warfarin and Aneurysm

Popliteal venous aneurysms are rare and are most often found in patients with pulmonary embolism suggesting that such aneurysms are thrombogenic. Only 16 cases have been found in the past and only a few of these patients were without thrombus or pulmonary embolism. In this paper three patients are presented of whom two showed signs of thrombus. Surgical resection was performed to prevent thrombosis with a successful result. The literature is reviewed and according to this and our own experience surgical resection under cover of anti-coagulation is recommended. Our surgical technique is presented.

Topics: Aged; Aneurysm; Female; Humans; Leg; Male; Middle Aged; Popliteal Vein; Postoperative Care; Pulmonary Embolism; Radiography; Thrombosis; Ultrasonography; Warfarin

No recommendation exists on the optimal antithrombotic therapy after left ventricular thrombus (LVT) resection in the current guidelines. The study aimed to investigate the role of prophylactic anticoagulation with warfarin for 3-6 months in LVT recurrence and other clinical outcomes after LVT resection and left ventricular aneurysm (LVA) surgery.. All consecutive patients undergoing LVT resection together with LVA surgery in our institution between 2010.1.1 and 2021.4.1 were included in the study. Individuals included were divided into two groups based on whether warfarin was administered at discharge. Patients with warfarin were matched to their counterparts without warfarin based on the baseline characteristics via propensity score matching (PSM) at the ratio of 1:1. The primary outcome was LVT recurrence. The secondary outcomes were major adverse cardiac and cerebrovascular events (MACCEs) and the composite endpoint of LVT recurrence and MACCEs.. After PSM, a total of 118 patients were included in the study, among whom 59 received warfarin therapy at discharge and 59 didn't. During the median follow-up of 56.5 months, 21 out of 118 patients had LVT recurrence and the recurrence rate was 17.8% There was no systemic embolism resulting from the recurrent LVT. Kaplan-Meir analysis showed no significant difference in LVT recurrence (p = .86), MACCEs (p = .48) and the composite endpoint of LVT recurrence, and MACCEs (p = .89). Cox proportional hazards regression model showed that history of PCI (hazard ratio [HR] 2.778, 95% confidence interval [CI] 1.087-7.100, p = .033) and LVA surgical strategy of linear suture (HR 8.768, 95% CI 1.139-67.517, p = .037) were independent risk factors of LVT recurrence.. Prophylactic anticoagulation with warfarin for 3-6 months may be unnecessary with no benefit in terms of LVT recurrence and other clinical outcomes.

Topics: Aneurysm; Anticoagulants; Cardiac Surgical Procedures; Humans; Percutaneous Coronary Intervention; Thrombectomy; Thrombosis; Warfarin

Extracranial carotid artery aneurysms (ECAA) are extremely rare, accounting for less than 1% of all peripheral artery aneurysms. The most common presentation is central neurologic dysfunction, typically due to embolization of thrombus from the aneurysm. Historically open surgical intervention is the treatment of choice for symptomatic ECAA. Recent data suggest that endovascular repair is a valuable alternative, with a high procedural success rate and relatively low complication rate. We present a case of an ECAA with symptoms of vision loss, successfully treated by endovascular covered stenting but complicated by late in stent thrombosis and cerebral infarction. The patient was subsequently treated with IV thrombolysis and life-long warfarin. The patient had discrete residual symptoms at follow-up 3 months later.

Topics: Aneurysm; Anticoagulants; Carotid Artery Diseases; Endovascular Procedures; Female; Graft Occlusion, Vascular; Humans; Middle Aged; Stents; Thrombolytic Therapy; Thrombosis; Warfarin

Due to the rarity of this condition, clinical treatment and outcomes in isolated superior mesenteric artery dissection (ISMAD) patients remain unknown. The primary aim of this retrospective multicenter study was to elucidate the treatment strategies and in-hospital outcomes for ISMAD patients by using administrative data.. We retrospectively analyzed patients that were primarily diagnosed with ISMAD using the Diagnosis Procedure Combination data collected at 141 hospitals in Japan in 2015. Patients with comorbidities that included "aneurysm" were excluded.. A total of 221 ISMAD without aneurysm patients (male: 90.5%; mean age: 52.5±10.1 years) were enrolled, and 95 (67.4%) of these encountered just one ISMAD case per year. We found only one (0.5%) in-hospital death and length of stay for ISMAD patients was 13.2±9.1 days. One-third of patients received antiplatelet therapy (32.1%) and anticoagulation therapies, such as heparin (38.9%) and warfarin (10.0%). A total of 146 (66.1%) patients received antihypertensive treatment (either orally or via an intravenous route) during hospitalization. Twelve (5.4%) patients underwent surgical procedures during hospitalization as follows: 4 (33.3%) patients underwent bypass surgery, 3 (25.0%) patients underwent exploratory laparotomies, 2 (16.7%) patients underwent bowel resection, 1 (8.3%) patient underwent a thrombectomy, and 2 (16.7%) patients underwent surgical angioplasties.. We found that conservative therapy for ISMAD patients without aneurysm is safe and is also associated with a low rate of surgical intervention in clinical practice.

Topics: Adult; Aneurysm; Anticoagulants; Antihypertensive Agents; Aortic Dissection; Comorbidity; Female; Heparin; Humans; Japan; Male; Mesenteric Artery, Superior; Middle Aged; Platelet Aggregation Inhibitors; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Behçet's disease is an inflammatory systemic disorder, characterized by a relapsing and remitting course, it manifests with oral and genital ulcerations, skin lesions, uveitis, vasculitis, central nervous system and gastrointestinal involvement. The main histopathological finding is widespread vasculitis of the arteries and veins. Therapy is variable and depends largely on the severity of the disease and organ involvement. There is common practice to treat with anticoagulation in patients suffering from vessel thrombosis, but there are no control trials to support this tendency. Anticoagulation treatment can cause major bleeding events in patients suffering from aneurysms. In this case report we describe a treatment dilemma in a patient suffering from deep vein thrombosis and pulmonary aneurysms.

Topics: Adolescent; Aneurysm; Anticoagulants; Behcet Syndrome; Biological Therapy; Cyclophosphamide; Fibrinolytic Agents; Glucocorticoids; Hemorrhage; Humans; Immunosuppressive Agents; Male; Medication Therapy Management; Pulmonary Artery; Radiography; Secondary Prevention; Severity of Illness Index; Treatment Outcome; Ultrasonography; Urokinase-Type Plasminogen Activator; Venous Thrombosis; Warfarin

Although the pulmonary position has been preferred for the placement of homografts or bioprosthetic valves, the limited longevity of these implants makes reoperation almost unavoidable. Good durability of mechanical valves in the pulmonary position has been reported. The mid-term outcomes were analyzed of patients who received an On-X mechanical heart valve for pulmonary valve replacement (PVR) with a relatively low International Normalized Ratio (INR).. Between February 2008 and February 2011, mechanical On-X valves (size range: 19 to 25 mm) were implanted for PVR in six patients. Tetralogy of Fallot (ToF) was the most common diagnosis (n = 6). Postoperatively, warfarin was used to maintain the INR at 1.5-2.0. The surgical results and follow up were reviewed retrospectively, with valve failure, thrombosis, embolism, bleeding, reoperation and death being defined as end-points.. There was no intraoperative or in-hospital mortality. The mean age of patients at the time of PVR was 31 +/- 19.7 years (range: 16-61 years). In patients who underwent repair of ToF (n = 4) the average duration between PVR and previous right ventricular outflow tract (RVOT) reconstruction was 8.75 +/- 3.3 years (range: 5-12 years). The mean follow up period was 3.13 +/- 1.31 years (range: 2-5 years). There was no 30-day mortality, late death, thromboembolism, major bleeding event or valve dysfunction, and no patient needed reoperation. All survivors were categorized as NYHA class I or II.. A three-year experience with the On-X bileaflet mechanical valve in the pulmonary position demonstrated excellent mid-term durability, with no thromboembolisms or bleeding events when the INR was maintained at 1.5-2.0. For patients who require PVR, either as primary procedure or reoperation, the On-X mechanical heart valve might represent an appropriate option.

Topics: Adolescent; Adult; Aneurysm; Anticoagulants; Aortic Valve; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; International Normalized Ratio; Male; Middle Aged; Postoperative Care; Prosthesis Design; Pulmonary Artery; Pulmonary Valve; Pulmonary Valve Insufficiency; Pulmonary Valve Stenosis; Tetralogy of Fallot; Treatment Outcome; Warfarin

A 46-year-old female was found to have a saccular superior mesenteric vein (SMV) aneurysm on computed tomography (CT) scan during workup for abdominal pain. It measured 3.5 cm in diameter. The SMV aneurysm was successfully resected, and the SMV was repaired with femoral vein patch angioplasty. She was placed on coumadin for 3 months. At follow-up, the vein patch repair was patent and the patient was doing well with complete resolution of her abdominal pain.

Topics: Abdominal Pain; Aneurysm; Angioplasty; Anticoagulants; Drug Administration Schedule; Female; Femoral Vein; Humans; Mesenteric Veins; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Surgical Procedures; Warfarin

An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries. The clinical symptoms associated with APFs may include abdominal pain, gastrointestinal bleeding, ascites, nausea, vomiting, diarrhea, or even congestive heart failure. We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis. The endovascular embolization of APF was accomplished successfully, and symptoms of portal hypertension resolved immediately after intervention. Unfortunately, the patient did not respond well to anticoagulation therapy with warfarin. Therefore, the patient underwent implantation of a transjugular intrahepatic portosystemic shunt, and the complications of portal hypertension resolved. In conclusion, the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.

Topics: Abdominal Pain; Aged; Aneurysm; Anticoagulants; Arteriovenous Fistula; Duodenum; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Mesenteric Veins; Phlebography; Portal Vein; Portasystemic Shunt, Surgical; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Abdominal Pain; Aneurysm; Anticoagulants; Female; Humans; Middle Aged; Portal Vein; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Warfarin

Iliac vein aneurysm is a rare vascular abnormality. It has been reported as a primary aneurysm of unknown cause, or, when a cause could be identified, as a secondary iliac vein aneurysm. Occasionally, iliac vein aneurysm develops in association with distal arteriovenous fistula. Although venous aneurysms occur most commonly in the neck and central thoracic veins, they also have been reported in the visceral veins and the extremities.Herein, we present the case of a 34-year-old man in whom a giant external-iliac-vein aneurysm was incidentally found during the investigation of a post-traumatic femoral arteriovenous fistula. The aneurysm was surgically resected, the iliac vein was reconstructed by means of lateral venorrhaphy, and the patient had an uneventful, complete recovery. We discuss the origin of the aneurysm and our choice of surgical techniques.

Topics: Adult; Aneurysm; Anticoagulants; Arteriovenous Fistula; Femoral Artery; Femoral Vein; Humans; Iliac Vein; Incidental Findings; Male; Stockings, Compression; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler; Vascular Surgical Procedures; Vascular System Injuries; Warfarin; Wounds, Gunshot

A 28-year-old female presented with a soft mass in the left popliteal fossa. She had a popliteal vein aneurysm repair 4 years ago. Magnetic resonance venography and ultrasound revealed a recurrent saccular aneurysm on the site of the repair. It measured 3 x 4 cm and had no thrombus. The aneurysm was resected, and as the vein had adequate length, it was primarily repaired with an end-to-end anastomosis. She was placed on coumadin for 3 months. At follow-up, the vein was competent and free of thrombosis.

Topics: Adult; Anastomosis, Surgical; Aneurysm; Anticoagulants; Female; Humans; Magnetic Resonance Angiography; Phlebography; Popliteal Vein; Recurrence; Reoperation; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Surgical Procedures; Warfarin

Portal venous aneurysms are rare and are usually discovered as incidental findings on abdominal imaging studies. Although most are asymptomatic, they may occasionally cause symptoms of compression of an adjacent structure, thrombosis, or bleeding. Treatment is usually not necessary and conservative follow-up is suggested. We present four patients with portal system aneurysms. One patient had a 10.5 cm thrombosed aneurysm, one had a right 3.5 cm intrahepatic portal aneurysm, one patient had a symptomatic 4 cm splenic artery aneurysm, which was repaired, and one patient had a 4 cm aneurysm at the confluence of the splenic and portal veins.

Topics: Adult; Aged; Aneurysm; Anticoagulants; Female; Hepatic Veins; Humans; Incidental Findings; Middle Aged; Phlebography; Portal Vein; Splenic Vein; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Warfarin

Selective right pulmonary arteriography and 3-dimensional computed tomography revealed multiple severe stenoses of the peripheral pulmonary artery associated with poststenotic aneurysms in a 65-year-old woman. She was referred to the hospital for evaluation of dry cough, gradually increasing dyspnea and multiple nodular shadows on a chest radiograph. Echocardiography and cardiac catheterization showed severe pulmonary hypertension, though other structural heart diseases or well-characterized congenital syndromes were ruled out. She was diagnosed as isolated peripheral pulmonary artery branch stenosis. Recent advances in CT technology enable a less-invasive assessment of pulmonary artery, and can be useful in the management of pulmonary arterial hypertension.

Topics: Aged; Aneurysm; Arterial Occlusive Diseases; Cardiac Catheterization; Constriction, Pathologic; Cough; Dyspnea; Epoprostenol; Female; Humans; Hypertension, Pulmonary; Imaging, Three-Dimensional; Oxygen Inhalation Therapy; Piperazines; Pulmonary Artery; Purines; Sildenafil Citrate; Sulfones; Tomography, X-Ray Computed; Ultrasonography; Vasodilator Agents; Warfarin

Kawasaki disease (KD) has potentially serious cardiac complications including coronary artery aneurysms. Children who develop giant aneurysms (GA) are at increased risk of thrombosis and ischemia, and although longterm oral anticoagulation with warfarin is recommended, its efficacy has not been studied. We examined the longterm outcome of patients with GA secondary to KD, to determine if anticoagulation with warfarin aids in the prevention of myocardial ischemia.. We studied patients with KD followed between May 1990 and April 2000.. Thirty-nine GA occurred in 2.2% of patients with KD (22/997 patients), and 33 non-GA were also identified in these patients. Patients were divided into 2 groups, those taking warfarin and no warfarin. Most patients in both groups were also taking antiplatelet agents. The demographics of the 2 groups were statistically similar, except the median duration of followup was significantly longer for patients in the no-warfarin group (6.9 vs 13.3 yrs; p = 0.008). Four early ischemic events (< 1 year after KD diagnosis) occurred (3 myocardial infarctions and one stroke). Screening for late ischemic events by stress nuclear medicine myocardial perfusion imaging revealed only one patient, in the no-warfarin group, with reversible perfusion defects. No patient had clinical signs or symptoms of late myocardial ischemia. Echocardiographic regression of aneurysms was observed in both groups. In the warfarin vs no-warfarin group, the diameters of the GA regressed a median 22% vs 32% (p = 0.27), and non-GA regressed a median of 30% vs 25% (p = 0.61). Compliance with anticoagulation was good, and no major bleeding complication of anticoagulation occurred.. Regression of GA occurred in most of our patients, and minimal late ischemia was observed. Further studies are required to evaluate the use of oral anticoagulation in patients with GA secondary to KD.

Topics: Adolescent; Aneurysm; Anticoagulants; Child; Child, Preschool; Coronary Thrombosis; Coronary Vessels; Female; Humans; Infant; Male; Mucocutaneous Lymph Node Syndrome; Myocardial Ischemia; Retrospective Studies; Treatment Outcome; Warfarin

We report facial palsy as the sole cranial neuropathy complicating an ipsilateral internal carotid artery dissection. A previously healthy 44-year-old man developed retro-orbital and temporal headache with associated nausea while engaged in modest physical exercise. On the following morning he noticed a left ptosis and miotic pupil. One week later he woke with a left facial weakness. On the same day he had a 90-minute episode of expressive dysphasia. Magnetic resonance imaging and angiography demonstrated left internal carotid artery dissection. The temporal association between our patient's facial nerve palsy and typical features of spontaneous internal carotid artery dissection suggests a common aetiology. We suggest that involvement of the VII cranial nerve in isolation followed disruption of an anomalous nutrient artery. The delay in clinical manifestation may imply extension of the dissection.

Topics: Adult; Aneurysm; Anticoagulants; Blepharoptosis; Brain; Carotid Artery, Internal, Dissection; Deglutition Disorders; Exercise; Facial Paralysis; Heparin, Low-Molecular-Weight; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Tinzaparin; Warfarin

We report a case of a 86-year-old woman, with a 1-year history of pain during walking and standing; a duplex scanning of the popliteal fossa was performed bilaterally. We pointed out the presence of a bilateral popliteal vein aneurysm, partially thrombosed. She was treated only with oral anticoaugulant therapy, because of her age. Venous aneurysms are quite rare and are considered to be true when all three cell layers are present in the vessel wall; bilateral popliteal venous aneurysm is very rare and only one case was previously described. This report describes, moreover, with a large review of the world literature, histologic features and diagnostics and therapeutic choices.

Topics: Aged; Aged, 80 and over; Aneurysm; Anticoagulants; Female; Humans; Popliteal Vein; Warfarin

Topics: Adolescent; Adult; Age Factors; Aged; Aneurysm; Arteries; Arteriovenous Fistula; Aspirin; Blood Vessels; Child; Child, Preschool; Colorado; Female; Heparin; Humans; Infant; Male; Methods; Middle Aged; Postoperative Complications; Radiography; Sex Factors; Thrombosis; Veins; Warfarin; Wounds and Injuries

Topics: Adult; Aneurysm; Blood Vessel Prosthesis; Cardiac Catheterization; Coronary Artery Bypass; Coronary Disease; Female; Follow-Up Studies; Humans; Infant; Isosorbide Dinitrate; Male; Middle Aged; Myocardial Revascularization; Nitroglycerin; Propranolol; Radiography; Saphenous Vein; Transplantation, Autologous; Warfarin

Topics: Acute Disease; Adolescent; Adult; Aged; Aneurysm; Child; Chronic Disease; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Female; Fetal Death; Fibrinolysis; Hemangioma; Heparin; Humans; Iliac Artery; Infusions, Parenteral; Lung Neoplasms; Lymphatic Metastasis; Male; Melanoma; Middle Aged; Pregnancy; Sepsis; Streptococcal Infections; Syndrome; Thrombophlebitis; Thumb; Warfarin