cardiovascular-agents and Hematoma

To date, thoracic endovascular aortic repair (TEVAR) for type B aortic dissection is favorable, but TEVAR for type B intramural hematoma (IMH) remains uncertain. There are numerous clinical (e.g., refractory pain) and radiologic (e.g., IMH thickness) factors that are reported to be associated with IMH progression, challenging the treatment for high-risk type B IMH with high risk factors in clinical practice.. The objective of the study was to perform a systematic review of clinical studies to investigate outcomes of TEVAR + best medical treatment (BMT) and BMT in the treatment of high-risk type B IMH.. The online databases of PubMed, MEDLINE, EMBASE, CNKI, Google Scholar, and Cochrane as well as some journals majoring in endovascular surgery and interventional therapy were searched on September 1, 2017. Observational studies that reported the effect of TEVAR and BMT on type B IMH were included. Two independent reviewers performed methodological assessment and data extraction. Random and fixed effects models were used to calculate pooled effect size estimates. A sensitivity analysis was also carried out.. In all 6 included studies, the total number of patients with type B IMH was 237 and 123 patients received TEVAR + BMT. There was a significantly higher IMH regression rate among patients undergoing TEVAR + BMT compared with BMT (odds ratios [OR] 10.0, 95% confidence interval [CI] 3.43-29.4). There were a significantly lower IMH progress rate and aortic-related death rate among patients undergoing TEVAR + BMT compared with BMT (OR 0.239, 95% CI 0.075-0.758; OR 0.248, 95% CI 0.085-0.725). When the study of Ye K et al. was excluded, the results showed no statistically significant differences.. Combined data from the present study demonstrate that TEVAR + BMT results in significantly higher IMH regression rate, lower IMH progression, and lower aortic-related death rate compared with BMT in high-risk type B IMH patients.

Topics: Adult; Aged; Aorta, Thoracic; Aortic Diseases; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Clinical Trials as Topic; Combined Modality Therapy; Endovascular Procedures; Female; Hematoma; Humans; Male; Middle Aged; Risk Factors; Treatment Outcome

Topics: Aorta, Thoracic; Aortic Diseases; Cardiovascular Agents; Chest Pain; Computed Tomography Angiography; Conservative Treatment; Coronary Angiography; Diagnosis, Differential; Electrocardiography; Fibrin Fibrinogen Degradation Products; Hematoma; Humans; Male; Middle Aged; Nitroglycerin; Telmisartan; Treatment Outcome

Topics: Acute Disease; Age Factors; Aneurysm, False; Aorta, Abdominal; Aorta, Thoracic; Aortic Diseases; Aortic Dissection; Aortic Valve; Atherosclerosis; Bicuspid Aortic Valve Disease; Cardiovascular Agents; Clinical Laboratory Techniques; Diagnostic Imaging; Early Diagnosis; Endovascular Procedures; Female; Genetic Diseases, Inborn; Heart Defects, Congenital; Heart Valve Diseases; Hematoma; Humans; Long-Term Care; Male; Neoplasms, Vascular Tissue; Physical Examination; Risk Factors; Vascular Calcification; Vascular Stiffness; Vascular Surgical Procedures

Spontaneous coronary artery dissection (SCAD) is known to be a rare but fatal cause of acute coronary syndromes. It is more frequent in young women, particularly in the peripartum period. Intravascular ultrasound (IVUS) has an important role in the diagnosis and management of SCAD. Intramural hematoma that occurs between adventitial and media layer of the vessel wall may occlude the true lumen. IVUS can identify intimal tears, the extension of intramural hematoma and show the adequate compression of intramural hematoma after percutaneous coronary intervention. We present a case of intramural hematoma caused by SCAD in a young woman presenting with acute anterior myocardial infarction, and the role of IVUS in the diagnosis and management of SCAD.

Topics: Adrenergic beta-Antagonists; Adult; Anterior Wall Myocardial Infarction; Anticoagulants; Aortic Dissection; Cardiovascular Agents; Coronary Aneurysm; Coronary Angiography; Female; Hematoma; Humans; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Stents; Treatment Outcome; Ultrasonography, Interventional

Although recent studies suggest that medical treatment is appropriate for patients with aortic intramural hematoma (IMH), the outcomes of supportive medical treatment alone have not been satisfactory, and clear guidelines for medical treatment are not yet available. We assessed whether a management protocol of combined early aggressive medical treatment and selective prophylactic aortic stent-grafting would benefit patients with IMH.. Nineteen patients with IMH were prospectively studied; after initial clinical and radiological evaluation, 13 underwent early aggressive medical therapy (group 1), and 6 underwent early aggressive medical therapy and prophylactic endovascular stent-grafting (group 2).. In group 1, one patient with type A IMH died prior to surgical consultation because of cardiac tamponade; another patient with type A IMH underwent replacement of the ascending aorta at the 6-month follow-up. The condition of the other 11 patients stabilized during hospitalization and after discharge. The disease spontaneously regressed in 10 patients, and the intramural hematoma completely resolved in 5 patients. In group 2, follow-up imaging revealed complete coverage of the penetrating aortic ulcers and regression of the intramural hematoma; endovascular leaks have not yet occurred.. Our protocol may be used as an alternative approach for patients with IMH. After initial clinical and radiological evaluation, the condition of patients without complications can be stabilized with medical treatment; frequent follow-up imaging is required in such cases. Early aggressive medical treatment combined with prophylactic aortic stent-grafting is a safe and effective treatment modality for IMH patients with penetrating aortic ulcers in the descending aorta.

Topics: Aged; Aortic Diseases; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; China; Combined Modality Therapy; Drug Therapy, Combination; Endovascular Procedures; Female; Hematoma; Humans; Male; Middle Aged; Prospective Studies; Stents; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ulcer

Primary intracerebral haemorrhage (ICH) is associated with considerable morbidity and mortality. Local endothelin release following ICH may contribute to the pathophysiology of perilesional ischaemia. In diabetics, endothelin release can be enhanced by hyperglycaemia and cerebrovascular dilation may be inhibited by vascular endothelial dysfunction. To examine the effects of endothelin-mediated vasoconstriction after spontaneous ICH in the normal and diabetic brain, regional cerebral blood flow (rCBF) was examined in insulin dependent BB-rats and non-diabetic BB control rats. These experiments were performed 24 h following experimental ICH in both groups of animals that were either given the endothelin antagonist SB209670 or saline. Perilesional oligaemia was similar in control and SB209670 treated diabetic rats, but SB209670 reduced perilesional oligaemia in normal rats. In brain contralateral to the experimental ICH, rCBF was increased by SB209670 in diabetic rats, but not in non-diabetic rats. These studies show that there are differences in the cerebrovascular effects of endothelin in perilesional and contralateral brain in non-diabetic and diabetic rats following ICH.

Topics: Animals; Cardiovascular Agents; Cerebral Hemorrhage; Cerebrovascular Circulation; Diabetes Mellitus, Experimental; Diabetic Angiopathies; Endothelin A Receptor Antagonists; Endothelin B Receptor Antagonists; Hematoma; Indans; Rats; Rats, Inbred BB

Infrainguinal bypass (IB) surgery is an effective means of improving arterial circulation to the lower extremity for patients with critical limb ischemia (CLI). However, wound complications (WC) of the surgical incision following IB can impart significant morbidity.. A retrospective analysis of WC from the 1404 patients enrolled in a multicenter clinical trial of vein bypass grafting for CLI was performed. Univariate and multivariable regression models were used to determine WC predictors and associated outcomes, including graft patency, limb salvage, quality of life (QoL), resource utilization (RU), and mortality.. A total of 543 (39%) patients developed a reported WC within 30 days of surgery, with infections (284, 52%) and hematoma/hemorrhage (121, 22%) being the most common type. Postoperative anticoagulation (odds ratio [OR], 1.554; 95% confidence interval [CI] 1.202 to 2.009; P = .0008) and female gender (OR, 1.376; 95% CI, 1.076 to 1.757; P = .0108) were independent factors associated with WC. Primary, primary-assisted, and secondary graft patency rates were not influenced by the presence of WC; though, patients with WC were at increased risk for limb loss (hazard ratio [HR], 1.511; 95% CI 1.096 to 2.079; P = .0116) and higher mortality (HR, 1.449; 95% CI 1.098 to 1.912; P = .0089). WC was not significantly associated with lower QoL at 3 months (4.67 vs 4.79, P = .1947) and 12 months (5.02 vs 5.13, P = .2806). However, the subset of patients with serious WC (SWC) demonstrated significantly lower QoL at 3 months compared with patients without WC, (4.43 vs 4.79, respectively, P = .0166), though this difference was not seen at 12 months (4.94 vs 5.13, P = .2411). Patients with WC had higher RU than patients who did not have WC. Mean index length of hospital stay (LOS) was 2.3 days longer, mean cumulative 1-year LOS was 8.1 days longer, and mean number of hospitalizations was 0.5 occurrences greater for patients with WC compared with patients without WC (all P < .0001).. WC is a frequent complication of IB for CLI, associated with increased risk for major amputation, mortality, and greater RU. Further detailed investigation into the link between female gender and oral anticoagulation use with WC may help identify causes of WC and perhaps prevent or lessen their occurrence.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Cardiovascular Agents; Extremities; Female; Graft Occlusion, Vascular; Health Care Costs; Health Resources; Hematoma; Humans; Incidence; Ischemia; Limb Salvage; Male; Middle Aged; North America; Odds Ratio; Oligonucleotides; Postoperative Hemorrhage; Quality of Life; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Surgical Wound Infection; Transplantation, Autologous; Treatment Outcome; Vascular Patency; Vascular Surgical Procedures; Veins

The development of an autoantibody to human Factor VIII is rare and presents many problems for diagnosis and treatment. We have seen several cases at our institution recently with widely heterogenous clinical and laboratory presentations. A wide range of treatment modalities were used in these cases with no gold standard of treatment or widely accepted guidelines existing. This has prompted us to examine all cases of this condition presenting at Fremantle Hospital over the last decade. We describe four cases which demonstrate the heterogeneity of this condition and its treatment and review the recent literature on the subject.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Autoantibodies; Autoimmune Diseases; Azathioprine; Breast Neoplasms; Cardiovascular Agents; Cardiovascular Diseases; Chlorambucil; Cyclophosphamide; Factor VIII; Female; Hematoma; Hemophilia A; Humans; Immunoglobulin G; Immunosuppressive Agents; Infections; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Neoplasms, Multiple Primary; Partial Thromboplastin Time; Prednisolone; Retrospective Studies

Topics: Autonomic Nervous System; Autonomic Nervous System Diseases; Cardiovascular Agents; Cerebral Hemorrhage; Ergoloid Mesylates; Ergot Alkaloids; Hematoma; Hibernation; Hypothermia, Induced; Norepinephrine