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Venous Occlusion (venous + occlusion)
Terms modified by Venous Occlusion Selected AbstractsVenous Occlusion of the Access Vein in Patients Referred for Lead Extraction:PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2003Influence of Patient, Lead Characteristics The aim of this study was to determine the effect of patient and lead characteristics on occlusion of the access vein in pacemaker and ICD patients. Contrast venography of the access vein was obtained in 89 patients (17 patients with an ICD) scheduled for lead extraction. The indication for extraction was infection in 57 patients (systemic infection in 9) and lead malfunction in 32 patients. In 6 of the 89 patients, leads were introduced in both the right and left subpectoral area, resulting in a total of 95 venous entry sites. In 22 of these entry sites one lead was present, in 61 two leads, in 11 three, and in 1 four leads. The vessel patency was graded open or occluded. Occlusion of the subclavian vein occurred in four (13%) patients with lead malfunction versus 18 (32%) patients with infection (P = 0.07). In patients with systemic infection, 5 of 9 showed venous occlusion (P = 0.01 when compared to patients with malfunction, odds ratio 8.75, 95% confidence interval 1.21,64.11). Considered per entry site, the incidence of occlusion was 7 of 22 with one lead present, 17 of 61 with two leads, 0 of 11 with three leads, and 0 of 1 with four leads (P = 0.13). No patient had a superior vena caval occlusion. Patients with systemic infection have an increased risk of occlusion of the access vein. On the contrary, the study found no support for the concept that the risk of venous occlusion increases with a higher number of leads present. (PACE 2003; 26:1649,1652) [source] Changes in skeletal muscle size, fibre-type composition and capillary supply after chronic venous occlusion in ratsACTA PHYSIOLOGICA, Issue 4 2008S. Kawada Abstract Aim:, We have previously shown that surgical occlusion of some veins from skeletal muscle results in muscle hypertrophy without mechanical overloading in the rat. The present study investigated the changes in muscle-fibre composition and capillary supply in hypertrophied muscles after venous occlusion in the rat hindlimb. Methods:, Sixteen male Wistar rats were randomly assigned into two groups: (i) sham operated (sham-operated group; n = 7); (ii) venous occluded for 2 weeks (2-week-occluded group; n = 9). At the end of the experimental period, specimens of the plantaris muscle were dissected from the hindlimbs and subjected to biochemical and histochemical analyses. Results:, Two weeks after the occlusion, both the wet weight of plantaris muscle relative to body weight and absolute muscle weight showed significant increases in the 2-week-occluded group (,15%) when compared with those in the sham-operated group. The concentrations of muscle glycogen and lactate were higher in the 2-week-occluded group, whereas staining intensity of muscle lipid droplets was lower in the 2-week-occluded group than those in the sham-operated group. The percentage of type I muscle fibre decreased, whereas that of type IIb fibre increased in the 2-week-occluded group when compared with the sham-operated group. Although the expression of vascular endothelial growth factor-188 mRNA increased, the number of capillaries around the muscle fibres tended to decrease (P = 0.07). Conclusion:, Chronic venous occlusion causes skeletal muscle hypertrophy with fibre-type transition towards faster types and changes in contents of muscle metabolites. [source] Regional distribution of collagen and haemosiderin in the lungs of horses with exercise-induced pulmonary haemorrhageEQUINE VETERINARY JOURNAL, Issue 6 2009F. J. Derksen Summary Reasons for performing study: Regional veno-occlusive remodelling of pulmonary veins in EIPH-affected horses, suggests that pulmonary veins may be central to pathogenesis. The current study quantified site-specific changes in vein walls, collagen and haemosiderin accumulation, and pleural vascular profiles in the lungs of horses suffering EIPH. Hypothesis: In the caudodorsal lung regions of EIPH-affected horses, there is veno-occlusive remodelling with haemosiderosis, angiogenesis and fibrosis of the interstitium, interlobular septa and pleura. Methods: Morphometric methods were used to analyse the distribution and accumulation of pulmonary collagen and haemosiderin, and to count pleural vascular profiles in the lungs of 5 EIPH-affected and 2 control horses. Results: Vein wall thickness was greatest in the dorsocaudal lung and significantly correlated with haemosiderin accumulation. Increased venous, interstitial, pleural and septal collagen; lung haemosiderin; and pleural vascular profiles occurred together and changes were most pronounced in the dorsocaudal lung. Further, haemosiderin accumulation colocalised with decreased pulmonary vein lumen size. Vein wall thickening, haemosiderin accumulation and histological score were highly correlated and these changes occurred only in the caudodorsal part of the lung. Conclusion: The colocalisation of these changes suggests that regional (caudodorsal) venous remodelling plays an important role in the pathogenesis of EIPH. Potential relevance: The results support the hypothesis that repeated bouts of venous hypertension during strenuous exercise cause regional vein wall remodelling and collagen accumulation, venous occlusion and pulmonary capillary hypertension. Subjected to these high pressures, there is capillary stress failure, bleeding, haemosiderin accumulation and, subsequently, lung fibrosis. [source] Forearm vascular responses to combined muscle metaboreceptor activation in the upper and lower limbs in humansEXPERIMENTAL PHYSIOLOGY, Issue 4 2006Ken Tokizawa Our previous studies showed that venous occlusion or passive stretch of the lower limb, assuming a mechanical stimulus, attenuates the vasoconstriction in the non-exercised forearm during postexercise muscle ischaemia (PEMI) of the upper limb. In this study, we investigated whether a metabolic stimulus to the lower limb induces a similar response. Eight subjects performed a 2 min static handgrip exercise at 30% maximal voluntary contraction (MVC) followed by 3 min PEMI of the upper limb, concomitant with or without 2 min static ankle dorsiflexion at 30% MVC followed by 2 min PEMI of the lower limb. During PEMI of the upper limb alone, forearm blood flow (FBF) and forearm vascular conductance (FVC) in the non-exercised arm decreased significantly, whereas during combined PEMI of the upper and lower limbs, the decreases in FBF and FVC produced by PEMI of the upper limb was attenuated. Forearm blood flow and FVC were significantly greater during combined PEMI of the upper and lower limbs than during PEMI of the upper limb alone. When PEMI of the lower limb was released after combined PEMI of the upper and lower limbs (only PEMI of the upper limb was maintained continuously), the attenuated decreases in FBF and FVC observed during combined PEMI of the upper and lower limbs was not observed. Thus, forearm vascular responses differ when muscle metaboreceptors are activated in the upper limb and when there is combined activation of muscle metaboreceptors in both the upper and lower limbs. [source] Experimental Models To Investigate Inflammatory Processes in Chronic Venous InsufficiencyMICROCIRCULATION, Issue S1 2000RONALD J. KORTHUIS ABSTRACT Chronic venous insufficiency (CVI) is characterized by leukocyte adhesion and infiltration, venous hypertension and dilatation, and valvular dysfunction. The fact that activated white cells can direct a powerful cytotoxic arsenal at parenchymal cells following their extravasation into the tissues led to the original proposal that leukocytes may play a causative role in the pathogenesis of venous disease. A large body of subsequent work indicates that white blood cells are indeed activated in CVI. However, identification of the factors responsible for initiating leukosequestration and activation in such disorders and determination of whether these activated cells then contribute to the progression of venous disease have been hampered by the lack of appropriate animal models that accurately mimic the human condition. Tantalizing evidence suggesting that cyclical periods of ischemia and reperfusion (I/R) may occur in diseased regions of the skin is beginning to accumulate. As is the case with CVI, leukocyte infiltration is a prominent feature in I/R and activated neutrophils play a causative role in the reperfusion component of tissue injury via the targeted release of reactive oxygen metabolites and hydrolytic enzymes. In light of these considerations, many investigators have suggested that examining the mechanisms of I/R injury in skin and skeletal muscle, where ischemia is produced by arterial occlusion, may provide a relevant model for studying the pathogenesis of CVI. Others have suggested that venous occlusion may represent a more appropriate model, as this approach also produces the venous hypertension that is characteristic of the disease. The purpose of this review is to summarize the evidence pointing to the involvement of I/R and venous hypertension as causative factors in CVI-induced leukocyte recruitment. In addition, we will describe the evidence in favor of the view that white blood cells contribute to the pathogenesis of CVI. Finally, we will describe several different experimental models that have been used to examine the role of I/R-induced microvascular dysfunction as it may pertain to the development of CVI, together with a discussion of the relative advantages and limitations of the various models. [source] Effect of the two-wall-stitch mistake upon patency of rat femoral vein anastomosis: Preliminary observationsMICROSURGERY, Issue 4 2004Marco Pignatti M.D. Anastomotic patency is believed to be the most important factor in microvascular surgery. The two-wall stitch is a technical error commonly considered to cause thrombosis of the anastomosis, especially on the venous side. In order to demonstrate the real effect on vein patency of the two-wall stitch, the authors performed a standardized mistake after correct microanastomosis on the femoral vein of 15 rats, with one stitch passing through the whole thickness of the two walls of the vein. Traditional correct anastomoses on the contralateral side were used as controls. Patency was assessed at 5, 20, and 60 min and at 24 h by the milking test, and by direct section of the vessel at 24 h. The results showed no statistically significant difference between the two techniques. Histological examination confirmed the clinical judgment about the vessel's patency, and ultrastructural microscopy evidenced only mild signs of endothelial activation. In conclusion, this study indicates that the occasional two-wall stitch does not necessarily increase the risk of venous occlusion in anastomoses of the rat femoral vein. © 2004 Wiley-Liss, Inc. [source] Beneficial effect of hyperbaric oxygen on island flaps subjected to secondary venous ischemia,MICROSURGERY, Issue 2 2002Thomas J. Gampper M.D. The potential for hyperbaric oxygen therapy (HBO) to decrease the untoward effects of a secondary ischemic event was studied in the rat superficial epigastric flap model. The secondary venous ischemic flap was created by cross-clamping the vascular pedicles for 2 h. Twenty-four hours later, the flap was reelevated and the venous pedicle was occluded for 5 h. Thirty-two rats were divided into three groups. In experimental group 1, animals received HBO treatment immediately prior to the initial flap elevation and ischemia at 2 atmosphere pressures for 90 min. In experimental group 2, the rats underwent a similar course except for a second 90-min HBO course immediately prior to the secondary venous occlusion. The rats without HBO therapy were used as controls. The results showed that all control flaps were nonviable at 1 week by clinical inspection and fluorescein injection. Complete flap survival occurred in 20% of group 1 flaps and 30.8% of group 2 flaps. Partial flap survival occurred in the rest of the flaps in these two groups, with mean survival areas of 48% and 55%, respectively. In conclusion, HBO treatments significantly increase the survival of flaps subjected to a secondary ischemia, even if administered before the primary ischemia. Administering HBO prior to secondary venous ischemia was marginal, which may be due to the effect of O2 given by HBO not lasting longer than 5 h. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:49,52 2002 [source] Initial Experience of Pacing with a Lumenless Lead System in Patients with Congenital Heart DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2009SANTABHANU CHAKRABARTI M.D. Background: Long-term pacing is frequently necessary in patients with congenital heart disease (CHD). Preservation of ventricular function and avoidance of venous occlusion is important in these patients. Site-selective pacing with a smaller diameter lead is achievable with the model 3830 lead (SelectSecure®, Medtronic Inc., Minneapolis, MN, USA), which was specifically designed to target these complications. We describe our initial experience with the Model 3830 lead in patients with CHD. Methods: Retrospective analysis of all patients undergoing site-selective implantation of a Model 3830 lead(s) from two congenital heart centers (Bristol, UK, and Dublin, Ireland) from October 2004 until February 2008. Results: We implanted 139 SelectSecure® leads (atrial n = 70; ventricular n = 69) in 90 patients (57 male) with CHD. Median age at implantation: 13.4 years (1.1,59.2 years), median weight: 43 kg. Sixty-nine patients (76%) were children (<18 years). Indications for lead implantation included atrioventricular block (n = 55), sinus node disease (n = 18), implantable cardiac defibrillator (n = 12), antitachycardia pacing (n = 4), and cardiac resynchronization (n = 1). Twenty-two patients underwent pre-existing lead extraction during the same procedure. All the attempted procedures resulted in successful pacing. One patient had a significantly raised threshold at implantation. There was no procedural mortality. There were two procedural complications. Three patients required lead repositioning for increasing thresholds early postprocedure (<6 weeks). Four leads (2.9%) had displaced on median follow-up of 21.8 months (0.5,42 months). Conclusions: The Model 3830 lead is safe and effective in patients with CHD. This is a technically challenging patient group yet procedural complication and lead displacement rates are acceptable. [source] Transfemoral Snaring and Stabilization of Pacemaker and Defibrillator Leads to Maintain Vascular Access During Lead ExtractionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2009AVI FISCHER M.D. Background: Lead extraction is an effective method for removing pacemaker and defibrillator leads and to obtain venous access when central veins are occluded. Objective: We report a series of patients who required lead extraction and preservation of vascular access requiring a vascular snare introduced from the femoral vein to provide traction on the lead. This technique allowed advancement of the extraction sheath beyond the level of vascular occlusion, preserving vascular access in all patients. Methods: All patients had peripheral contrast venography performed immediately prior to the procedure to identify the site(s) of venous occlusion. An extraction sheath was employed and with direct manual traction, the lead tip pulled free from the myocardial surface prior to advancement of the sheath beyond the occlusion. A transfemoral snare was used to grasp the distal portion of the lead and traction was used to immobilize the lead. Results: In all patients, transfemoral snaring of the leads was necessary to allow safe advancement of a sheath to open the occluded venous system. There were no complications in any of the patients. Conclusion: Our series demonstrates the simple and safe technique of transfemoral lead snaring to assist lead extraction and maintain vascular access in the setting of venous occlusion, when the distal lead tip pulls free of the myocardium before an extraction sheath is passed beyond the point of venous obstruction. [source] Upgrading Patients with Chronic Defibrillator Leads to a Biventricular System and Reducing Patient Risk: Contralateral LV Lead PlacementPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2006DAVID J. FOX Increasing numbers of patients with indwelling single- or dual- chamber internal cardioverter defibrillators (ICDs) will require upgrading of an existing system to a biventricular ICD providing cardiac resynchronization with back-up defibrillation. Upgrading, usually by the addition of a new left ventricular (LV) lead, can be technically challenging with central venous occlusion or stenosis often being the main obstacle to a successful procedure. We report a new technique of implanting a LV lead from the contralateral side to the existing ICD system to minimize the peri- and postoperative risk to the patient. [source] Innovative Techniques for Placement of Implantable Cardioverter-Defibrillator Leads in Patients with Limited Venous Access to the HeartPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2006BRYAN C. CANNON Background: Because of venous occlusion, intracardiac shunting, previous surgery, or small size placement of implantable cardioverter-defibrillator (ICD) leads may not be possible using traditional methods. The purpose of this study was to evaluate and describe innovative methods of placing ICD leads. Methods: The records of all patients undergoing ICD implantation at our institution were reviewed to identify patients with nontraditional lead placement. Indications for ICD, method of lead and coil placement, defibrillation thresholds, complications, and follow-up results were reviewed retrospectively. Results: Eight patients (aged 11 months to 29 years) were identified. Six patients with limited venous access to the heart (four extracardiac Fontan, one bidirectional Glenn, one 8 kg 11-month-old) underwent surgical placement of an ICD coil directly into the pericardial sac. A second bipolar lead was placed on the ventricle for sensing and pacing. Two patients with difficult venous access had a standard transvenous ICD lead inserted directly into the right atrium (transatrial approach) and then positioned into the ventricle. All patients had a defibrillation threshold of <20 J, although one patient required placement of a second coil due to an elevated threshold. There have been no complications and two successful appropriate ICD discharges at follow-up (median 22 months, range 5,42 months). Conclusions: Many factors may prohibit transvenous ICD lead placement. Nontraditional surgical placement of subcutaneous ICD leads on the pericardium or the use of a transatrial approach can be effective techniques in these patients. These procedures can be performed at low risk to the patient with excellent defibrillation thresholds. [source] Venous Occlusion of the Access Vein in Patients Referred for Lead Extraction:PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2003Influence of Patient, Lead Characteristics The aim of this study was to determine the effect of patient and lead characteristics on occlusion of the access vein in pacemaker and ICD patients. Contrast venography of the access vein was obtained in 89 patients (17 patients with an ICD) scheduled for lead extraction. The indication for extraction was infection in 57 patients (systemic infection in 9) and lead malfunction in 32 patients. In 6 of the 89 patients, leads were introduced in both the right and left subpectoral area, resulting in a total of 95 venous entry sites. In 22 of these entry sites one lead was present, in 61 two leads, in 11 three, and in 1 four leads. The vessel patency was graded open or occluded. Occlusion of the subclavian vein occurred in four (13%) patients with lead malfunction versus 18 (32%) patients with infection (P = 0.07). In patients with systemic infection, 5 of 9 showed venous occlusion (P = 0.01 when compared to patients with malfunction, odds ratio 8.75, 95% confidence interval 1.21,64.11). Considered per entry site, the incidence of occlusion was 7 of 22 with one lead present, 17 of 61 with two leads, 0 of 11 with three leads, and 0 of 1 with four leads (P = 0.13). No patient had a superior vena caval occlusion. Patients with systemic infection have an increased risk of occlusion of the access vein. On the contrary, the study found no support for the concept that the risk of venous occlusion increases with a higher number of leads present. (PACE 2003; 26:1649,1652) [source] Evolution in the Assessment and Management of Trigeminal SchwannomaTHE LARYNGOSCOPE, Issue 2 2008Bharat Guthikonda MD Abstract Educational Objective: At the conclusion of this presentation, the participants should be able to understand the contemporary assessment and management algorithm used in the evaluation and care of patients with trigeminal schwannomas. Objectives: 1) Describe the contemporary neuroradiographic studies for the assessment of trigeminal schwannoma; 2) review the complex skull base osteology involved with these lesions; and 3) describe a contemporary management algorithm. Study Design: Retrospective review of 23 cases. Methods: Chart review. Results: From 1984 to 2006, of 23 patients with trigeminal schwannoma (10 males and 13 females, ages 14,77 years), 15 patients underwent combined transpetrosal extirpation, 5 patients underwent stereotactic radiation, and 3 were followed without intervention. Of the 15 who underwent surgery, total tumor removal was achieved in 9 patients. Cytoreductive surgery was performed in six patients; of these, four received postoperative radiation. One patient who underwent primary radiation therapy required subsequent surgery. There were no deaths in this series. Cranial neuropathies were present in 14 patients pretreatment and observed in 17 patients posttreatment. Major complications included meningitis (1), cerebrospinal fluid leakage (2), major venous occlusion (1), and temporal lobe infarction (1). Conclusions: Trigeminal schwannomas are uncommon lesions of the skull base that may occur in the middle fossa, posterior fossa, or both. Moreover, caudal extension results in their presentation in the infratemporal fossa. Contemporary diagnostic imaging, coupled with selective use of both surgery and radiation will limit mor-bidity and allow for the safe and prudent management of this uncommon lesion. [source] Pretreatment with ketorolac and venous occlusion to reduce pain on injection of propofolANAESTHESIA, Issue 3 2000D. N. Yull We performed a randomised, double-blind, prospective trial to discover whether intravenous ketorolac 10 mg made up to 2 ml with saline, with or without venous occlusion for 2 min, reduces the pain on injection of propofol. In 90 patients, pain scores were obtained during injection of propofol following pretreatment of the vein with saline, ketorolac or ketorolac with venous occlusion. Pain on injection of ketorolac was more common than with saline (p = 0.02). The incidence of severe pain following propofol was reduced by ketorolac with venous occlusion (p = 0.019) compared with saline or ketorolac without venous occlusion. There was no difference in venous sequelae at 7 days postoperatively between the groups. Our results suggest that pain on injection of propofol may be related to release of local kininogens and that nonsteroidal anti-inflammatory drugs may have a role in reducing that pain. [source] Repeatability of local forearm vasoconstriction to endothelin-1 measured by venous occlusion plethysmographyBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2002Fiona E. Strachan Aims ,We ,investigated ,the ,repeatability ,of ,the ,forearm ,blood ,flow ,response ,to intra-arterial infusion of endothelin-1 (ET-1), assessed by venous occlusion plethysmography. Methods In eight healthy men (aged 18,50 years), on four separate occasions, ET-1 (2.5 or 10 pmol min,1) was infused for 120 min via a 27 SWG cannula sited in the brachial artery of the nondominant arm. Each dose level was administered twice on consecutive visits. The dose order was randomized. Results are expressed as percentage change from baseline at 120 min (mean ± s.e. mean). Results ET-1 caused significant vasoconstriction (P < 0.0001 anova) at both doses (38 ± 3%, 2.5 pmol min,1 and 62 ± 3%, 10 pmol min,1; mean visit 1 and 2). There was no difference in the response to either dose on repeated challenge. Responses appeared to be less variable when expressed as percentage change in the ratio of blood flow (infused:noninfused) in both arms than as percentage change in blood flow in the infused arm alone, as indicated by repeatability coefficients (15% vs 21%, 2.5 pmol min,1 and 11% vs 13%, 10 pmol min,1; ratio vs infused arm alone). Conclusions We have shown dose-dependent vasoconstriction in the forearm vascular bed to intra-arterial infusion of ET-1 and that this response is less variable when expressed as percentage change in the ratio of forearm blood flow than percentage change in the infused arm. These data should also provide useful information to determine the power of early clinical pharmacology studies investigating the activity of endothelin receptor antagonists. [source] 4413: Analysis of gene expression in acute ischemic neuroretinas : a genome-wide screen discriminating occlusion (BRVO) versus laser effects in ratsACTA OPHTHALMOLOGICA, Issue 2010C OROPESA Purpose Identification of genes differentially regulated in rat neuroretinas submitted to an experimental acute branch retinal vein occlusion (BRVO), to a laser treatment, or to no treatment at all. Methods We have developed an in vivo experimental model of venous occlusion by photodynamic thrombosis in rat retinas. After anaesthesia, a sodium fluorescein solution was injected in rat tail 15 minutes before laser treatments. To induce ischemia in tested retina, venous sites adjacent to the optic nerve head were photocoagulated with an argon laser. In one group of tested animals, the retina was exposed to laser treatment at sites located between major vessels. As this treatment may have an effect upon choroidal blood flow, control eyes were not subjected to laser treatment. RNAs were isolated from the neuroretina 30 minutes post treatments, and processed for Affymetrix gene-chip analysis. Results Genome-wide screen enabled us to identify 308 and 348 genes which were up- or down-regulated, respectively, by BRVO and laser treatment only. When we compared the transcriptomes of retinas subjected to vessel occlusion or laser treatment to the control one, we found that the expression profiles of, respectively, 116 and 126 genes were specifically modified. The majority of the up- and down-regulated genes encode proteins involved in different aspects of early stress response, neuroprotection, inflammation and apoptosis. Conclusion Our microarray analysis revealed changes in gene expression bearing similarities to gene expression results from other ischemia models. Furthermore, it revealed that laser treatment may have an unreported impact on retina's metabolism. [source] Is there still a place for vitrectomy in the treatment of macular edema due to venous occlusion ?ACTA OPHTHALMOLOGICA, Issue 2009CJ POURNARAS Purpose Persistent macular edema (ME) is the main cause of poor visual outcome in either non-ischemic BRVO or CRVO. Among multiples treatment approaches, vitreoretinal surgery with the goal to achieve the recanalisation of the occluded vessels and/or the resolution of ME, were proposed. Methods Vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane,asociated to intravitreal (IVT) triamcinolone , neurotomy, sheathotomy, intravascular rtPA injection were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema and restore the normal foveal contour without significant change in best corrected visual acuity. In contrast, visual improvement occurs after vitrectomy for vitreous haemorrhage, epiretinal membrane formation and retinal detachment complicating BRVO. Evidence to date does not support any therapeutic benefit from radial optic neurotomy, optic nerve decompression, arteriovenous crossing sheathotomy or intravascular rtPA. Vitrectomy combined with IVT triamcinolone, induces a ME decrease rapidly and durably, without any improvement in visual acuity. Conclusion Vitrectomy with IVT triamcinolne seems to have a more durable effect than IVT triamcinolone alone.Vitrectomy, A-V sheathotomy combined with intravenous t-PA may offer benefits in BRVO. Despite uncertainty and open questions, surgical interventions are likely to be a therapeutic option for RVO in the future. Randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease. [source] Resolution of protein-losing enteropathy after radiofrequency perforation and subsequent stent implantation for relief of complete occlusion of a redirected left superior vena cavaCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2006Rainer Schaeffler MD Abstract The application of radiofrequency (RF) technologies in the treatment of congenital heart defects has provided a safe and effective alternative to conventional therapies in the restoration of vascular patency for a variety of arterial and venous occlusions. This report concerns an 8-year old girl that developed protein-losing enteropathy and elevated central venous pressure after occlusion of a surgically redirected anomalous draining left superior vena cava (SVC). Cardiac catheterization revealed complete obstruction of the anastomosis of the SVC into the coronary sinus. Transcatheter recanalization by RF perforation and subsequent stent implantation led to the restoration of upper venous blood flow and the resolution of her symptoms. © 2006 Wiley-Liss, Inc. [source] Prospective assessment of hemodialysis access patency after percutaneous intervention: Cox proportional hazards analysisCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2005John A. Bittl MD Abstract Vascular access failure is the greatest limitation of successful hemodialysis, but the factors associated with long-term patency have not been fully elucidated. Outcomes in a consecutive series of 294 thrombosed or failing accesses [128 fistulas (43.5%) and 166 grafts (56.5%) in 179 patients] were analyzed with life table and multivariable Cox proportional hazards analysis. Initial success was achieved in 275 of 294 accesses (95.6%). The median patency after intervention was 206 days (interquartile range, 79,457 days). Fistulas had longer median patency after intervention than grafts (286 vs. 170 days). Nonthrombosed accesses had longer median patency than thrombosed accesses (238 vs. 136 days), but thrombosed fistulas had similar median patency as thrombosed grafts (140 vs. 136 days). The selective use of stents as a bailout for failed balloon dilatation did not significantly reduce long-term patency (196 days for stented accesses vs. 210 days for unstented accesses). Long-term patency was inversely related to final access pressure, but access patency was not related to the presence of central venous occlusions, graft age, patient age, sex, or diabetes. Catheter-based intervention of thrombosed and failing dialysis accesses significantly prolongs patency and usefulness of dialysis accesses. The expanding use of fistulas, improved detection of early access failure, and selective use of bailout stents should enhance long-term access patency. © 2005 Wiley-Liss, Inc. [source] 3412: Anti-VEGF and corticosteroids therapy in macular edema secondary to venous occlusionsACTA OPHTHALMOLOGICA, Issue 2010JAC POURNARAS Purpose To assess the evidence on interventions to improve visual acuity (VA) and to treat macular edema (ME) secondary to central (CRVO) and branch retinal vein occlusion (BRVO) Methods Recent randomized studies have evaluated the safety and efficacy of corticosteroids (triamcinolone, dexamethasone) and anti-VEGF therapies (ranibizumab). Score study evaluates preservative-free intravitreal triamcinolone with standard care in BRVO and CRVO. In Geneva study, dexamethasone (DEX) intravitreal implant is compared with sham in BRVO and CRVO. BRAVO and Cruise studies evaluate intraocular injections of ranibizumab in patients with ME following BRVO and CRVO, respectively. Results In SCORE study, there was no difference identified in visual acuity at 12 months for the standard care group compared with the triamcinolone groups in BRVO patients. Intravitreal triamcinolone is superior to observation for treating vision loss associated with ME secondary to CRVO. Improvements in BCVA with DEX implant were seen in patients with BRVO and CRVO, although the patterns of response differed. Intraocular injections of 0.3 mg or 0.5 mg ranibizumab provided rapid, effective treatment for ME following BRVO and CRVO Conclusion Grid photocoagulation remains the standard care for patients with vision loss associated with ME secondary to BRVO. Intravitreal triamcinolone is superior to observation for treating vision loss associated with ME secondary to CRVO. Dexamethasone intravitreal implant can both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with ME secondary to BRVO or CRVO. Anti-VEGF therapies represent new therapeutical option in the treatment of ME secondary to BRVO and CRVO. Further randomized studies are needed [source] | |||||||||||||