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Journal of Clinical Case Studies and Reviews

Current Issue [Volume 2 | Issue 2]

Atrial Fibrillation: Stroke and bleeding Risk Assessment

Journal of Clinical Case Studies and Reviews

Article Type: Review Article Volume 2 | Issue 1
Authors:

Hussein M Ismail1, Hussein A Yamany2, Hassan A. Shora3*

Atrial fibrillation increases with increased elderly population and it increases the risk of thromboembolism that may lead to stroke. Both CHADS2 and CHA2DS2 VAS scores are widely used to assess the stroke risk according to current international guidelines. The accuracy of both scores in predicting stroke risk is only modest. Some important clinical risk factors are missing of those scores such as chronic kidney disease, Body Mass Index BMI, echocardiographic abnormalities and other biomarkers. Assessment of bleeding risk using HEMORR2HAGES, HAS-BLED, and ATRIA scores are discussed in detail

DOI: 10.47755/2766-9556.100110

Complete Visual Rehabilitation in a Patient with Complicated CMV Retinitis and Macular Involvement

Journal of Clinical Case Studies and Reviews

Article Type: Case Report Volume 2 | Issue 1
Authors:

Jad G Ayash1, Charbel H Wahab1, Fady K Sammouh2 and Elias L Warrak3*

Introduction: There have been many reports in the literature demonstrating successful restoration of ocular anatomy post pars Plana Vitrectomy (PPV) in patients with cytomegalovirus (CMV) retinitis induced retinal detachment. We aim to report a rare case of complete visual rehabilitation with best corrected visual acuity (BCVA) reaching 20/20 post PPV in a patient with complicated CMV retinitis and macular involvement.

Case presentation: We present a case of a 45-year-old Lebanese male patient with newly diagnosed human immunodeficiency virus (HIV) infection. Findings suggestive of CMV retinitis bilaterally were found on fundus examination. Appropriate systemic and intravitreal treatment was started. At 4 months follow up, patient developed a secondary retinal detachment in left eye (OS) and surgery was performed (PPV with silicone oil and scleral buckle) after a latency of 3 weeks. Patient had a smooth recovery with BCVA reaching 20/20 after silicone oil removal.

Conclusion: HIV patients with macula-off retinal detachment post CMV retinitis may retain BCVA of 20/20 even with delayed surgical procedure. Close follow up and appropriate timely interventions play important role for improved final outcomes.

DOI: 10.47755/2766-9556.100109

Initial Experience of Aspiration Thrombectomy using the Indigo Aspiration System for Acute Iliofemoral Deep Vein Thrombosis

Journal of Clinical Case Studies and Reviews

Article Type: Research Article Volume 2 | Issue 1
Authors:

Huasen B1*, Khan A 2, Suwathep P 3, Beropoulis E. 4, Bisdas T5

Objective: The objective of this study was to report initial experience using aspiration thrombectomy with the Indigo Aspiration System, as the first line treatment for acute iliofemoral deep vein thrombosis (DVT).

Methods: This study is a retrospective case review of patients with acute symptomatic iliofemoral DVT who underwent aspiration thrombectomy using the Indigo Aspiration System between December 2015 and January 2018 at three centres. Data on patient demographics, adjunctive treatments, and intraprocedural complications were collected from electronic patient records. Technical success was defined as antegrade flow and maximal luminal stenosis of 30% assessed following the use of Indigo System. Clinical and imaging follow-up was conducted at 30 days and 12-months.

Results: A total of 35 patients (20 females; median age 43 years) met study criteria. Technical success was achieved in 80% (28/35) of patients, with the Indigo System alone. There were no intra-procedure or immediate post-procedure complications. Adjunctive interventions included venous stents (with post-dilatation) in 97.1% of patients, thrombolytics in 37.1% of patients, and caval filters in 14.2% of patients. No DVT recurrence, pulmonary embolism, or deaths occurred over 12 months of follow-up except for one patient with active neo-plastic disease. Moderate to severe post-thrombotic syndrome occurred in two patients.

Conclusion: This study provides evidence that aspiration thrombectomy using the Indigo System is an effective treatment for acute iliofemoral DVT. There were no procedural complications and complication rates over the 12-month follow-up period were low.

DOI: 10.47755/2766-9556.100107

Multi-center Registry For Vacuum-Assisted Thrombectomy of Acute Superior Mesenteric Artery Thrombosis

Journal of Clinical Case Studies and Reviews

Article Type: Research Article Volume 2 | Issue 1
Authors:

Bella Huasen1,*, Alexander Massmann2, Theodosios Bisdas3, Efthymois Beropoulis4, Maria Gelabert5, Massimo Sponza6, Costantino Del Giudice7, Giuseppe Guzzardi8, Michele Rossi9, Cariati Maurizio10 and Luan D Nguyen11

 

Objectives: The aim of our study was to evaluate safety and efficacy of percutaneous vacuum-assisted thrombectomy (VAT) for treatment of acute thrombosis or thromboemboli of the superior mesenteric artery (SMA).

Methods: This study is a retrospective review of data from a multi-national registry, including consecutive patients with acute thrombosis or thromboemboli of the SMA who underwent VAT at 11 international study centers. Technical success was defined as successful removal of acute thrombus material without the need for alternative thrombectomy devices, systemic thrombolysis, or other revascularization strategies such as vascular surgery. Safety endpoints were in-hospital major adverse events e.g. intestinal gangrene or death. Mean follow-up period was 9.5 (3-16) months.

Results: A total of 98 patients (53 females; mean age 73 years; range 55-93 years) were included. Symptom onset defined as initial occurrence of abdominal pain to treatment time ranged from 8 hours to 7 days. Thromboemboli affected a native SMA vessel in all cases. Mean occlusion length was 20 mm (Range 18 to 22 mm). Technical success was achieved in 100% of cases. There was no relevant dissection, vessel rupture or peripheral embolization reported. Provisional stenting was required in 5 cases to treat underlying atherosclerotic stenosis. Mortality in the first 24 hours was 0%. Two deaths on day 27 and 28, following cardiac arrest from other co-morbidities were reported. Bowel resection was performed in 4 cases due to delayed intestinal gangrene.

Conclusions: Endovascular management using vacuum-assisted thrombectomy proved to be a safe and effective option for acute thrombotic SMA occlusion.

DOI: 10.47755/2766-9556.100108

Use of Alkalinized Lidocaine in Interventional Radiology for Endovascular Access

Journal of Clinical Case Studies and Reviews

Article Type: Research Article Volume 2 | Issue 1
Authors:

Bella Huasen1, Farda Aazeb1, Aazeb Khan1,’ Stephen D Souza, Omar Bashir2*

Purpose: To demonstrate the effectiveness of alkalinized local anaesthetic (LA) over plain LA in interventional radiology (IR) procedures, in terms of pain experienced by patient, and times of onset of LA action.

Materials and Methods: 34 patients requiring 2 endovascular access sites, within the same procedure (arterio-venous fistula salvage or bilateral iliac angioplasty/ stenting) were included in the study, 17 patients for each intervention. Alkalinized LA was infiltrated at one site, and plain LA at the other. Pain experienced (on the National Institute of Health numeric pain scale) was compared on LA infiltration and sheath placement for endovascular access, and the time of anesthesia onset was measured.

Results: A statistically significant difference was demonstrated in the amount of pain experienced by the patients, with a preference for alkalinized LA, which was also observed to have a quicker onset of action.

Conclusion: Use of alkalinized LA in IR procedures is effective, inexpensive and safe

DOI: 10.47755/2766-9556.100106
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