The Journal of invasive cardiology
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Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality in trauma patients. Anticoagulation therapy is often contraindicated in these patient populations. ⋯ Bedside IVC filter placement by guidance of intravascular ultrasound eliminates the risk of transportation; it is safe, efficient, and cost effective. We hereby present a case of bedside IVC filter placement in a morbidly obese patient with modified intravascular ultrasound approach.
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Case Reports
Massive pulmonary embolism with shock: role of thrombolysis using central venous access.
Massive pulmonary embolism (PE) complicated with shock has an extremely high mortality rate with medical treatment. Since access to emergency vascular surgery or endovascular specialists is not readily available in most centers, patients are frequently treated with thrombolytic agents delivered via a peripheral venous access. Patients with shock, however, have poor peripheral perfusion, and peripheral administration of thrombolytic agents may thus not reliably deliver the agent to the embolus, reducing treatment efficacy. ⋯ This report describes the case of a 46-year-old man presenting with new-onset atrial fibrillation, right bundle branch block, and shock from a massive PE. In view of shock, thrombolytics were given via a subclavian central venous catheter. He improved dramatically within 1 hour, with prompt resolution of the shock and the dysrhythmia.
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Case Reports
Transfemoral aortic valve implantation in a renal transplant patient with a Dacron aorto-bi-iliac bypass.
Transcatheter aortic valve implantation (TAVI) is becoming the standard of care for inoperable patients with symptomatic severe aortic stenosis and the transfemoral approach is generally the first option chosen. However, transfemoral aortic valve replacement is contraindicated in patients with a Dacron aorto-bi-iliac bypass. To the best of our knowledge, we present the first case report of transfemoral aortic valve implantation in a kidney transplant patient with a history of aorto-bi-iliac bypass. ⋯ This case highlights the importance of a detailed anatomic vascular assessment combined with a multidisciplinary evaluation of the access site in patients evaluated for TAVI. We used multi-slice computed tomography scans of the iliofemoral arteries, the aorto-bi-iliac bypass and the thoraco-abdominal aorta to predict the potential pitfalls of a fully percutaneous transfemoral aortic valve implantation. The transfemoral approach was finally chosen in this case after considering the patient's suitable aorto-iliofemoral vasculature, his patent coronary artery bypass grafts and his predisposition for severe acute kidney injury.