1/21. Trousseau's syndrome treated with long-term subcutaneous lepirudin (case report and review of the literature).We report here a case of recurrent venous and arterial thromboembolism, Trousseau's syndrome, in a cancer patient who developed heparin-induced thrombocytopenia. She was treated with lepirudin and after establishing the patient-specific half-life for subcutaneous lepirudin, she was successfully maintained on this therapy for more than eight months.To our knowledge this case represents the longest reported use of subcutaneous lepirudin.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/21. Peripheral arterial embolism originating from a thrombus in the ascending aorta.A 45-year-old man experienced arterial thromboembolism to the right leg requiring surgical restoration of blood flow. Transesophageal echocardiography (TEE) was performed to determine the source of embolism and identified a localized atherosclerotic lesion in the distal ascending aorta with an adherent, highly mobile thrombus. The patient underwent surgery with removal of the atherosclerotic plaque and attached thrombus, and resection of the adjacent aortic wall. This case illustrates an unusual location for a complex atherosclerotic lesion in the ascending aorta, and points out the opportunity for remedial surgery once a symptomatic embolus has occurred.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
3/21. Occlusion of the left common iliac artery and consecutive thromboembolism of the left popliteal artery following anterior lumbar interbody fusion.We report on a case of occlusion of the left common iliac artery due to arteriosclerosis and consecutive thrombotic occlusion of the left popliteal artery in a 52-year-old man following anterior retroperitoneal interbody fusion of L4--S1. Initial symptoms included leg pain and numbness of the lateral shank, which were thought to be a result of lumbar nerve root irritation from surgery. Diagnosis was not made until 13 days after surgery, when motor deficits were observed. angiography showed occlusion of the left common iliac artery and thromboembolism of the left popliteal artery. After thromboendarterectomy of the common iliac artery and thrombectomy of the popliteal artery, motor deficits of the left foot were resolved whereas symptoms of pain and sensory deficits continued. spine surgeons should be aware of this rare complication in cases of postoperative leg pain or of neurologic deficits in the lower extremity after anterior lumbar interbody fusions.- - - - - - - - - - ranking = 5keywords = thromboembolism (Clic here for more details about this article) |
4/21. Arterial occlusion after surgery for ovarian malignancy. A case report.BACKGROUND: Inherent in the risks of pelvic surgery is the postoperative morbidity and mortality associated with the procedure. The gynecologic oncology patient presents further risks for several reasons, including a relative state of hypercoagulability. Anticipation of the problem and early recognition are the keys to decreasing the long-term sequelae of a complication. A well-recognized complication of gynecologic oncology surgery is venous thromboembolism. Advances allow the prophylaxis, recognition and treatment of this problem. Acute arterial occlusion is a much less common but potentially devastating complication. CASE: A woman underwent surgery for ovarian malignancy and developed bilateral arterial occlusion of the lower extremities postoperatively. CONCLUSION: Understanding the various genetic defects that predispose certain individuals to hypercoagulability will help identify patients with a particularly high risk of developing acute arterial occlusive disease.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
5/21. Left atrial thrombus causing pulmonary embolism by passing through an atrial septal defect.A 66-year-old woman admitted with dyspnea on exertion had atrial fibrillation and left ventricular dysfunction. echocardiography revealed an atrial septal defect (ASD) and a soft, easily deformable thrombus in the dilated left atrium. The atrial mass suddenly disappeared on the 10th day after admission, and contrast-enhanced chest computed tomography and pulmonary blood flow scintigraphy showed that the thrombus had detached from the left atrium, floated into the right atrium through the ASD and caused pulmonary embolism. This is the first documented case of a left atrial thrombus causing pulmonary embolism by passing through an ASD. When an ASD is present, it is important to consider not only paradoxical thromboembolism (from the right to the left atrium), but also pulmonary embolism caused by thromboembolism from the left to the right atrium.- - - - - - - - - - ranking = 2keywords = thromboembolism (Clic here for more details about this article) |
6/21. Arterial complications following anterior lumbar interbody fusion: report of eight cases.The objective of this study is to report eight cases of arterial complication following anterior lumbar interbody fusion (ALIF) and to analyze the data in order to identify possible risk factors. The authors have encountered six cases of common iliac artery occlusion and two cases of acute vasospasm as a complication of ALIF using two different approaches to spine: hypogastric-midline-transperitoneal approach at one center and minimally invasive muscle-sparing retroperitoneal approach at the other. All cases involved surgery at the L4-L5 level. All patients were smokers, and three had an existing history of vascular disease. The left iliac and common femoral arteries were involved in seven cases, while the right common iliac was involved in one case. Five patients had thromboembolism, one patient had an intimal tear and two had functional vasospasm. Circulation to the lower limb was restored by thrombectomy (five patients) and arterioplasty for the intimal tear (one patient). One of the vasospasm cases was explored (false-positive), while the other was treated conservatively. One of the patients with thrombosis developed rhabdomyolysis resulting in fatal acidosis. All but the first case at each center was diagnosed either intraoperatively or within 2 h of surgery. We believe that awareness of this potentially serious complication will lead to precautionary measures for prevention of the problem as well as early diagnosis and management of the complication if it does occur. Intraoperative monitoring of lower limb blood flow by measuring the toe oxygenation with a pulse oxymeter can prove to be helpful in early diagnosis.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
7/21. Mixed arterial and venous thromboembolism in a person with hiv infection.People with human immunodeficiency virus (hiv) infection are more susceptible to thromboembolic events. venous thromboembolism (VTE) occurs frequently in hiv infected persons but arterial thrombosis has only rarely been reported. We describe a case of a person with hiv infection who developed an arterial thrombosis and 3 months later an extensive VTE. Several non-hiv and hiv related thrombogenic factors were identified.- - - - - - - - - - ranking = 5keywords = thromboembolism (Clic here for more details about this article) |
8/21. pulmonary artery obstruction caused by thoracic aortic dissection: a case with unique pathological findings.pulmonary artery obstruction is a rare complication of acute thoracic aortic dissection. A 74-year-old woman was admitted to hospital with respiratory distress. Computed tomography scan showed right pulmonary artery occlusion and a thoracic aortic dissection of the Stanford A type. lung perfusion scan revealed a defect in the entire right lung field. These findings mimicked acute pulmonary thromboembolism accompanying aortic dissection. On the other hand, pulmonary angiography revealed a round smooth defect of the right pulmonary artery, indicating an extrinsic compression. The patient finally died of cardiac tamponade. autopsy disclosed that the right pulmonary artery was compressed by a hematoma in the adventitial space around the pulmonary artery. Such a mechanism of pulmonary artery obstruction caused by acute aortic dissection is unique, and is distinct from that caused by chronic non-dissecting aortic aneurysms, which themselves compress the pulmonary arteries. This complication inevitably follows aortic rupture; therefore, emergency operation to repair the dissected aorta must be performed to avoid the following catastrophic event.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
9/21. Rheumatic mitral stenosis presenting as acute abdominal aortic occlusion and foot drop.Systemic thromboembolism in not an infrequent complication of rheumatic mitral stenosis. We report a case of acute abdominal aortic occlusion due to rheumatic mitral stenosis, in the absence of atrial fibrillation, mimicking spinal cord compression. Systemic streptokinase given 48 hours after symptom's onset lead to rapid and dramatic recovery with limb salvage.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
10/21. Thromboembolic complications in beta thalassemia major.Thromboembolic complications in beta-thalassemia major have seldom been reported and their association with risk factors such as left ventricular failure and postsplenectomy thrombocytosis has remained speculative. In this report we describe 4 patients with unusual thromboembolic manifestations: recurrent arterial occlusion, recurrent pulmonary thromboembolism, venous thrombosis and a fatal cerebrovascular event. Although in all patients both risk factors were present, the precise causes for their thromboembolic complications were not identified. In 1 patient, however, a marked increase in hematocrit following blood transfusion resulted, in all likelihood, in a fatal cerebrovascular infarction. We suspect that these patients (constituting 4% of our beta-thalassemic group) represent a subset of those with high susceptibility to both arterial and venous thromboembolic complications.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
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