Iatrogenic Bleeding Research Articles

Comparison of transradial and transfemoral access for transcatheter arterial embolization of iatrogenic renal hemorrhage.

BackgroundThere are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage.Materials and methodsThis study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated.ResultsThere were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period.ConclusionRAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients.

Efficacy of Uterine Artery Embolization for Treatment of Anticoagulant-Associated Abnormal Uterine Bleeding

Data regarding uterine artery embolization (UAE) to specifically treat anticoagulant-associated iatrogenic abnormal uterine bleeding (AUB-I) are sparse. This manuscript aimed to quantify the effectiveness of UAE in treating this subset of patients. Retrospective case series. Academic hospital serving a large minority-majority population. Twenty-four patients with AUB-I that was provoked or aggravated by the initiation of anticoagulation therapy. Treatment of anticoagulant-associated AUB-I that failed medical management or was acute with UAE rather than inferior vena cava filter placement and hysterectomy. An imaging database search was performed to identify patients who underwent UAE for anticoagulant-associated AUB-I from May 2011 to July 2020. Medical and radiologic records were reviewed. Short- and long-term outcomes were obtained to date, ranging from 10 months to 10 years after the procedure. In total, 24 patients were identified, ranging in age from 35 to 54 (mean 44.9) years. Venous thromboembolic disease was the most common (92%) indication for anticoagulation. At presentation, 14 patients (58%) were anticipated to require lifelong anticoagulation. Most UAE procedures (54%) occurred within 10 days of anticoagulation initiation. Before UAE, 17 patients (71%) attempted and failed medical management, myomectomy, or endometrial ablation to control bleeding. After UAE, 21 patients (88%) experienced substantial improvement or resolution of AUB and continued anticoagulation therapy. Three patients (14%) did not experience improvement and were treated with hysterectomy. Amenorrhea immediately after UAE occurred in 1 patient at age 45. UAE was an effective tool in the management of anticoagulant associated AUB-I in this cohort, resulting in decreased bleeding while allowing the continuation of anticoagulation therapy, with high rates of uterine preservation and preserved menses.

Intracerebral hemorrhage with tentorial herniation: Conventional open surgery or emergency stereotactic craniopuncture aspiration surgery?

BackgroundTo observe the therapeutic effect of conventional decompressive craniectomy with hematoma evacuation and frame-based stereotactic minimally invasive surgery (MIS) for supratentorial intracranial hematoma with herniation.MethodsOne hundred forty-nine patients with hypertensive ICH complicated with tentorial herniation were reviewed and analyzed in the present study. The intracranial hematoma was evacuated by emergency surgery within 6 h after admission. According to the authorized representatives’ wishes and consent, 74 of the 149 patients were treated by conventional decompressive craniectomy followed by hematoma removal, defined as the CDC group, and the remaining 75 patients underwent frame-based stereotactic MIS for ICH evacuation, defined as the MIS group. The intervals between the admission to surgery, the duration of surgery, the amount of iatrogenic bleeding, the occurrence of postoperative rebleeding, and the recovery of neurological functions were compared between the two groups. All patients were followed up for 3 months. Secondary epilepsy, survival in a vegetative state, severe pulmonary complications, mortality, and activities of daily living (ADL) classification were also recorded and compared.ResultsThe interval between admission and surgery, the duration of surgery, and intraoperative blood loss in the MIS group were significantly decreased compared to the CDC group. The mortality rate, the rate of rebleeding, prevalence of vegetative state, and severe pulmonary complications in the MIS group were remarkably decreased compared to the CDC group. In the MIS group, the survivors’ (ADL) grade also showed advantages.ConclusionsIn the surgical treatment of hypertensive ICH complicated with tentorial herniation, frame-based stereotactic MIS for ICH showed advantages compared to conventional open surgery.

Endoscopic application of mussel-inspired phenolic chitosan as a hemostatic agent for gastrointestinal bleeding: A preclinical study in a heparinized pig model.

Marine mussels secrete adhesive proteins to attach to solid surfaces. These proteins contain phenolic and basic amino acids exhibiting wet adhesion properties. This study used a mussel-inspired hemostatic polymer, chitosan-catechol, to treat gastrointestinal bleeding caused by endoscopic mucosal resection in a heparinized porcine model. We aimed to evaluate the hemostatic efficacy and short-term safety of this wet adhesive chitosan-catechol. We used 15 heparinized pigs. Four iatrogenic bleeding ulcers classified as Forrest Ib were created in each pig using an endoscopic mucosal resection method. One ulcer in each pig was untreated as a negative control (no-treatment group). The other three ulcers were treated with gauze (gauze group), argon plasma coagulation (APC group), and chitosan-catechol hemostatic agent (CHI-C group) each. The pigs were sacrificed on Days 1, 5, and 10, and histological examination was performed (n = 5 per day). Rapid hemostasis observed at 2 min after bleeding was 93.3% (14/15) in the CHI-C group, 6.7% (1/15) in the no-treatment group, 13.3% (2/15) in the gauze group, and 86.7% (13/15) in the APC group. No re-bleeding was observed in the CHI-C group during the entire study period. However, a few re-bleeding cases were observed on Day 1 in the no-treatment, gauze, and APC groups and on Day 5 in the gauze and APC groups. On histological analysis, the CHI-C group showed the best tissue healing among the four test groups. Considering the results, chitosan-catechol is an effective hemostatic material with reduced re-bleeding and improved healing.

Cutting-Edge Technologies for Gastrointestinal Therapeutic Endoscopy.

With advancements in the development of flexible endoscopes and endoscopic devices and the increased demand for minimally invasive treatments, the indications of therapeutic endoscopy have been expanded. Methods of endoscopic treatment used for tissue removal, hemostasis, and dilatation are as follows. Endoscopic submucosal dissection (ESD) is considered the gold standard curative method for removal of gastrointestinal node-negative neoplasms, regardless of their size or the presence of ulcer formation. Laparoscopic endoscopic cooperative surgery (LECS), which incorporates ESD, was introduced for removal of lesions in deeper layers. Another technique is endoscopic full-thickness resection, which is challenging without the assistance of laparoscopy. In terms of hemostasis, management of iatrogenic bleeding after endoscopic treatment is an important issue. Shielding methods and suturing techniques have been introduced for large mucosal defects after ESD, and their efficacy has been investigated clinically. Peroral endoscopic myotomy (POEM) is a new alternative surgical approach for minimally invasive treatment of esophageal achalasia. Furthermore, endoscopic fundoplication after POEM was devised to prevent post-POEM gastroesophageal reflux disease. Many endoscopic treatments, including ESD, LECS, and POEM, have been introduced in Japan. With the aging of the population, more attention will be directed toward therapeutic endoscopy for elderly patients, because it is less invasive. Development of endoscopic treatments with expanded indications is expected.

Tethered Liquid Perfluorocarbon Coating for 72 Hour Heparin-Free Extracorporeal Life Support.

Coagulopathic complications during extracorporeal life support (ECLS) result from two parallel processes: 1) foreign surface contact and shear stress during blood circulation and 2) administration of anticoagulant drugs to prevent circuit thrombosis. To address these problems, biocompatible surfaces are developed to prevent foreign surface-induced coagulopathy, reducing or eliminating the need for anticoagulants. Tethered liquid perfluorocarbon (TLP) is a nonadhesive coating that prevents adsorption of plasma proteins and thrombus deposition. We examined application of TLP to complete ECLS circuits (membranes, tubing, pumps, and catheters) during 72 hours of ECLS in healthy swine (n = 5/group). We compared TLP-coated circuits used without systemic anticoagulation to standard of care: heparin-coated circuits with continuous heparin infusion. Coagulopathic complications, device performance, and systemic effects were assessed. We hypothesized that TLP reduces circuit thrombosis and iatrogenic bleeding, without impeding gas exchange performance or causing untoward effects. No difference in bleeding or thrombotic complication rate was observed; however, circuit occlusion occurred in both groups (TLP = 2/5; CTRL = 1/5). TLP required elevated sweep gas rate to maintain normocapnia during ECLS versus CTRL (10-20 vs. 5 L/min; p = 0.047), suggesting impaired gas exchange. Thrombus deposition and protein adhesion on explanted membranes were comparable, and TLP did not preserve platelet or blood cell counts relative to controls. We conclude that neither TLP nor standard of care is an efficacious solution to prevent coagulation disturbances during ECLS. Further testing of promising biomaterials for ECLS utilizing the model outlined here is warranted.

1329: Novel Use of REBOA in Refractory Iatrogenic Hemorrhage in a Complex Patient After Liver Transplant

1329: Novel Use of REBOA in Refractory Iatrogenic Hemorrhage in a Complex Patient After Liver Transplant

Pulmonary passport: a service evaluation study of a standardised web-based procedure logbook to aid specialist respiratory training and appraisal

IntroductionThe pulmonary passport (PP) is a secure web-based procedural logbook for specialist respiratory trainees with enhanced functionality that includes automated analysis to provide key performance metrics and in-platform interactions with...

Value of Angioembolization in the Treatment of Iatrogenic Renal Vascular Injury Assisted by 3-Dimensional Digital Subtraction Angiography.

BackgroundThis study was conducted to investigate the reliability and efficacy of polyvinyl alcohol combined with coils in the embolization of iatrogenic renal vascular injury with the assistance of 3-dimensional digital subtraction angiography (3D-DSA).Material/MethodsTwenty-six patients with minimally invasive renal bleeding who underwent transarterial embolization from January 2012 to January 2019 in our hospital were included in the study. We obtained demographic data from these patients, as well as information on clinical presentation, renal procedures used for treatment, and perioperative details. The changes in renal function tests, serum hemoglobin, serum hematocrit, and technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA) levels pre- and postembolization were compared. In addition, the embolic area and the technical and clinical success rates were analyzed. Finally, an angiographic manifestation of the renal artery, 3D-DSA, and the effect of embolization were analyzed retrospectively.ResultsAll patients achieved technical and clinical success after embolization (100%, 26/26). There were no significant differences between pre- and postoperative estimated glomerular filtration rate, serum parameters, and 99mTc-DMSA. The embolic area was 12%±10%. Patients did not exhibit severe complications during the follow-up period.ConclusionsProximal embolization technique assisted by 3D-DSA for renal iatrogenic hemorrhage and vascular lesions is both safe and efficacious, offering high rates for both clinical and technical success. It maximizes the protection of the kidney and reduces the rate of renal resection.

Balloon-assisted Transcatheter arterial embolization using N-butyl cyanoacrylate for iatrogenic arterial bleeding by groin puncture: a new technology

BackgroundBalloon-assisted transcatheter arterial embolization (TAE) using n-butyl cyanoacrylate (NBCA) and lipiodol (Lp) mixture is a new endovascular treatment technique for iatrogenic arterial bleeding by groin puncture. It is less invasive compared to surgical repair, and NBCA migration into the circulation can be prevented by temporary balloon occlusion of the parent artery without ultrasound-guidance. This study aimed to report on the technical aspects and evaluate the efficacy and safety of fluoroscopically guided balloon-assisted transcatheter arterial embolization using NBCA for iatrogenic arterial bleeding by groin puncture.Materials and methodsThe study included five patients (mean age 54.6 years; 3 male and 2 female) with iatrogenic arterial bleeding by groin puncture. We performed transcatheter arterial embolization using NBCA while occluding the responsible artery with a balloon catheter during the embolization to prevent NBCA migration. Two sheaths were inserted into the common femoral artery. A microcatheter was advanced into the pseudoaneurysm or extravasation via the contralateral sheath. A balloon catheter was advanced into the responsible artery until the balloon portion covered the leakage site via another sheath. After balloon inflation, the NBCA and Lip mixture was slowly injected until the pseudoaneurysm, or the extravasation was filled without touching the balloon. The microcatheter was removed immediately after the filling. We assessed technical success, overall success, and complications.ResultsThe injured arteries were the external iliac artery (n = 1), the common femoral artery (n = 2), and the proximal portion of the superficial femoral artery (n = 2). NBCA was injected once in four cases and twice in one case where complete hemostasis could not be achieved with one injection. The technical and overall success rate was 100% with no complications, including distal embolization of NBCA.ConclusionsBalloon-assisted TAE using NBCA is a feasible, effective, and safe treatment for iatrogenic arterial bleeding by groin puncture. It may also be applicable in other arterial bleeding situations where the potential risk of distal embolization can be decreased by applying the balloon-assisted technique.

Spontaneous Hemomediastinum due to thyroid artery aneurysm A rare case report

Spontaneous Hemomediastinum is a rare pathological disorder. Multiple underlying causes and contributory factors can be identified, such as trauma, malignancy, iatrogenic, bleeding disorder or mediastinal organ hemorrhage. Using contrast enhanced computed tomography (CT) of the chest, hemomediastinum can be adequately diagnosed. Spontaneous hemomediastinum may occur due to muliple and cotributory causes such as: secondary to haemorragic disorders, mediastinal tumors or after sudden increase in intrathoracic pressure, (e.g. during coughing, sneezing or vomiting, or sudden sustained hypertension) [1, 2]. In this case report, a 76-year-old male is presented with of thyroid artery aneurysm resulting in hemomediastinum causing thoracic pain.

Transarterial embolization of acute iatrogenic hemorrhages: predictive factors for mortality and outcome.

Iatrogenic hemorrhages occur in 0.5-16% of medical procedures. A retrospective study was conducted to analyze technical and clinical outcome of transarterial embolization (TAE) used for acute iatrogenic hemorrhage and to identify factors predicting outcome. All patients undergoing TAE for acute iatrogenic bleeding from 2006 to 2013 were retrospectively analyzed. Primary end points were technical and clinical success or failure and 30 day mortality. A total of 153 patients underwent 182 TAEs. Factors associated with clinical failure were lower blood hemoglobin concentration, use of higher number of units of red blood cell concentrate, TAE performed at night or weekend, embolization of more than one vessel, shock state before digital subtraction angiography (DSA), and intensive care before TAE. In multivariate analysis, independent factors for clinical success were hemoglobin concentration, number of units of red blood cell concentrate, and TAE of more than one vessel. Technical failure was associated with female gender, failure to detect signs of bleeding in DSA, TAE of more than one vessel, and shock state before DSA. Bleeding related to anticoagulation medication resulted in a significantly higher mortality rate compared with bleeding due to the remaining causes (30% vs 15%, p < 0.05). Despite excellent technical success, the mortality rate was significant. The only factors affecting clinical success were bleeding intensity and extent of injury. Bleeding attributed to anticoagulation is related to high mortality and therefore requires special attention. This study gives insights into morbidity and mortality of iatrogenic bleedings and the technical and clinical success rates of TAE in a large study population.

When the Drain Hits the Brain

The insertion of a subdural drain (SDD) after burr-hole drainage of chronic subdural hematoma (cSDH) was shown to reduce recurrence rate and improve outcome at 6 months. However, studies analyzing the rate of drain misplacement and complications associated with drain misplacement are sparse. We analyzed retrospectively a cohort of consecutive patients undergoing burr-hole drainage for cSDH in 2 institutes. Drain type (subperiosteal drain vs. SDD), drain misplacement rate, and drain-associated complications were analyzed. We explored potential risk factors for drain misplacement and associated complications in the SDD subgroup using univariate and multivariate analysis. Drain misplacement was defined as incorrect drain position exceeding the subdural cavity and was categorized into drain misplacement without radiologic sequelae, drain misplacement causing radiologically confirmed iatrogenic bleeding, and drain misplacement causing neurologic symptoms. Of 463 included patients, 290 (62.6%) received an SDD. Drain misplacement occurred in 73 patients (15.8%). In 5 (6.9%) and 9 (12.3%) of these patients, iatrogenic bleeding and neurologic symptoms occurred, respectively. Intake of vitamin K antagonists (odds ratio [OR], 3.64) or different oral anticoagulants (OR, 10.24), and low preoperative Glasgow Coma Scale score (OR, 7.81) remained associated risk factors for drain misplacement after multivariate analysis. Patients with misplaced drains showed a strong association with postoperative bleeding (OR, 5.81), longer operation time (OR, 1.01), and hospitalization time (OR, 1.08) after multivariate analysis. The occurrence of SDD misplacement is unignorable, because it leads to iatrogenic drain-associated complications and seems to affect bleeding events and hospitalization time of patients undergoing burr-hole drainage of cSDH.

Evaluating the origin of vascular structures in ectopic kidneys with multidetector computed tomography.

The purpose of this study is to investigate the origin of the vascular structures in ectopic kidneys with multidetector computed tomography (CT). The abdominal CT images of 96 cases with 106 ectopic kidneys were retrospectively reviewed. The ectopic kidney location, type of ectopia, and the origins of renal arteries and veins of the ectopic kidneys were evaluated. The origins of the renal arteries and veins were classified as suprarenal aorta/inferior vena cava (IVC), normal origin, infrarenal aorta/IVC, aortic/IVC bifurcation, common iliac artery/vein, iliac bifurcation, internal iliac artery/vein, and external iliac artery/vein. Finally, the ectopic kidneys were classified according to the most common combinations of artery and vein origins. The renal artery originated from the suprarenal aorta in 1 case, normal origin in 13 cases, the infrarenal aorta in 36 cases, aortic bifurcation in 50 cases, the common iliac artery in 17 cases, and the iliac artery bifurcation in 2 cases. The renal vein was of normal origin in 19 cases, originated from the infrarenal IVC in 44 cases, IVC bifurcation in 36 cases, the common iliac vein in 23 cases, the internal iliac vein in 1 case, and the external iliac vein in 1 case. We classified the artery and vein origins of the ectopic kidneys into 7 most common types and other less common types. A significant correlation was found between the level of the ectopic kidneys and the origin of the arteries and veins (P < 0.001). Our study shows that the majority of ectopic kidneys have various origins of arterial and venous supply. We described the most common vascular origins of ectopic kidneys. Prior knowledge of these vascular variations may have important implications in preventing iatrogenic hemorrhage during surgery of patients with ectopic kidney.

Assessment of the efficacy of uterine artery Doppler in predicting the response to Mefenamic acid during treatment of women having IUCD associated menorrhagia

Background: Bleeding with IUCDs is considered iatrogenic dysfunctional uterine bleeding. The bleeding associated with IUCD use may either occur during menstruation (heavy and/or prolonged) or in the form of intermenstrual bleeding and spotting.Patients and Methods:This study was carried out on 156 women attended the family planning out-patient clinic in the Obstetrics and Gynecology Department, Ain-Shams University Hospitals, during the period from May 2017 to May 2018. Patients were divided according to the response to treatment into two groups: Group (I): Responders to treatment with Mefenamic acid and Group (II): Non-responders to treatment with Mefenamic acid. Response to treatment was evaluated according to: Pictorial blood loss assessment chart.Results: Interpretation of the results of this work showed that uterine artery mean value of the PI of the women who responded to treatment with Mefenamic acid (group I) (1.54±0.42) were significantly higher than mean value of PI of women who didn’t respond to treatment with Mefenamic acid (group II) (0.96±0.28), also showed that uterine artery mean value of the RI of the who responded to treatment with Mefenamic acid (group I) (1.01±0.25) were significantly higher than mean values of RI of women who didn’t respond to treatment with Mefenamic acid (group II) (0.71±0.21). Doppler indices showed that pulsatility index ≥ 1.27 had moderate sensitivity (75.3%) and NPV (75.3%) but high specificity (90.1%) and PPV (90.1%) in prediction of responders. Resistive index ≥ 0.93 had low sensitivity (69.4%) and NPV (70.8%) but moderate specificity (88.7%) and PPV (88.1%) in prediction of responders.Conclusion:There is a strong relationship between uterine artery Doppler indices and prediction of response to Mefenamic acid.

Regime for cytomegalovirus retinitis based on aqueous virology and inflammatory cytokine determination

Objective To observe the safety and efficacy of regime that based on aqueous cytomegalovirus-DNA (CMV-DNA) load and IL-8 determination for therapeutic monitoring and local treatment cessation of cytomegalovirus retinitis (CMVR) patients after allogeneic hematopoietic stem cell transplantation (HSCT). Methods A prospective case series study. A total of 14 CMVR patients (22 eyes) after allogeneic HSCT diagnosed in Ophthalmology Department of Peking University People's Hospital between January 2016 and December 2018 were involved in this study. All patients were CMV-DNA seronegative at baseline and were treated with intravitreous injection of ganciclovir (IVG, 3 mg in 0.05 ml) twice per week for 4 times in the induction stage and once a week in the maintenance stage. Aqueous humor sample was collected during the first time of IVG every week. CMV-DNA and the level of IL-8 were measured by real time quantitative PCR and ELISA, respectively. During follow-up, negative CMV-DNA (<103/ml) or level of IL-8<30 pg/ml in aqueous sample was set as local treatment cessation. Then patients were followed every 2 weeks for at least 6 months. BCVA, intraocular pressure and fundus examination were taken for each visit. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. BCVA and intraocular pressure at the baseline and the last follow-up were compared by the Student t matching test. Results Of the 14 CMVR patients (22 eyes) after allogeneic HSCT, 8 patients (16 eyes) were bilateral, 6 patients (6 eyes) were unilateral. At the baseline, the mean logMAR BCVA was 0.814±0.563, the intraocular pressure was 17.2±7.8 mmHg (1 mmHg=0.133 kPa), the mean aqueous CMV-DNA load was (3.43±4.96)×105/ml, the mean level of IL-8 was 518±541 pg/ml. At cessation of local treatment, the median number of intravitreal injections was 5 times. Nine eyes showed negative CMV-DNA in aqueous humor, of which, 7 eyes showed negative IL-8 in aqueous. CMV-DNA could still be detected in 13 eyes, while IL-8 was negative. Only one eye’s retinal lesion was completely quiet. Six months after local treatment cessation, the mean logMAR BCVA was 0.812±0.691, the intraocular pressure was 14.8± 5.4 mmHg; which was not significantly different from baseline (t=-0.107, 1.517; P=0.916, 0.137). Recurrence of CMVR happened in only 1 eye because of systemic EB virus infection. Retinal lesions progressively improved and became completely quiet in all the remaining 20 eyes. In 22 eyes, iatrogenic vitreous hemorrhage occurred due to low platelet count during treatment (<30×109/ml) in 4 eyes. When the treatment was terminated for 6 months, the fundus of hematoma absorption was clearly visible. At the time of CMVR diagnosis, there were 2 eyes (9%) with posterior subcapsular opacity, which may be caused by systemic glucocorticoid therapy after allogeneic HSCT. Conclusion Aqueous CMV-DNA load and level of IL-8 could be used as quantitative variables for monitoring the therapeutic effect and determining time for local treatment cessation for CMVR after HSCT safely and efficiently. Key words: Cytomegalovirus retinitis; Aqueous humor; Virology; Intereukin-8

Pseudoaneurysm of the Internal Maxillary Artery in Recurrent Head And Neck Cancer Patient—a Rare Case Report

Acute bleeding in the head and neck area occurs due to various causes and often is a life-threatening situation. Head and neck cancers can be a cause of intractable hemorrhage from local tumour irradiation or spontaneous tumourbleeding1. In addition to tumour-related bleeding, iatrogenic bleeding related to surgical procedures or trauma, can also lead to intractable, life-threatening bleeding1. A pseudoaneurysm is an extravascular hematoma that communicates with the intravascular space. This rare lesion receives its name from the fact that its vascular wall is composed of fibrous connective tissue (pseudo-capsule) that develops after rupture of the endothelium2. Pseudoaneurysms occur when there is a partial disruption in the wall of a blood vessel, causing a hematoma that is either contained by the vessel adventitia or the perivascular soft tissue3.

Prospective Study of Doppler Ultrasound Surveillance for Deep Venous Thromboses in 1000 Plastic Surgery Outpatients.

Current guidelines recommend individual risk stratification, chemoprophylaxis, and risk mitigation to prevent venous thromboembolism. However, the evidence for efficacy is lacking in plastic surgery outpatients. Anticoagulation can cause bleeding. Ultrasound technology offers a highly accurate screening method. A prospective study was undertaken among 1000 consecutive cosmetic surgery outpatients who were scanned at three times: before surgery, the day after surgery, and 1 week after surgery (inclusion rate, 93 percent). Intravenous sedation was used, with no muscle relaxation. Compression, Doppler color flow, and waveform analysis were performed on the deep veins of the lower extremities, including the calves. Affected patients were followed with weekly scans. No chemoprophylaxis was ordered. Sequential compression devices were used during the first half of the study. Nine deep venous thromboses were detected (0.9 percent). Two thromboses were found on scans performed the day after surgery. Six thromboses were detected on the scan approximately 1 week after surgery. One deep venous thrombosis was detected 35 days after surgery. Eight of the nine patients were prescribed oral anticoagulants. All affected patients recovered fully. The mean time to thrombosis resolution was 4.8 weeks. A logistic regression found no deep venous thrombosis risk reduction from sequential compression devices. Patient age was significantly associated with deep venous thromboses (p < 0.05). Ultrasound surveillance offers an effective method for early detection and treatment of postoperative deep venous thromboses. This technology offers an alternative to risk stratification and chemoprophylaxis, which causes iatrogenic bleeding. Sequential compression devices are unnecessary for plastic surgery outpatients undergoing total intravenous anesthesia. Diagnostic, IV.

Outcomes of over-the-scope clip application in various gastrointestinal indications: experience from a tertiary care in India.

BackgroundRecent advances in endoscopic tools and techniques have allowed the minimally invasive management of iatrogenic gastrointestinal (GI) perforations and bleedings. However, surgery may be required in cases with larger defects and bleeding refractory to conventional endoscopic modalities. The use of over-the-scope clips (OTSC) has been shown to improve the outcomes in these patients compared with conventional treatment modalities. In this study, we evaluated the safety and efficacy of OTSC for different indications in the GI tract.MethodsThe data of consecutive patients in whom OTSC was utilized for different indications between February 2017 and October 2019 were analyzed retrospectively. The following outcomes were recorded: technical and clinical success, and adverse events related to the procedure.ResultsThirty-six patients (22 male, mean age 52.673±14.97 years, range 11-72 years) underwent OTSC application. Indications for OTSC were: GI defects (perforation n=13, fistula n=5); esophageal metallic stent fixing n=9; GI bleeding n=8; and neuroendocrine tumor endotherapy n=1. The average size of the defect was 15.88±8.01 mm. The technical and clinical success rates were 88.89% and 83.33%, respectively. There were 4 (11.1%) technical failures: colonic perforations n=2; duodenal ulcer bleeding n=1; and esophageal metal stent fixation n=1. There were 2 (9.5%) adverse events, including 1 partial duodenal obstruction and 1 delayed bleeding.ConclusionsThe use of OTSC is safe, easy and effective for various indications in the GI tract. Prospective trials are required to see if the use of OTSC is cost effective as a primary endoscopic treatment method in these cases.

MVP (Micro Vascular Plug\xae) embolization of severe renal hemorrhages after nephrostomic tube placement

BackgroundWe report our experience in managing iatrogenic renal bleedings after nephrostomic procedures by transarterial embolization using Micro Vascular Plug (MVP) (Medtronic, USA) as single or complementary embolization device with parenchimal sparing.Materials and methodsFive patients have been treated in a single center with transarterial embolization because of renal hemorrhages occurring after positioning of nephrostomic drainages.All patients presented with back pain, severe hematuria and/or bright red blood into the nephrostomic bag, with fall in hemoglobin value.After contrast enhanced CT scan confirming arterial active bleeding, rescue embolization was performed using MVP.The renal parenchimal loss was estimated on final postembolization DSA. Creatinine values were monitored before and after the procedure.ResultsTechnical and clinical successes were obtained in all patients.Two patients presented with extraluminal blush, one with multiple pseudoaneurysms, one with pseudoaneurysm with arterovenous fistula, one with extraluminal blush with arterovenous fistula.MVP models were choosen oversized because of vasospasm that would underestimate the effective caliber of target vessel; MVP 3Q and MVP 7Q were adopted in one patient each, while MVP 5Q was released in three cases.MVP was the sole embolizing agent in four patients; in one patient, MVP was employed after microcoils failed to obtain complete embolization.The percentage of renal parenchimal lost was lower than 20%; no increase in Creatinine values was detected at dismission.ConclusionsAccording to proposed data, MVP seems to be a safe, effective and fast embolizing device that interventionalists could consider when facing renal bleedings, even as sole agent.