Emergency embolization

Table 4.1. Basic data that should be recorded before emergent embolization...

Finally, emergent embolization of PAVMs in patients with life-threatening complication such as pulmonary hemorrhage, hemothorax or hemoptysis can be discussed [1,13,18]. 

Hashimoto S, Hiramatsu K, Ido K et al. (1990) Expanding role of emergency embolization in the management of severe blunt hepatic trauma. Cardiovasc Intervent Radiol 13 193-199... 

Meyer FB, Piepgras DG, Sundt TM, Yanagihara T. Emergency embolectomy for acute embolic occlusion of the middle cerebral artery. Clin Neurosurg 1985 32 155-173. 

Neumar RW (2000) Molecular mechanisms of ischemic neuronal injury. Ann Emerg Med 36 483-506 Niessen F, Hilger T, Hoehn M, Hossmann KA (2002) Thrombolytic treatment of clot embolism in rat comparison of intra-arterial and intravenous application of recombinant tissue plasminogen activator. Stroke 33 2999-3005 Nordborg C, Sokrab TE, Johansson BB (1994) Oedema-related tissue damage after temporary and permanent occlusion of the middle cerebral artery. Neuropathol Appl Neurobiol 20 56-65... 

Thrombosis (blood clot) - may occur up to six weeks after surgery. Rarely, a blood clot can pass to the lungs causing a pulmonary embolism and a medical emergency. Treatment may necessitate anticoagulants. 

Aberrant thrombus formation and deposition on blood vessel walls imderlies the pathogenesis of acute cardiovascular disease states which remain the principal cause of morbidity and mortality in the industrialized world [1,2,3]. Plasma proteins, proteases and specific cellular receptors that participate in hemostasis have emerged as important risk considerations in thrombosis and thromboembolic disorders. The clinical manifestations of the above disease states include acute coronary artery and cerebrovascular syndromes, peripheral arterial occlusion, deep vein thrombosis and pulmonary/renal embolism [3]. The most dilabilitating acute events precipitated by these disorders are myocardial infarction and stroke. In addition, the interplay between hemostatic factors and hypertension (4) or atherosclerosis (5) dramatically enhances the manifestation of these pathologic states. 

Indude tissue plasminogen activator (tPA, recombinant) and streptokinase (bacterial). Used IV for short-term emergency management of coronary thromboses in MI, deep venous thromboses, pulmonary embolism, and ischemic stroke (tPA). 

Clinical diagnostic use of cTn has been extended to other cardiac diseases (Gupta and de Lemos 2007), and applications include monitoring acute injury from exacerbation of congestive heart failure, pulmonary embolism, sepsis, hypertensive emergency, cardiac trauma, myocarditis, and pericarditis. Also included are chronic conditions with ongoing injury such as congestive heart failure or left ventricular... 

Interest in thrombolytic therapy for acute ischemic stroke re-emerged with reports of successful thrombolysis for arterial thrombosis in the peripheral vascular system. Local lA infusion was found to have higher rates of recanalization compared with systemic IV delivery of thrombolytics without increased levels of hemorrhagic complications IV use of UK and SK was found to provide clinical benefit in patients with pulmonary embolism [5, 6]. In the early 1980s, lA infusion of UK or SK for acute MI was shown to be highly effective [5, 6]. At the same time, technical advances in endovascnlar microcatheter and microguidewire design made access to the intracranial vessels safer... 

A 39-year-old woman with familial type 1 antithrombin deficiency and a history of extensive deep vein thrombosis and pulmonary embolism, taking warfarin, was given levonorgestrel for emergency contraception. 

Lanzino, G., Kanaan, Y., Perrini, P., Dayoub, H. Fraser, K. (2005) Emerging concepts in the treatment of intracranial aneurysms stents, coated coils, and liquid embolic agents. Neurosurgery, 57, 449-459. 

Linfante, I. Wakhloo, A. K. (2007) Brain aneurysms and arteriovenous malformations advancements and emerging treatments in endovascular embolization. Stroke, 38,... 

TLE without reimplantation Temporary PM, vacuum drainage, and arterial line (if still present) are removed the day after the procedure and the patient is completely mobilized. Chest X-ray is planned to confirm radiological success of the procedure and identify possible occult complications (i.e., pleural effusion, pulmonary embolism, mild pneumothorax). Discharge is feasible after 48 h if infective problems or other complications do not emerge. Sometimes, it is necessary to remove a PM from one side while another pacing system is present contralaterally. In such cases, the temporary PM is usually removed at the end of the procedure and the maintained system is checked before discharge, especially in case of complex procedures, in order to exclude a post extraction malfunction. 

Choice of embolic material/method is paramount and must be based on the target vascular territory and the desired effect. Ability to reach distal vascular beds. For example, emergent non-selective embolization of a large vascular territory is best accomplished with a potentially temporary occlusive agent such as Gelfoam. 

Before starting any elective embolization it is important to talk to the patient and obtain informed consent. In talking to the patient, emphasis should not only be on the advantages but also on the risks and complications of embolization therapy. Alternative therapeutic options should be discussed. In both emergency and elective embolization there is no scientific proof that antibiotics should be given prior to embolization. Always work as a team with the referring physician, to have a back-up plan for possible procedure failure or complications. 

The major aims of interventional procedures for portal hypertension are prophylactic and emergent treatment of variceal bleeding, control of hepatic encephalopathy, and treatment of refractory ascites. Hypersplenism associated with hematological disorder is an additional clinical problem in patients with portal hypertension. At present, the main primary embolotherapies available for portal hypertension are balloon-occluded retrograde transvenous obliteration (BRTO) and partial splenic embolization (PSE). In Japan, BRTO has recently been applied for gastric varices instead of either endoscopic treatment or transhepatic intrahepatic portosystemic shunt (TIPS) procedure, and numerous studies have reported that this method has an excellent success rate. Its efficacy for control of hepatic encephalopathy has also been demonstrated. 

Our unpublished data in a retrospective study showed that embolization following PPH might prevent blood transfusion when close medical management and rapid evaluation of the emergency status is performed. These findings probably highlighted an additional advantage of embolization procedures after delivery. 

Pelage JP, Le Dref O, Mateo J et al. (1998) Life-threatening primary postpartum hemorrhage treatment with emergency selective arterial embolization. Radiology 208 359-362... 

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