Clinical Characteristics of Patients with Isolated Calf Vein Thrombosis in a Large Teaching Hospital

Objective. To identify the clinical characteristics of a patient population newly diagnosed with acute isolated calf deep venous thrombosis (ICDVT) by duplex ultrasound scan (DUS). Methods. A retrospective review of the records of 100 consecutive patients diagnosed with ICDVT by DUS was conducted. Results. Patients (59% male) were predominantly Caucasian (86%) and inpatients (69%) with an average age of 53 years. The most frequent risk factors were malignancy (22%), immobility (18%), and previous DVT (13%). Thrombus was present in named tibial veins in 58% and muscular branches in 42%. The peroneal vein was most frequently involved (39/117, 33%) followed by the gastrocnemius veins (29/117, 22%) and muscular calf tributaries (14%). Conclusions. Our patient population with ICDVT was predominantly symptomatic, in-patient cohort with a high incidence of risk factors such as malignancy, immobility, previous DVT, trauma, and postoperative status. Partial or complete resolution was documented by DUS in 53%

Abstract P243: Potential Cost Savings With CMR-Guided Selective Invasive Strategy in Non-ST Elevation Acute Coronary Syndrome

Background We have previously shown that rapid cardiac magnetic resonance imaging (CMR) to identify myocardium at risk predicts the need for subsequent coronary revascularization in low and moderate risk patients with NSTE-ACS. The current standard diagnostic approach routinely employs invasive coronary angiography with attendant costs and risks, even though large randomized trial suggest that 50% may not have coronary stenoses requiring revascularization. We describe the potential cost savings associated with a CMR-guided strategy that reserves invasive angiography for patients with myocardium at risk in NSTE-ACS. Methods Revascularization outcome was recorded in 712 patients admitted with NSTE-ACS referred for coronary angiography identified as part of an IRB-approved protocol. The study population included those who had a catheterization with no subsequent revascularization procedure, and those who had a catheterization with subsequent percutaneous or surgical coronary revascularization. Standard costs of $2,000 for CMR and$15,000 for coronary angiography were applied to both groups to project the cost savings of using CMR as the initial diagnostic modality. If no revascularization was required, a cost savings equal to the difference between the cost of CMR and angiography was computed. If revascularization was performed, a cost increase by adding CMR to the angiography cost was computed. Results 49.6% of study patients did not undergo revascularization after invasive angiography. Assuming that only patients with CMR-identified myocardium at risk would undergo angiography, the net cost reduction equated to a $3.9MM (36.2%) in this cohort. Initial analysis suggests similar rates of catheterization-related complications in both groups. Conclusion Using CMR to identify myocardium at risk in low-to-moderate risk NSTE-ACS patients may realize significant cost savings while insuring appropriate invasive care for patients most likely to benefit. A prospective, randomized study is warranted to better quantify the impact of a CMR-guided strategy on outcomes and cost in NSTE-ACS. </jats:p

Pelvic necrosis: a complication of infected aortic graft excision.

Infection is a devastating complication of synthetic aortic graft surgery. Patients with significant occlusive atherosclerosis of the internal iliac arteries undergoing aortic graft removal for graft infection may be at risk of pelvic and midbody necrosis. An unusual and fatal complication of this nature associated with the management of synthetic aortic graft infection has been encountered in two patients treated by extra-anatomic revascularization and staged removal of the infected aortic prosthesis. The hallmark of their presentation was pelvic and midbody necrosis in the presence of excellent distal perfusion with palpable pulses. Marginal pelvic circulation was therefore compromised further by graft removal and absence of retrograde pelvic perfusion. The finding of focal ischemic changes in the pelvic area of a patient with increasing serum creatinine phosphokinase activity, leukocytosis, myoglobinuria and paraplegia following infected aortic graft removal signals a grave and fatal prognosis