Background: Catheter directed thrombolysis (CDT) and thrombectomy represent well established techniques for the treatment of intermediate pulmonary embolism (IPE). The long-term effect of catheter directed thrombolysis of IPE is unknown. Methods: Clinical, interventional and echocardiographic data from 80 consecutive patients with IPE who were treated with CDT were evaluated. Primary end-points were technical success and major adverse events. Secondary end-points were cardiovascular mortality, all-cause mortality, clinical success, rate of bleeding complications, improvement in pulmonary pressure and echocardiography parameters. CDT completed with alteplase (10 mg bolus and 1 mg/h maintenance dose) through a pigtail catheter for 24 h. After 24 h, control pulmonary angiography was performed. Results: In total, 80 patients with a mean age of 59.0 ± 16.8 years were treated. CDT was successful after the first post-operative day in 72 (90%) patients, but thrombus aspiration and fragmentation was performed due to failed thrombolysis in 8 (10%) patients. Final technical and clinical success was reached in 79 (98.8%) and 77 (96.3%) patients, respectively. The mean CDT time in IPE was 27.8 ± ± 9.6 h. Invasive pulmonary pressure dropped from 57.5 ± 16.7 to 38.9 ± 13.5 (p < 0.001). A caval filter was implanted in 4 (5%) patients. The 1-year major adverse events and cardiovascular mortality rate was 4.0% and 1.4%, respectively. Access site complications (6 major and 6 minor) were encountered in 12 (16.2%) patients. Conclusions: Catheter directed thrombolysis in submassive pulmonary embolism had excellent results. However, additional mechanical thrombectomy was necessary in some patients to achieve good clinical outcomes.

KecskemétBevezetés és célkitűzés: A sebészi tibialis bypassműtétnek kritikus végtagischaemiában limitált a kivitelezhetősége, míg a percutan angioplastica széles körben elérhető és jó rövid távú eredményei vannak. Regiszterünk célja az volt, hogy kritikus végtagischaemiában a térd alatti angioplastica hosszú távú eredményeit vizsgáljuk. Módszer: Prospektíven dolgoztuk fel 2008-2011ben kritikus végtagischaemia miatt térd alatti angioplasticán átesett 281 betegünk adatait. A beavatkozás célja az egyeres kiáramlás biztosítása volt ballonos angioplasticával. Stentimplantációt csak akkor vé geztünk, ha a ballonos tágítás után jelentős residualis szűkület vagy dissectio maradt vissza. A vizsgálat elsődleges végpontja a klinikai siker (a fájdalom enyhülése, sebgyógyulás, végtagmentés) és a major események előfordulása volt. A major események közzé tartozott a halál, a myocardialis infactus, a major nem tervezett amputáció, a sebészi revas cularisatio szükségessége és a major vérzés. Másodlagos végpontok voltak a beavatkozás sikere, proceduralis adatok és az eszközfelhasználás. Vizsgáltuk a beavatkozás sikerének és a diabeteses láb szindrómának a végtagmentésre kifej tett hatását. A major amputáció hosszú távú halálozásra kifejtett hatását is vizsgáltuk. Eredmények: Betegeink átlag életkora 72,5 ± 10,6 év és a vizsgálati periódus átlaga 40,8 ± 9,7 hónap volt. Jó angiográfiás eredményt 255 végtag ban (90,7%) értünk el egy egyenes, térd alatti artériában. Ballonos angioplasticát 278 (98,9%) betegnél végeztünk, két betegnél (0,7%) rotációs atherectomiát és 74 betegnél (26,3%) stentimplantációt. Az elsődleges végpontok tekin tetében hosszú távú nyomon követés során (klinikai siker) a nyugalmi fájdalom 56,6%ban szűnt meg, a fekély 73,5% ban és a gangraena pedis 46,5%ban gyógyult be. A hosszú távú végtagmentés 73,5% volt; 65,8% diabeteses és 89,6% nem diabetes láb szindrómában (p = 0,001). A major nemkívánatos események előfordulása a hosszú távú kontroll során 122 (43,4%) volt. A hosszú távú nyomon követés során 57 (20,3%) beteg hunyt el: 38 (13,5%) diabeteses és 19 (6,8%) nem diabeteses láb szindróma esetén (p = 0,932). Sikeres intervenció esetén a betegek 72,3%ában, míg sikertelen intervenció esetén a betegek 84,6%ában értünk el végtagmentést (p = 0,225). Következtetés: A térd alatti angioplasticának jó hosszú távú klinikai eredményei vannak, azonban a betegekben a major események előfordulása magas. Diabeteses láb szindrómában magasabb a hosszú távú amputációszám és a mortalitás. Orv. Hetil., 2017, 158(11), 418-425. Kulcsszavak: kritikus végtagischaemia, percutan angioplastica, térd alatti angioplastica Long term results after invasive treatment of critical limb ischemiaIntroduction and aim: Surgical tibial bypass for critical limb ischemia is associated with significant morbidity, mortal ity, and graft failure, whereas percutaneous angioplasty and stenting has promising results. The objective of this study was the investigation of the long term results of belowknee percutaneous angioplasty for restoring straight inline ...

Pulmonary embolism: risk-adjusted management / Pregnancy in women with congenital heart disease, foetal cardiology and imaging 349lated to VTE or whether NLR can be a surrogate marker of VTE development after TKR. Purpose: In this study, we examined how many VTE events occur and whether preoperative NLR have a predictive value for VTE in patients taken thromboprophylaxis after TKR surgery. Methods: We retrospectively enrolled 234 patients undergoing TKR surgery. The biochemical tests were performed within 2 weeks prior to surgery and the neutrophil lymphocyte ratio (NLR) was defined as the absolute neutrophil count divided by lymphocyte count in peripheral blood. Low molecular heparin was started 12-24 h after surgery and continued for 10-15 days in all the patients. The enhanced pulmonary artery and lower extremity venography CT scan was routinely performed in all patients at post-operative 5 days. Results: Among of 234 patients, 93 patients (39.7%) were diagnosed as deep vein thrombosis or pulmonary embolism on CT scan. There were no significant differences in terms of age, gender, proportion of one-stage bilateral TKR, indication of TKR, hypertension, diabetes, dyslipidemia and atrial fibrillation between both groups with or without VTE. However, VTE group had higher mean NLR value than group without VTE (2.71±1.77 vs 2.15±1.13, p=0.004). By ROC curve analysis of NLR, NLR cut-off value at 1.90 showed sensitivity 60.2% and specificity 55.3% for prediction of VTE in patients undergoing TKR surgery (area under curve: 0.595, confidence interval: 0.519-0.670, p=0.014). In addition, multivariate regression analysis showed high NLR (NLR value ≥1.90) was a solely independent predictor of VTE after adjusting to age, gender, one-stage bilateral TKR, hypertension, diabetes and dyslipidemia. Conclusion: Our study shows a higher incidence of VTE (39.7%) after TKR in patients with thromboprophylaxis than that of previous studies. Furthermore, mean neutrophil lymphocyte ratio (NLR) was significantly higher in patients with VTE and high NLR (≥1.90) was an independent predictor of VTE after TKR. NLR measurement may be a simple and useful method for prediction of VTE in patients undergoing TKR surgery. Introduction: Percutaneous thrombectomy and catheter directed thrombolysis (CDT) represent well established techniques for the treatment of submassive pulmonary embolism (SPE). The purpose of CDT is to dissolve thrombus in the main and distal pulmonary branch. Methods: Clinical, interventional and echocardiographic data from 72 consecutive patients with SPE who were treated with CDT were evaluated. Diagnosis was made by transthoracal ultrasound and computer tomography. Primary end-points were: technical success, major cardiac and cerebral events (MACCE) and invasive pulmonary pressure. Secondary end-points: rate of procedural and access site complications. The access site for CDT was the femoral vein. CDT was done with Alteplase (10 mg bolus and 1 mg/h maintenance dose) over a pig-tail catheter for 24 hours. After 24 hours, cont...

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