Bc Srinivas

Catheter-Directed Thrombolysis Along with Mechanical Thromboaspiration versus Anticoagulation Alone in the Management of Lower Limb Deep Venous Thrombosis-A Comparative Study.

Catheter-directed thrombolysis (CDT) with assisted mechanical thrombolysis is now considered as the standard of medical care for deep vein thrombosis (DVT). The study was conducted to describe the immediate and long-term (6 months) safety and effectiveness of CDT in patient with lower limb DVT compared with the routine anticoagulation alone. All 12 to 85 years old patients with recent (0-8 weeks) DVT were included. In CDT group, thrombus was aspirated mechanically and streptokinase (STK) was given along with unfractionated heparin (UFH). After 6 months, deep venous patency and postthrombotic syndrome (PTS) was assessed by using duplex ultrasound and Villalta scale, respectively. Among 51 patients with completed data, 25 patients were allocated additional CDT given for a mean duration of 108 ± 32 hours and 26 patients were allocated standard treatment alone. Grade III (complete) lysis was achieved in 37% patients and grade II (50-90%) lysis in 63% of patients. Patients with partial lysis underwent percutaneous transluminal angioplasty and/or venous stenting. After 6 months, iliofemoral patency was found in 20 (80%) in the CDT group versus 7 (23%) in anticoagulation alone group (p < 0.01). PTS was seen in 5 (20%) in the CDT group versus 19 (77%) in anticoagulation alone group (p < 0.01). We conclude that CDT and conventional manual aspiration thrombectomy are an effective treatment for lower extremity DVT. STK infusion can be safely given up to 6 days. As addition of UFH can cause thrombocytopenia, so daily monitoring of complete blood counts is needed during CDT.

Endovascular management of proximal lower limb deep venous thrombosis – A prospective study with six-month follow-up

Background Catheter-directed thrombolysis with assisted mechanical thrombolysis is the standard of medical care for proximal deep vein thrombosis. We studied the immediate and intermediate (six months) safety and effectiveness of catheter-directed thrombolysis in patients with proximal lower limb deep vein thrombosis. Methodology Thirty consecutive patients aged between 20 and 70 years with proximal lower limb deep vein thrombosis formed the study group. Catheter-directed thrombolysis was done with streptokinase infuse through a catheter kept in the ipsilateral popliteal vein. Unfractionated heparin was given along with streptokinase. Mechanical thromboaspiration using guiding catheter was performed in addition to thrombolytic therapy. After six months, post-thrombotic syndrome and deep venous patency were assessed by using Villalta scale and duplex ultrasound, respectively. Results Thirty patients with proximal lower limb deep vein thrombosis were treated with catheter-directed thrombolysis. Mean age of the study patients was 41.7 ± 15 years. Mean duration of illness was 13.3 ± 12 days. The mean duration of thrombolysis was 4.5 ± 1.3 days. Grade III (complete) lysis was achieved in 10 (33%) and Grade II (50–90%) lysis in 20 (67%) of patients. Patients with significant residual lesion in Grade II lysis following catheter-directed thrombolysis underwent percutaneous transluminal angioplasty alone (12/20) or venous stenting (8/20). All patients improved clinically following catheter-directed thrombolysis or assisted catheter-directed thrombolysis. Four patients (13%) developed pulmonary embolism during course of hospital stay and among them two (6.5%) patients died. Eleven patients (37%) had minor bleeding or hematoma at local site, and seven (23%) developed anemia requiring blood transfusion and four (13%) patients had thrombocytopenia. After six months, iliofemoral patency was found in 20 (72%) and post-thrombotic syndrome was seen in six (21%) patients. Two (6.5%) patients died during follow-up due to nephrotic syndrome and carcinoma breast. Conclusion Catheter-directed thrombolysis and conventional manual aspiration thrombectomy are an effective treatment for proximal lower extremity deep vein thrombosis with good short and intermediate outcome.

Catheter-directed thrombolysis in management of postpartum lower limb deep venous thrombosis - A case series.

Deep vein thrombosis (DVT) is a major health problem in pregnancy and postpartum period. Catheter-directed thrombolysis (CDT) is safe and effective in the management of symptomatic DVT. Value of CDT in postpartum DVT is not fully evaluated. We describe five patients presenting with acute iliofemoral DVT in their early postpartum period who were treated with mechanical thromboaspiration and CDT. The CDT was done using streptokinase infusion and unfractionated heparin. Percutaneous angioplasty was done in patients with symptomatic residual lesion following thrombolysis. Patients were discharged with oral anticoagulant and compression stockings. This approach was successful in all five cases. Percutaneous endovascular therapy using CDT, mechanical thromboaspiration, and balloon angioplasty is safe and effective in iliofemoral DVT in postpartum period.

Super dominant left anterior descending artery with origin of both posterior descending artery and posterior left ventricular artery from septal branch

The posterior descending artery (PDA) arises from the right coronary artery (RCA) in approximately 85% of people in right dominant circulation. Whereas only in 10–15% of cases, it arises from the circumflex artery (LCX) or from both RCA and LCX.1 Rarely the posterior descending artery can arise from the left anterior descending (LAD) coronary artery.2 ,3 A 65-year-old man presented with new onset effort angina of Canadian Cardiovascular Society class II severity. He was hypertensive and a smoker. Exercise treadmill test was positive in 9.1 metabolic equivalents of task (METS). Blood investigations revealed only the presence of hyperlipidaemia (low …

Thrombolysis With Single Bolus Tenecteplase Compared With Streptokinase Infusion in the Treatment of Acute Pulmonary Embolism A Pilot Study

Objective: This study was planned to compare the efficacy of bolus regimens of tenecteplase (TNK) and 24 hours infusion of streptokinase (STK) in acute pulmonary embolism (APE) in a resource-poor setting. Interventions: In all, 25 patients received injection of TNK, and 75 patients received infusion of STK over 24 hours. Results: Pulmonary artery systolic pressure and right ventricular function were improved separately and significantly (P = .01) in both the study groups of patients from baseline at 24 hours or at seventh day and was comparable among the TNK and STK groups of patients. Mean duration of stay in intensive care unit was significantly less (2.2 ± 0.8 vs 3.2 ± 1.3 days; P = .04), and bleeding risk was also found to be nonsignificantly less in the TNK group. Conclusion: These results suggest that a 24-hour infusion regimen of STK is as effective as bolus TNK in the treatment of patients with APE in countries with limited resources.

Catheter-Directed Thrombolysis Is a Safe and Alternative Therapeutic Approach in the Management of Postpartum Lower Limb Deep Venous Thrombosis.

Deep vein thrombosis (DVT) is a major health problem in pregnancy and postpartum period. Catheter-directed thrombolysis (CDT) is safe and effective in management of symptomatic DVT. Value of CDT in postpartum DVT is not fully evaluated. We describe five patients presenting with acute iliofemoral DVT in their early postpartum period who were treated with mechanical thromboaspiration and CDT. The CDT was done using streptokinase infusion and unfractionated heparin. Percutaneous angioplasty was done in patients with symptomatic residual lesion following thrombolysis. Patients were discharged with oral anticoagulant and compression stockings. This approach was successful in all four cases. Percutaneous endovascular therapy using CDT, mechanical thromboaspiration, and balloon angioplasty is safe and effective in iliofemoral DVT in postpartum period.

Recurrent myocardial infarction in a case of congenital Afibrinogenemia

Afibrinogenemia is a rare autosomal recessive bleeding disorder with an estimated prevalence of 1:1,000,000. Usual presentation of this disorder is spontaneous bleeding, bleeding after minor trauma and excessive bleeding during interventional procedures. Paradoxically, few patients with afibrinogenemia may also suffer from severe thromboembolic complications. The management of these patients is particularly challenging because they are not only at risk of thrombosis but also of bleeding. We are presenting a case of 33-year-old male patient of congenital afibrinogenemia who had two episodes myocardial infarction in a span of two years. The patient was managed conservatively with antiplatelet therapy and thrombolytic therapy was not given due to high risk for bleeding.

Thrombolytic therapy in the treatment of acute sub-massive pulmonary embolism: a prospective observational study.

The use of thrombolytic therapy in haemodynamically stable patients with sub-massive pulmonary embolism is still controversial. We conducted this study to observe the safety and efficacy of thrombolytic therapy in acute pulmonary embolism patients with normal blood pressure in a tertiary cardiac centre. In this study, 130 patients with sub-massive pulmonary embolism who had right-ventricular dysfunction were included and treated with thrombolytic therapy. Forty-one percent of patients in our study were within 40 years of age. Eighty-three percent of patients had clinical improvement. Both right-ventricular dysfunction and pulmonary artery systolic pressure were improved significantly following thrombolytic therapy from baseline (49 vs. 28 mmHg; P = 0.01; 95% confidence interval −13 to −56). Only 9% patients had died and two patients had intra-cerebral haemorrhage during this study. Thrombolytic therapy may be helpful in improving clinical course following sub-massive acute pulmonary embolism, especially for those who had low risk of bleeding. Further randomized study with large sample size is needed for final conclusion.

Physical and optical studies of BaO-TeO2-TiO2-B2O3 glasses containing Cu2+ transition metal ion

Glasses with the composition xBaO-(30-x) TeO2-10TiO2-59B2O3-1CuO (where x = 10, 15, 20 and 25 mole %) were prepared by melt quenching technique. The XRD studies were made on these glass samples at room temperature. The amorphous nature of the glass samples was confirmed from the XRD patterns. The physical parameters such as density (ρ), molar volume (Vm), average boron-boron separation (dB-B) and oxygen packing density (OPD) were calculated. The change in density and molar volume has been investigated in terms of the variation of BaO in the glass composition. The optical absorption spectra have been recorded at room temperature. The values of optical band gap have been estimated from the ASF and Tauc’s methods. Both Tauc’s and ASF methods have been showing progressively increasing indirect optical band gap values with the increase of BaO concentrations.Glasses with the composition xBaO-(30-x) TeO2-10TiO2-59B2O3-1CuO (where x = 10, 15, 20 and 25 mole %) were prepared by melt quenching technique. The XRD studies were made on these glass samples at room temperature. The amorphous nature of the glass samples was confirmed from the XRD patterns. The physical parameters such as density (ρ), molar volume (Vm), average boron-boron separation (dB-B) and oxygen packing density (OPD) were calculated. The change in density and molar volume has been investigated in terms of the variation of BaO in the glass composition. The optical absorption spectra have been recorded at room temperature. The values of optical band gap have been estimated from the ASF and Tauc’s methods. Both Tauc’s and ASF methods have been showing progressively increasing indirect optical band gap values with the increase of BaO concentrations.

Aortoiliac reconstruction in the setting of in-stent restenosis

Complex iliac artery obstructions, particularly bilateral stenosis or total iliac artery occlusions, are usually treated with aortofemoral or aortobifemoral graft surgery. However, surgical treatment is associated with 3% mortality rate and significant morbidity such as intestinal ischemia, spinal cord injury, and ureteral damage. Percutaneous interventions of aortic bifurcation offer a promising alternative to surgery with potentially lower morbidity and mortality risk. We report a case of peripheral artery disease who had underwent right transfemoral iliac angioplasty with femoropopliteal bypass presented again with bilateral lower limb ischemia, who was successfully treated with stent implantation with the kissing balloon technique.