRNAs play a substantial role in the procoagulant states. The aim. To analyze the levels of miR-144-3р, miR-451a, and miR-451b in blood plasma-derived EMVs and erythrocytes in patients with history of PE and in the control group. Materials and Methods. 18 patients with history of PE (13 CTEPH, 5 CTED) and 8 controls were enrolled into the study. All the participants had undergone clinical and biochemical blood tests as well as the coagulogram. We used flow cytometry to assess plasma-derived EMVs (CD9, CD41, CD45, CD235a, CD105). We measured the expression of miR-144-3р, miR-451a, miR-451b by real-time PCR with endogenous control (miR-152-3p) and five exogenous quality controls. Results. The levels of miR-144-3р and miR-451a in patients were lower than in controls, both in EMVs (р = 0.030; р = 0.065) and in erythrocytes (р = 0.023;р = 0.086). In female patients, the levels of miR-144-3р and miR-451a in CTEPH were lower than in CTED (р = 0.087; р = 0.031). Mir-451b in EMVs has not been detected, while in erythrocytes its levels have not differed between the groups. In patients, the levels of miR-144-3р and miR-451a directly correlated with each other both in EMVs (р = 0.004) and in erythrocytes (р = 0.042). In all the participants, the levels of miR-144-3р and miR-451a in EMVs directly correlated with those in erythrocytes (р = 0.002; р = 0.078). The number of erythrocyte-derived EMVs correlated with miR-451a levels both in EMVs (R = 0.472; p = 0.065) and in erythrocytes (R = –0.829; p = 0.011). The level of miR-451a in EMVs correlated with blood plasma levels of factor VIII and fibrinogen (R = 0.584; p = 0.022 and R= –0.489; p = 0.047), and with the International Normalized Ratio (R = 0.894; p = 0.041). Conclusion. The microRNA-144/451 cluster may influence both the hemostasis system and the risk of post-thromboembolic complications development. In the present study, miR-144-3р and miR-451a showed themselves as protective factors in relation to both the development of PE and severity of post-thromboembolic complications.

C-53 | In-Hospital Outcomes of COVID-19 Infection Among Patients With a History of Pulmonary Embolism and Deep Venous Thrombosis: An Analysis of the 2020 Nationwide Inpatient Sample

C-53 | In-Hospital Outcomes of COVID-19 Infection Among Patients With a History of Pulmonary Embolism and Deep Venous Thrombosis: An Analysis of the 2020 Nationwide Inpatient Sample

Association between cardiac conditions with venous leg ulcers in patients with chronic venous insufficiency

Venous leg ulcers (VLUs) are the final stage of chronic venous insufficiency. This study aims to characterize the association between cardiovascular diseases and VLU. A multicentric case-control study analyzed 17,788 patients between 2015 and 2020. Cases were matched (1:2) by age and sex, and odds ratios (OR) were analyzed with conditional logistic regressions adjusted by risk factors. The prevalence of VLU was 15.2%. 2390 cases were analyzed. Diseases found to be associated with VLU were atrial fibrillation (OR, 1.21; 95% CI: 1.03-1.42), pulmonary hypertension (OR, 1.45; 95% CI: 1.06-2.00), right heart failure (OR, 1.27; 95% CI: 1.13-1.43), peripheral artery disease (OR, 2.21; 95% CI: 1.90-2.56), and history of pulmonary embolism (OR, 1.45; 95% CI: 1.06-2.00). Certain cardiovascular conditions showed an association with VLU. Further studies are warranted to evaluate the effect that treating concomitant cardiovascular diseases might exert on the natural history of venous leg ulcers.

Cross-cultural validity of the Pulmonary Embolism Quality of Life questionnaire in the quality of life survey after pulmonary embolism: A Persian-speaking cohort

BackgroundThe Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire is the first disease-specific scale for assessing the quality of life in patients with a history of pulmonary embolism (PE). ObjectivesTo assess the cross-cultural validity and reliability of the disease-specific PEmb-QoL questionnaire. MethodsThe Persian version was prepared through the forward and backward translation of the English questionnaire. Six months after the diagnosis of acute PE, consecutive Persian-speaking patients were asked to complete the PEmb-QoL, the generic 36-item Short Form (SF-36) questionnaires and undertake a 6-minute walk test (6MWT). Acceptability was assessed via item missing rate, reproducibility by the test-retest method, and internal consistency reliability by Cronbach’s α and McDonald’s ω coefficients. Convergence validity was assessed using the Spearman rank correlation between scores of PEmb-QoL, SF-36, and 6MWT. The questionnaire structure was evaluated through exploratory factor analysis. ResultsNinety-six patients with a confirmed diagnosis of PE completed the questionnaires. The Persian version of PEmb-QoL had good internal consistency (α = 0.95, 3-factor ω = 0.96), inter-item correlation (0.3–0.62), item-total correlation (0.38–0.71), reproducibility (test-retest ICC with 25 participants = 0.92–0.99), and good discriminant validity. Convergence validity was confirmed by the moderate-to-high correlations between PEmb-QoL and SF-36 scores, and a good correlation between the “limitation in daily activities” dimension of the PEmb-QoL questionnaire and 6MWT results. Exploratory factor analysis suggested a 3-component structure with functional (items 1h, 4b-5d, 6, 8, 9i, and 9j), symptoms (1b-h, 7, and 8), and emotional (5a, 6, and 9a-h) components. ConclusionThe Persian version of the PEmb-QoL questionnaire is valid and reliable for measuring the disease-specific quality of life in patients with PE.

Predictors and outcomes of acute pulmonary embolism in COVID-19; insights from US National COVID cohort collaborative

ObjectivesTo investigate whether COVID-19 patients with pulmonary embolism had higher mortality and assess the utility of d-dimer in predicting acute pulmonary embolism.Patients and methodsUsing the National Collaborative COVID-19 retrospective cohort, a cohort of hospitalized COVID-19 patients was studied to compare 90-day mortality and intubation outcomes in patients with and without pulmonary embolism in a multivariable cox regression analysis. The secondary measured outcomes in 1:4 propensity score-matched analysis included length of stay, chest pain incidence, heart rate, history of pulmonary embolism or DVT, and admission laboratory parameters.ResultsAmong 31,500 hospitalized COVID-19 patients, 1117 (3.5%) patients were diagnosed with acute pulmonary embolism. Patients with acute pulmonary embolism were noted to have higher mortality (23.6% vs.12.8%; adjusted Hazard Ratio (aHR) = 1.36, 95% CI [1.20–1.55]), and intubation rates (17.6% vs. 9.3%, aHR = 1.38[1.18–1.61]). Pulmonary embolism patients had higher admission D-dimer FEU (Odds Ratio(OR) = 1.13; 95%CI [1.1–1.15]). As the d-dimer value increased, the specificity, positive predictive value, and accuracy of the test increased; however, sensitivity decreased (AUC 0.70). At cut-off d-dimer FEU 1.8 mcg/ml, the test had clinical utility (accuracy 70%) in predicting pulmonary embolism. Patients with acute pulmonary embolism had a higher incidence of chest pain and history of pulmonary embolism or deep vein thrombosis.ConclusionsAcute pulmonary embolism is associated with worse mortality and morbidity outcomes in COVID-19. We present d-dimer as a predictive risk tool in the form of a clinical calculator for the diagnosis of acute pulmonary embolism in COVID-19.

361: PROFOUND EPISTAXIS IN CYTOKINE RELEASE SYNDROME FOLLOWING CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY

Introduction: Chimeric antigen receptor T-cells (CAR-T) represent a promising immunotherapeutic approach in the treatment of refractory malignancies, but carry the risk of unique inflammatory toxicities including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). In moderate to severe cases, these toxicities necessitate intensive care unit (ICU) admission for aggressive support and management. Description: A 63-year-old male with a history of pulmonary embolism, prostate cancer with resection and relapsed/refractory IgG-κ multiple myeloma (diagnosed 4 years earlier and status-post multiple chemotherapy regimens) was admitted for conditioning chemotherapy and CAR-T cell infusion. 1 day post-infusion on the ward, he developed CRS and ICANS, with fever and altered mental status, for which he received tocilizumab, dexamethasone, and anakinra, in addition to empiric antibiotics. He progressed with worsening hypotension and encephalopathy and was admitted to the ICU and required vasopressors, pulse-dose steroids, and siltuximab. A nasal swab was performed to rule out COVID-19, following which he developed persistent epistaxis, requiring packing and, after aspiration of blood, intubation for airway protection. Laboratory data showed anemia and thrombocytopenia, prolonged PT and aPTT, low fibrinogen, and elevated levels of ferritin of 44,124 mg/mL, D-Dimer of 1.35 µg/mL, interleukin-6 of 8,595 pg/mL, interleukin-10 of 1,042 pg/mL, tumor necrosis factor-α of 103 pg/mL, and interferon-γ above 244 pg/mL. The patient received numerous red cell and platelet transfusions, aminocaproic acid, cryoprecipitate, and additional packing and thrombin application by ENT before his epistaxis was controlled. Ultimately, he was weaned from vasopressors, extubated after two weeks and transferred out of the ICU, discharged to rehabilitation, and later home. Discussion: Severe CRS can be associated with hemophagocytic lymphohistiocytosis and disseminated intravascular coagulation (DIC), which can lead to life-threatening bleeding as demonstrated in our patient. Effective and timely treatment of bleeding associated with DIC and severe CRS can be life-saving. It behooves the intensivist to recognize the toxicities of CAR-T as therapeutic applications broaden in the coming years.

IBC-Ox32 Streamlining preoperative risk assessment: counterintuitive results in the Bariatric patient

Abstract Background Bariatric surgical operations continue to be performed in high numbers nationally, thus it is important to identify factors associated with post-surgical complications. This study aims to identify preoperative risk factors associated with bariatric surgery mortality. Methods A retrospective analysis was conducted on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database to determine the strength of association between pre-operative exposures and 30-day mortality following bariatric surgery. A total of 701,265 primary bariatric operations were registered between the years of 2015 and 2017, consisting of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), and duodenal switch (DS) Results From the 701,265 surgeries registered in the database, 636,286 had complete data points for the variables of interest and therefore were included in this analysis. The mean age of the cohort was 45.01 (SD= 11.96) years, mean BMI was 45.54 kg/m2 (SD=7.72), and 80.07% were female. Overall 30-day mortality was 0.10% (n=629). The association between the following preoperative variables and mortality within 30 days of bariatric surgery was not statistically significant: hyperlipidemia, history of pulmonary embolism, oxygen dependence, obstructive sleep apnea and history of venous stasis. Smoking status (AOR=1.38), insulin dependent diabetes (AOR=1.37) and the use of more than 3 hypertensive medications (AOR=1.30) were weakly associated with postoperative mortality (p&amp;lt;0.05; CI=95%). History of chronic obstructive pulmonary disease (COPD; AOR=2.00), partial functional dependency (AOR=2.09), renal insufficiency (AOR=1.63), dialysis (AOR=3.15), history of deep venous thrombosis (AOR=1.78), history of myocardial infarction (AOR=1.65) and history of cardiac surgery (AOR=1.87) were strongly associated with mortality (P&amp;lt;0.05; c.i. = 95%) Conclusion Bariatric surgery continues to be safe. Many factors that have traditionally been thought to contribute to mortality, such as diabetes, hypertension, smoking, and oxygen dependence may have little impact. Other variables such as previous heart surgery, functional dependency status and COPD may play a bigger role in adverse outcomes. While these associations do not determine causality, understanding the strength of them can guide physicians on preoperative risk assessment and care.

Hand compartment syndrome secondary to contrast media extravasation: A case report

IntroductionContrast media extravasation injury is a recognized complication of contrast media use. Compartmental syndrome of the hand secondary to contrast extravasation is exceptional. We describe a case of compartment syndrome of the hand secondary to contrast media extravasation.Case presentationWe present a 47-year-old woman with a history of pulmonary embolism who was diagnosed of compartment syndrome of the left hand after injection of contrast medium during a CT scan. Whose first diagnosis was mild contrast medium extravasation injury 24 h before the compartment syndrome. Standard radiography showed an accumulation of contrast medium in the left hand. The patient underwent a fasciotomy and secondary healing. Follow-up showed good radiographic, clinical, and hand function after 2 months.DiscussionThe occurrence of hand compartment syndrome secondary to contrast media extravasation is rare. Most of the time, they are initially diagnosed as medium extravasation before the worsening of symptoms. Because of its unknown incidence, treatment is not codified. The goal of treatment is to save the limb and restore function. This can be achieved rapidly with early surgery because of the unpredictable course.ConclusionContrast media injection is not a harmless gesture. Hand compartment syndrome after contrast extravasation is rare and is a severe injury, our experience with this case suggests that early surgery helps save the limb and restore function. Always fear a compartmental syndrome in case of extravasation of contrast medium.

Soleal Venous Aneurysm in a Patient With a History of Pulmonary Embolism

A lower extremity venous aneurysm is an uncommon disease process known to increase the risk for pulmonary embolism. While most are popliteal venous aneurysms, crural aneurysms are rarely documented. We present a rare case of a soleal venous aneurysm in a patient with a history of pulmonary embolism. A risk-reducing open aneurysm resection with lateral venorrhaphy was performed.

“Milking” the way to diagnosis

A 43-year-old non-smoker man presented to the emergency department with exertional dyspnoea and left pleuritic pain lasting for 3 days. He denied fever and cough and described a history of pulmonary embolism, deep venous thrombosis and multiple opportunistic infections, namely angio-invasive pulmonary aspergillosis and pulmonary and brain Nocardia sp. Infections, the brain abscess requiring surgical excision and causing squeal epilepsy. He was chronically medicated with rivaroxaban 20 mg id, Levetiracetam 500 mg bid and co-trimoxazole 960 mg bid 3 times a week.

PH Roundtable: Tailoring CTEPH Imaging for Evaluation and Postintervention Assessment—What Works and What’s New?

PH Roundtable: Tailoring CTEPH Imaging for Evaluation and Postintervention Assessment—What Works and What’s New?

Anaesthetic Management of a Case of Sinonasal Mucormycosis with Post Covid -19 Pulmonary Embolism for Endoscopic Debridement

Coronavirus disease (COVID)-19, especially the severe disease is associated with an increased risk and prevalence of venous thromboembolism [1]. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) binds to the angiotensin converting enzyme-2 (ACE-2) receptors on endothelial cells, especially within the kidneys, heart, lungs, etc. causing endothelial cell damage leading to thrombosis and thrombotic complications like deep vein thrombosis, pulmonary embolism, myocardial infarction, etc [2].We present here our experience of the anaesthetic management of a 40 year old male with post COVID-19 sinonasal mucormycosis and history of pulmonary embolism posted for bilateral functional endoscopic sinus surgery (FESS) and endoscopic debridement.

Rosuvastatin treatment decreases plasma procoagulant phospholipid activity after a VTE: A randomized controlled trial

BackgroundVenous thromboembolism (VTE) is a frequent cardiovascular disease with severe complications, including recurrence and death. There is a great need for alternative prophylactic treatment options as anticoagulation is accompanied by increased bleeding risk. Statins are reported to reduce the risk of incident and recurrent VTE, but the mechanisms are elusive. Procoagulant phospholipids (PPL), and phosphatidylserine in particular, are crucial for efficient coagulation activation, but no studies have investigated the effect of statin treatment on plasma PPL activity. ObjectivesTo investigate the impact of rosuvastatin treatment on plasma PPL activity and levels of extracellular vesicles (EVs). Patients/MethodsPatients with a history of VTE (≥18 years) allowed to stop anticoagulant treatment were randomized to either 20 mg/day of rosuvastatin treatment or no treatment for 28 days in the Statins Reduce Thrombophilia (NCT01613794) trial. Plasma samples were collected at baseline and study end. PPL activity was measured in samples from 245 participants using a factor Xa‐dependent clotting assay and EV levels by flow cytometry. ResultsRosuvastatin treatment yielded an overall 22% (95% confidence interval [CI] −38.2 to −5.8) reduction in PPL activity, and 37% (95% CI −62.9 to −11.2) reduction in PPL activity in participants with a history of pulmonary embolism. The effect of rosuvastatin on plasma PPL activity was not explained by changes in total cholesterol nor change in levels of total‐ or platelet‐derived EVs. ConclusionsRosuvastatin treatment caused a substantial decrease in plasma PPL activity, suggesting that a PPL‐dependent attenuation of coagulation activation may contribute to a reduced VTE risk following statin treatment.