Efficacy of Manual Hemostasis for Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal

Background. The prevalence of peripheral vascular disease has led to the re-emergence of percutaneous axillary vascular access as a suitable alternative access site to femoral artery. We sought to investigate the efficacy and safety of manual hemostasis in the axillary artery. Methods. Data were collected from a prospective internal registry of patients who had a Maquet® (Rastatt, Germany) Mega 50 cc intra-aortic balloon pumps (IABP) placed in the axillary artery position. They were anticoagulated with weight-based intravenous heparin to maintain an activated partial thromboplastin time (aPTT) of 50-80 seconds. Anticoagulation was discontinued 2 hours prior to the device explantation. Manual compression was used to achieve the hemostasis of the axillary artery. Vascular and bleeding complications attributable to manual hemostasis were classified based on the Valve Academic Research Consortium-2 (VARC-2) and Bleeding Academic Research Consortium-2 (BARC-2) classifications, respectively. Results. 29 of 46 patients (63%) achieved axillary artery homeostasis via manual compression. The median duration of IABP implantation was 12 days (range 1-54 days). Median compression time was 20 minutes (range 5-60 minutes). There were no major vascular or bleeding complications as defined by the VARC-2 and BARC-2 criteria, respectively. Conclusion. Manual compression of the axillary artery appears to be an effective and safe method for achieving hemostasis. Large prospective randomized control trials may be needed to corroborate these findings

Response to Rituximab in a Case of Lupus Associated Digital Ischemia

We report the case of a 38-year-old female patient with systemic lupus erythematosus (SLE) and Jaccoud arthritis (JA) that sequentially developed digital ischemic lesions of the hands. In spite of follow-up treatment with glucocorticoids, immunosuppressant, antiaggregant, and potent vasodilatator agents, a serious progression to digital gangrene over a one-month period was observed. Surprisingly, her nonhealing digital lesions improved after two cycles of rituximab (RTX) administration

Treatment Resistant Severe Digital Ischemia Associated with Antiphospholipid Syndrome in a Male Patient with Systemic Sclerosis

We report the case of a male patient with limited cutaneous systemic sclerosis (SSc) that was complicated with severe digital ischemia, resistant to medical treatment. Due to the lack of treatment response, further laboratory and imaging studies were conducted. Findings were compatible with antiphospholipid syndrome and oral warfarin was added to the treatment regimen. After successful anticoagulation no further recurrences of digital ischemia were seen. An underlying etiology in SSc patients with treatment resistant digital ischemic necrosis should be suspected for accompanying antiphospholipid syndrome (APS)

A New Technique of Radiofrequency-assisted Ultrasound-guided Needle-localized Laparoscopic Resection of Disappearing Colorectal Liver Metastases

The management of disappearing colorectal liver metastases in the postadjuvant chemotherapy setting is challenging. We describe a novel technique that facilitates laparoscopic resection of disappearing metastatic liver lesions with great precision. Details of this new technique are described in 2 patients with colorectal cancer synchronously metastatic to the liver. Both patients had small indistinct intraparenchymal liver lesions after adjuvant chemotherapy. A video displays the steps of the procedure. Both patients presented with colorectal cancer with synchronous liver metastasis. They received FOLFOX regimen after resection of their primary. They both responded to adjuvant chemotherapy. On repeat posttreatment imaging, the liver lesions became smaller and indistinct. With laparoscopic ultrasound, subtle parenchymal heterogeneities were identified. The lesions were initially ablated with a wide radiofrequency ablation zone. Then, without removing the needle, the prongs were deployed to the borders of the parenchymal heterogeneity. Using an ultrasonic vessel sealer, the lesions were resected. Final pathology identified 1 viable focus of cancer in each patient. Both patients were discharged home uneventfully on their second postoperative day. There were no complications. We have described a novel technique that could facilitate precise resection of intraparenchymal small indistinct or disappearing liver metastases of colorectal origin. This option should be kept within the armamentarium of the laparoscopic liver surgeon managing patients with malignant liver tumors

Impact of Atrial Fibrillation on Hospitalization Outcomes of Heart Failure in Patients ≥ 60 Years with Implantable Cardioverter Defibrillator

The impact of atrial fibrillation (AF) on the hospitalization outcomes in patients ≥ 60 years of age with implantable cardioverter defibrillators (ICD) is not well studied. We queried the National Inpatient Sample database for all patients aged ≥ 60 who had a history of ICD placement, and were admitted with a primary diagnosis of heart failure (HF) during the years 2016-2017. Patients were stratified into 2 groups based on their history of AF. The primary outcome of the study was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock, myocardial infarction (MI), ventricular fibrillation (VF), stroke and acute kidney injury (AKI). The association between different age strata and outcomes was investigated. The hospitalization outcomes were modeled using logistic regression. A total of 178,045 patients were included, of whom 56.2% had AF. AF correlated with increased mortality (A-OR 1.22 (95% CI: 1.06-1.4), p=0.005), cardiogenic shock (A-OR 1.21 (95%CI: 1.08-1.36), p 70 years. We conclude that AF is an independent predictor for increased all-cause in-hospital mortality and cardiogenic shock. Such risk is influenced by age

Sekonder peritonitte prokalsitonin, CRP ve tiroit hormonlarının prognostik değeri; ileriye yönelik çalışma

AMAÇ: Enfeksiyon ve sepsis, sekonder peritonitli hastalarda morbidite ve mortalitenin en önemli sebeplerinden biri olmaya devam etmektedir. Klinisyenler helen septik komplikasyonların erken ve güvenilir tanı yöntemini bulma konusunda çaba sarfetmektedir. Bu çalışmada sekonder peritonitin şiddetini belirlemede enflamatuvar markır olarak Prokalsitonin (PKT), C-reaktif protein (CRP) ve tiroit hormonlarının yerini değerlendirmeyi amaçladık. GEREÇ VE YÖNTEM: Ocak 2008-Ocak 2010 tarihleri arasında, sekonder peritonit nedeniyle ameliyat olan 84 ardışık hasta üzerinde ameliyat öncesi ve sonrası 1-3-5-7-14. günlerde PKT, CRP ve tiroit hormaon seviyeleri incelendi. Veriler Statistical Package for Social Sciences 15.0 (SPSS 15.0) programında analiz edildi. BULGULAR: Organ perforasyonu (peptik ülserperforasyonu, ince bağırsak ve kolon perforasyonu) olan olgular değerlendirildiğinde, PKT anlamlı olarak düşük seyretti. Ameliyat sonrası komplikasyonu olan veya ölen hastalara göre ameliyat sonrası dönemi sorunsuz olan veya taburcu olan hastalarada yüksek tiroit hormon düzeyler gözlendi. PKT düzeyleri ise CRP düzeylerleri ve beyaz küre sayısıyla anlamalı olarak ilişkili bulundu. TARTIŞMA: Ameliyat sonrası komplikasyonların yokluğunda PKT, sekonder peritonit tanısında CRP'den daha iyi bir belirliyicidir. Çalışmamız sekonder peritonitin şiddetini belirlemede düşük tiroit hormon düzeylerinin önemli bir prognostik faktör olduğunu ortaya koymuştur.AMAÇ: Enfeksiyon ve sepsis, sekonder peritonitli hastalarda morbidite ve mortalitenin en önemli sebeplerinden biri olmaya devam etmektedir. Klinisyenler helen septik komplikasyonların erken ve güvenilir tanı yöntemini bulma konusunda çaba sarfetmektedir. Bu çalışmada sekonder peritonitin şiddetini belirlemede enflamatuvar markır olarak Prokalsitonin (PKT), C-reaktif protein (CRP) ve tiroit hormonlarının yerini değerlendirmeyi amaçladık. GEREÇ VE YÖNTEM: Ocak 2008-Ocak 2010 tarihleri arasında, sekonder peritonit nedeniyle ameliyat olan 84 ardışık hasta üzerinde ameliyat öncesi ve sonrası 1-3-5-7-14. günlerde PKT, CRP ve tiroit hormaon seviyeleri incelendi. Veriler Statistical Package for Social Sciences 15.0 (SPSS 15.0) programında analiz edildi. BULGULAR: Organ perforasyonu (peptik ülserperforasyonu, ince bağırsak ve kolon perforasyonu) olan olgular değerlendirildiğinde, PKT anlamlı olarak düşük seyretti. Ameliyat sonrası komplikasyonu olan veya ölen hastalara göre ameliyat sonrası dönemi sorunsuz olan veya taburcu olan hastalarada yüksek tiroit hormon düzeyler gözlendi. PKT düzeyleri ise CRP düzeylerleri ve beyaz küre sayısıyla anlamalı olarak ilişkili bulundu. TARTIŞMA: Ameliyat sonrası komplikasyonların yokluğunda PKT, sekonder peritonit tanısında CRP’den daha iyi bir belirliyicidir. Çalışmamız sekonder peritonitin şiddetini belirlemede düşük tiroit hormon düzeylerinin önemli bir prognostik faktör olduğunu ortaya koymuştur

Periprocedural Complications After Transcatheter Aortic Valve Replacement and Their Impact on Resource Utilization

To examine the incidence and trends of peri-procedural complications after TAVR and their impact on resource utilization. The incidence of complications by type [acute kidney injury (AKI), permanent pacemaker (PPM), vascular, paravalvular leak, in-hospital mortality, others] was calculated for TAVR patients at a high-volume center between 2012 and 2018. Clinical data were matched with hospital-billing data of patients. Trends in high resource utilization (discharge to a rehabilitation facility or PLOS >7 days) (HRU) and complication rates were assessed. Multivariable logistic regression models were used to determine predictors of HRU. Out of 1163 patients, 966 (83%) had no complications, others in 95 (8%), PPM in 56 (5%), AKI alone in 32 (3%), vascular in 31 (3%), in-hospital mortality in 28 (2%) and PVL in 10 (1%). A significant decreasing trend in the incidence of complications (29% vs 10%; p trend <0.001) and HRU (75% vs 12%; p trend <0.001) was observed between 2012 and 2018 respectively. Mean ± SD direct procedure cost of having a complication was $58,234 ±$24,568, was associated with an incremental cost of $10, 649 and a prolonged stay of 3-days. On multivariable logistic regression analysis, PPM, vascular complications, high STS risk score, NYHA class III/IV, frailty and ≥ moderate tricuspid regurgitation were significantly associated with HRU. TAVR year was protective against HRU. We established that, post-TAVR resource utilization and morbidity is high among frail and patients with higher STS risk scores. However, these rates decrease over time with experience

Effect of Transcatheter Aortic Valve Implantation on Renal Function in Patients With Previous Renal Dysfunction

The study aims to investigate the incidence of immediate renal function improvement in renal dysfunction patients who had transcatheter aortic valve implantation (TAVI). TAVI patients with >= moderate reduced renal function [estimated GFR = 10%, no change, Decline >= 10 %. Multivariable logistic regression was performed to identify factors that predicted improvement/decline in GFR postprocedure. Out of 677 patients, 359 (53%) had eGFR = 10%, 125 (34%) had no change and 48 (14 %) observed decline >= 10%. All groups had similar proportions of females and age was comparable in patient groups. Patients in whom a decline in eGFR was observed had significantly higher Society of thoracic Surgeons scores (10.7 vs 8.2 vs 8.2; p = 0.007) and incidence of liver disease (6% vs, 0% vs 2%; p = 0.014) than the no-change or improved groups respectively. On multivariable analysis, independent predictors of decline/improvement in eGFR were being female, low left ventricular ejection fraction and baseline liver dysfunction. In conclusion, over half of patients with compromised renal function who underwent TAVI experience an immediate improvement in kidney function post-TAVI. Being female, baseline liver dysfunction and a low left ventricular ejection fraction is associated with an immediate decline in eGFR. Published by Elsevier Inc