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Flow pattern analysis in type B aortic dissection patients after stent-grafting repair: Comparison between complete and incomplete false lumen thrombosis

Wan Ab Naim WN, Ganesan PB, Sun Z, Lei J, Jansen S, Hashim SA, et al.

Int J Numer Method Biomed Eng, 2018 05;34(5):e2961.
PMID: 29331052 DOI: 10.1002/cnm.2961

Endovascular stent graft repair has become a common treatment for complicated Stanford type B aortic dissection to restore true lumen flow and induce false lumen thrombosis. Using computational fluid dynamics, this study reports the differences in flow patterns and wall shear stress distribution in complicated Stanford type B aortic dissection patients after endovascular stent graft repair. Five patients were included in this study: 2 have more than 80% false lumen thrombosis (group 1), while 3 others had less than 80% false lumen thrombosis (group 2) within 1 year following endovascular repair. Group 1 patients had concentrated re-entry tears around the abdominal branches only, while group 2 patients had re-entry tears that spread along the dissection line. Blood flow inside the false lumen which affected thrombus formation increased with the number of re-entry tears and when only small amounts of blood that entered the false lumen exited through the branches. In those cases where dissection extended below the abdominal branches (group 2), patients with fewer re-entry tears and longer distance between the tears had low wall shear stress contributing to thrombosis. This work provides an insight into predicting the development of complete or incomplete false lumen thrombosis and has implications for patient selection for treatment.

Matched MeSH terms: Thrombosis/surgery*
Follicular thyroid carcinoma with direct tumour extension into the great cervical veins and right atrium: is transcervical thrombectomy a safe option?

Taib NA, Hisham AN

Asian J Surg, 2007 Jul;30(3):216-9.
PMID: 17638642

Direct tumour extension into the internal jugular veins (IJV) and right atrium in thyroid cancer is extremely uncommon. We report three cases of advanced thyroid cancer invading into the IJV and right atrium. All three patients had well-differentiated thyroid cancer and presented with typical clinical picture of the superior cava syndrome coupled with significant compressive symptoms. Two patients had obvious tumour thrombus extending to the superior vena cava (SVC) and right atrium, whilst in one patient, the thrombus extended to the SVC close to the edge of the right atrium. In all three patients, the intraluminal tumour thrombus was clinically palpable. Involvement of the IJV, SVC and right atrium was confirmed with computed tomography (CT) scan and echocardiography. The decision to extract the thrombus transcervically was made on the basis of the positive "ring sign", which is a thin rim of contrast surrounding the tumour thrombus documented on CT. All three patients underwent total thyroidectomy with segmental resection and ligation of the IJV. The tumour thrombus was successfully extracted transcervically. The histopathology report confirmed follicular carcinoma in all three patients. Two patients had radioiodine ablation therapy postoperatively, and were well 18 months after operation. One patient who had lung metastases documented on chest CT succumbed to the disease due to massive haemoptysis 3 weeks after operation.

Matched MeSH terms: Thrombosis/surgery*
Fulltext Obstruction of mechanical heart valve--diagnosis, surgical treatment and outcome

Pau KK, Yakub A, Sallehuddin A, Awang Y

Med J Malaysia, 2001 Jun;56(2):196-200.
PMID: 11771080

From 1982 till 1999, our department performed a total of 2970 heart valve replacements--92% of which were with mechanical heart valves. During this period, there were 8 patients who came to our department with mechanical heart valve obstruction. All these patients presented with signs of heart failure or compromised haemodynamic. Confirmatory tests included transthoracic or transoesophageal echocardiography and cine fluoroscopy. Seven patients were operated upon urgently. Four of the patients had valve thrombosis. The time interval between the initial implantation and presentation varies from 4 months to 11.3 years. Six of the seven patients who were operated on recovered well from the surgery.

Matched MeSH terms: Thrombosis/surgery*
Fulltext Lateral sinus thrombosis

Nurliza I, Saim L

Med J Malaysia, 2007 Aug;62(3):245-6.
PMID: 18246917 MyJurnal

We describe four cases of lateral sinus thrombosis secondary to otitis media. They presented with low-grade fever, headache, nausea, vomiting and ear discharge. One patient had facial nerve palsy. CT scan was helpful in managing these patients. They were treated with antibiotics followed by surgery. Two patients had intracranial abscesses and were treated accordingly.

Matched MeSH terms: Lateral Sinus Thrombosis/surgery
Dislodgement of the MGuard Prime MicroNet™ During Primary PCI

Ismail MD, Han CK, Loch A

Cardiovasc Intervent Radiol, 2016 May;39(5):785-787.
PMID: 26757911 DOI: 10.1007/s00270-015-1290-1
Matched MeSH terms: Thrombosis/surgery
Robot-assisted Cavectomy Versus Thrombectomy for Level II Inferior Vena Cava Thrombus: Decision-making Scheme and Multi-institutional Analysis

Shi T, Huang Q, Liu K, Du S, Fan Y, Yang L, et al.

Eur Urol, 2020 10;78(4):592-602.
PMID: 32305170 DOI: 10.1016/j.eururo.2020.03.020

BACKGROUND: Robot-assisted thrombectomy (RAT) for inferior vena cava (IVC) thrombus (RAT-IVCT) is being increasingly reported. However, the techniques and indications for robot-assisted cavectomy (RAC) for IVC thrombus are not well described.
OBJECTIVE: To develop a decision-making program and analyze multi-institutional outcomes of RAC-IVCT versus RAT-IVCT.
DESIGN, SETTING, AND PARTICIPANTS: Ninety patients with renal cell carcinoma (RCC) with level II IVCT were included from eight Chinese urological centers, and underwent RAC-IVCT (30 patients) or RAT-IVCT (60 patients) from June 2013 to January 2019.
SURGICAL PROCEDURE: The surgical strategy was based on IVCT imaging characteristics. RAT-IVCT was performed with standardized cavotomy, thrombectomy, and IVC reconstruction. RAC-IVCT was mainly performed in patients with extensive IVC wall invasion when the collateral blood vessels were well-established. For right-sided RCC, the IVC from the infrarenal vein to the infrahepatic veins was stapled. For left-sided RCC, the IVC from the suprarenal vein to the infrahepatic veins was removed and caudal IVC reconstruction was performed to ensure the right renal vein returned through the IVC collaterals.
MEASUREMENTS: Clinicopathological, operative, and survival outcomes were collected and analyzed.
RESULTS AND LIMITATIONS: All procedures were successfully performed without open conversion. The median operation time (268 vs 190 min) and estimated blood loss (1500 vs 400 ml) were significantly greater for RAC-IVCT versus RAT-IVCT (both p < 0.001). IVC invasion was a risk factor for progression-free and overall survival at midterm follow-up. Large-volume and long-term follow-up studies are needed.
CONCLUSIONS: RAC-IVCT or RAT-IVCT represents an alternative minimally invasive approach for selected RCC patients with level II IVCT. Selection of RAC-IVCT or RAT-IVCT is mainly based on preoperative IVCT imaging characteristics, including the presence of IVC wall invasion, the affected kidney, and establishment of the collateral circulation.
PATIENT SUMMARY: In this study we found that robotic surgeries for level II inferior vena cava thrombus were feasible and safe. Preoperative imaging played an important role in establishing an appropriate surgical plan.

Matched MeSH terms: Venous Thrombosis/surgery*