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Rosenov A, Haine A, Walti LN, Capiaghi D, Schindewolf M, Baumgartner I. Upside-down positioning of a peri-interventional cava filter during endovascular thrombectomy of a septic superior vena cava thrombosis. SAGE Open Med Case Rep 2022; 10:2050313X221117333. [PMID: 35966122 PMCID: PMC9364187 DOI: 10.1177/2050313x221117333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022] Open
Abstract
A 43-year-old male patient with advanced colon carcinoma presented with disseminated
staphylococcus aureus bacteremia and central venous catheter associated septic thrombosis
of the superior vena cava. Despite appropriate antimicrobial therapy and surgical
debridement of distant foci, bacteremia persisted, so an endovascular thrombectomy was
performed. Contrary to the usual application, the Capturex® peri-interventional cava
filter was positioned upside down, in the direction of the blood flow, in the superior
vena cava to prevent septic embolism during mechanical thrombectomy. The wall-adherent
septic thrombus was mechanically detached using a RAT fragmentation basket® followed by
Aspirex® rotational thrombectomy. Final phlebography showed complete thrombus removal.
Small thrombus fragments could be demonstrated in the filter after retrieval. The adapted
technique of a reverse positioning of the Capturex® filter in the superior vena cava seems
feasible and effective.
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Affiliation(s)
- Alexander Rosenov
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Axel Haine
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura Naëmi Walti
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Debora Capiaghi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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2
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Liang TM, Martinez JJ, Jessen ME, Wait MA, Shah HM, Lamus D, Huffman LC. Percutaneous Aspiration for Septic Thrombi in Burn Patients. Ann Thorac Surg 2020; 110:e5-e7. [PMID: 31926156 DOI: 10.1016/j.athoracsur.2019.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022]
Abstract
Therapeutic interventions are limited for high-risk burn patients with caval and intracardiac septic thrombi. Percutaneous thrombectomy represents a less invasive alternative to median sternotomy. However, there is limited literature on application of this approach and outcomes in these patients. We report two cases of patients with large total body surface area burns with similar caval and right intracardiac septic thrombi. Both patients were successfully treated using a percutaneous aspiration device.
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Affiliation(s)
- Tyler M Liang
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Joseph J Martinez
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Hriday M Shah
- Division of Vascular Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Daniel Lamus
- Division of Vascular Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Lynn C Huffman
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas.
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3
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Bauman ZM, Morizio K, Singer M, Hood CR, Feliciano DV, Vercruysse GA. The Heroin Epidemic in America: A Surgeon's Perspective. Surg Infect (Larchmt) 2019; 20:351-358. [PMID: 30900946 DOI: 10.1089/sur.2019.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The United States is currently experiencing a heroin epidemic. Recent reports have demonstrated a three-fold increase in heroin use among Americans since 2007 with a shift in demographics to more women and white Americans. Furthermore, there has been a correlation between the recent opioid epidemic and an increase in heroin abuse. Much has been written about epidemiology and prevention of heroin abuse, but little has been dedicated to the surgical implications, complications, and resource utilization. Discussion: This article focuses on the surgical problems encountered from heroin abuse and how to manage them in a constant effort to improve morbidity and mortality for these heroin abusers.
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Affiliation(s)
- Zachary M Bauman
- 1 Division of Trauma, Emergency General Surgery, and Critical Care, Department of Surgery, University of Nebraska, Omaha, Nebraska
| | - Kate Morizio
- 2 Department of Pharmacy, University of Arizona, Tucson, Arizona
| | - Matthew Singer
- 3 Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Courtney R Hood
- 3 Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - David V Feliciano
- 4 Division of Surgical Critical Care, University of Maryland Medical Center, Baltimore, Maryland
| | - Gary A Vercruysse
- 5 Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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4
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Maulat C, Lapierre L, Migueres I, Chaufour X, Martin-Blondel G, Muscari F. Caval replacement with parietal peritoneum tube graft for septic thrombophlebitis after hepatectomy: A case report. World J Hepatol 2019; 11:133-137. [PMID: 30705726 PMCID: PMC6354118 DOI: 10.4254/wjh.v11.i1.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/04/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.
CASE SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy, the patient’s condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.
CONCLUSION Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.
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Affiliation(s)
- Charlotte Maulat
- Digestive Surgery, Toulouse University Hospital, Toulouse 31400, France
| | - Léopoldine Lapierre
- Department of Infectious and Tropical Diseases, Toulouse-Purpan University Hospital, Toulouse 31300, France
| | - Isabelle Migueres
- Digestive Surgery, Toulouse University Hospital, Toulouse 31400, France
| | - Xavier Chaufour
- Vascular Surgery Department, Toulouse-Rangueil University Hospital, Toulouse 31059, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse-Purpan University Hospital, Toulouse 31300, France
| | - Fabrice Muscari
- Digestive Surgery, Toulouse University Hospital, Toulouse 31400, France
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Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2019; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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6
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Talaie T, Drucker C, Aicher B, Khalifeh A, Lal B, Sarkar R, Toursavadkohi S. Endovascular Thrombectomy of Septic Thrombophlebitis of the Inferior Vena Cava: Case Report and Review of the Literature. Vasc Endovascular Surg 2018; 52:641-647. [PMID: 29898647 DOI: 10.1177/1538574418779475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We describe the cases of 2 patients who had septic thrombophlebitis and were successfully managed with endovascular thrombectomy. Patient A developed septic thrombophlebitis of the inferior vena cava after several retroperitoneal resections for metastatic renal cell carcinoma. The thrombus was successfully removed via endovascular mechanical balloon thrombectomy. Patient B was a patient with pancreatic adenocarcinoma involving the portal vein who developed a septic inferior vena cava thrombus extending from the level and beyond the renal veins, for which she underwent endovascular thrombectomy. We argue that this approach is safe and feasible. It should be considered as a supplemental treatment modality for select decompensating patients who require lifesaving interventions and have contraindications to traditional management of surgical thrombectomy or excision of the involved venous segment.
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Affiliation(s)
- Tara Talaie
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles Drucker
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brittany Aicher
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Khalifeh
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brajesh Lal
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rajabrata Sarkar
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shahab Toursavadkohi
- 1 Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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7
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Wagenhäuser MU, Sadat H, Dueppers P, Meyer-Janiszewski YK, Spin JM, Schelzig H, Duran M. Open surgery for iliofemoral deep vein thrombosis with temporary arteriovenous fistula remains valuable. Phlebology 2017; 33:600-609. [PMID: 29065779 DOI: 10.1177/0268355517736437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective We assessed outcomes of open surgical venous thrombectomy with temporary arteriovenous fistula, and the procedure's effect on health-related quality of life. Method We retrospectively analyzed 48 (26 at long-term) patient medical records. Mortality rates, patency, and risk of post-thrombotic syndrome were analyzed using Kaplan-Meier estimation. The association between risk factors/coagulation disorders and patency/post-thrombotic syndrome along with patient health-related quality of life at long-term was analyzed employing various statistical methods. Results Patient one-year survival rate was 93 ± 4% and primary one-year patency rate was 89 ± 5% (secondary one-year patency rate 97 ± 3%). Freedom from post-thrombotic syndrome after eight years was 80 ± 12% (post-thrombotic syndrome rate 20 ± 12%). Health-related quality of life was impaired vs. normative data in the physical and social subscales, and in the mental component score ( p < .05). Conclusions Open surgical venous thrombectomy appears safe compared with literature-reported outcomes in similar patients using alternative approaches. Iliofemoral deep vein thrombosis impairs physical, social, and mental health-related quality of life.
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Affiliation(s)
- Markus U Wagenhäuser
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany.,2 Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hellai Sadat
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Philip Dueppers
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Yvonne K Meyer-Janiszewski
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Joshua M Spin
- 2 Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hubert Schelzig
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Mansur Duran
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
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8
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Chalifoux JR, Vachha B, Moonis G. Imaging of Head and Neck Infections: Diagnostic Considerations, Potential Mimics, and Clinical Management. Semin Roentgenol 2016; 52:10-16. [PMID: 28434498 DOI: 10.1053/j.ro.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Behroze Vachha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gul Moonis
- Columbia University Medical Center, New York, NY.
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9
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A rare case of septic thrombosis in the inferior vena cava with embolism. PHLEBOLOGIE 2016. [DOI: 10.12687/phleb2325-4-2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SummaryThis paper presents the case of a 61-year-old female patient who complained about exhaustion and fever during curative therapy, a few weeks after hysterectomie and adnexectomy. Antibiotic therapy could only improve these symptoms though only in the short term. Additionally, a venous port, which had been implanted for the purpose of cytoreduction chemotherapy, was suspected of a catheter infection and was removed. However, this did not lead to a substantial improvement of the patient’s general state of health, but ultimately triggered a sepsis, making necessary treatment in intensive care unit. At this stage, the detailed search for the focus of the infection led to the discovery of an infected thrombosis of the inferior vena cava with bilateral septic pulmonal embolisms and with an abscess. Thus, the source of sepsis had to be removed by surgery, a transfemoral thrombectomy was performed and an inguinal arteriovenous fistula was created. The further course of the disease was without complications; the patient could be released into ambulant treatment 24 days after the surgery. The elective sealing of the arteriovenous fistula was carried out 11 months later. In the follow- up, there were no hints for infection; the deep venous system in particular did not indicate any new thrombosis or of residual thrombi, with the tumor follow-up-care showing a complete remission.
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10
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Kim M, Kwon H, Hong SK, Han Y, Park H, Choi J, Kwon TW, Cho YP. Surgical Treatment of Central Venous Catheter Related Septic Deep Venous Thrombosis. Eur J Vasc Endovasc Surg 2015; 49:670-675. [DOI: 10.1016/j.ejvs.2015.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/16/2015] [Indexed: 11/26/2022]
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11
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Koh YX, Chng JK, Tan SG. A rare case of septic deep vein thrombosis in the inferior vena cava and the left iliac vein in an intravenous drug abuser. Ann Vasc Dis 2013; 5:389-92. [PMID: 23555542 DOI: 10.3400/avd.cr.12.00036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/22/2012] [Indexed: 01/03/2023] Open
Abstract
The patient was a 41 year-old Chinese female, a known intravenous drug abuser (IVDA), who presented with a left inguinal discharging sinus. A computed tomography (CT) scan showed inflammation in the left groin involving the left femoral vein and resulting in thrombus within the iliac veins extending to the distal portion of the inferior vena cava. Septic deep vein thrombosis is a well-recognized complication in intravenous drug abusers (IVDA) when large proximal veins are used for drug injection. Life threatening complications such as septic pulmonary embolism and right sided infective endocarditis may result. The aims of treatment are to prevent the septic thrombus from further embolisation and also to remove the thrombus. Treatment options include catheter directed thrombolysis, mechanical thrombectomy, endovascular treatment, surgical thrombectomy and excision of the involved venous segment.
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Affiliation(s)
- Ye Xin Koh
- Department of General Surgery, Singapore General Hospital, Singapore
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13
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Kan'o T, Nishimaki H, Kataoka Y, Soma K. Pulse-spray treatment of total occlusive jugular venous suppurative thrombophlebitis. Intern Med 2013; 52:819-22. [PMID: 23545683 DOI: 10.2169/internalmedicine.52.7804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 63-year-old man was diagnosed with jugular venous suppurative thrombophlebitis after undergoing strangulation ileus surgery. His condition was not stabilized by therapy with antibiotics, heparin or other supportive treatments. Pulse-spray treatment (PST) was administered, following which, the patient was afebrile without symptoms and the laboratory data improved. There were no complications such as sustained sepsis, septic embolisms or pulmonary embolisms. This is a unique case report of the use of a pulse-spray catheter in the treatment of total occlusive jugular venous suppurative thrombophlebitis following the failure of medical therapy.
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Affiliation(s)
- Tomomichi Kan'o
- Department of Emergency & Critical Care Medicine, Kitasato University, Japan.
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14
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Cox ER, Amoroso A, Gilliam BL. Pannus attack: septic thrombophlebitis. Am J Med 2012; 125:1175-7. [PMID: 23062405 DOI: 10.1016/j.amjmed.2012.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Eric R Cox
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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15
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Liang SY, Khair H, Durkin MJ, Marschall J. Prevention and management of central line-associated bloodstream infections in hospital practice. Hosp Pract (1995) 2012; 40:106-18. [PMID: 22406886 DOI: 10.3810/hp.2012.02.951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this article aimed at hospitalists, we examine the literature on preventive measures for central line-associated bloodstream infections (CLABSIs) and optimal management once a CLABSI has been established. We focus on a number of core preventive measures and the contemporary approach of bundling these measures for maximal impact in reducing infection rates. We then discuss empiric and pathogen-specific antibiotic therapy, including the role of newer antimicrobial agents, as well as the management of an infected central venous catheter.
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Affiliation(s)
- Stephen Y Liang
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110-1093, USA
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Fiddes R, Khattab M, Abu Dakka M, Al-Khaffaf H. Patterns and management of vascular injuries in intravenous drug users: A literature review. Surgeon 2010; 8:353-61. [DOI: 10.1016/j.surge.2010.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 05/23/2010] [Accepted: 07/12/2010] [Indexed: 11/30/2022]
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18
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Han Z, Liang SY, Marschall J. Current strategies for the prevention and management of central line-associated bloodstream infections. Infect Drug Resist 2010; 3:147-63. [PMID: 21694903 PMCID: PMC3108742 DOI: 10.2147/idr.s10105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Indexed: 11/29/2022] Open
Abstract
Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs). While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment.
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Affiliation(s)
- Zhuolin Han
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, MO, USA
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Sulaiman L, Hunter J, Farquharson F, Reddy H. Mechanical thrombectomy of an infected deep venous thrombosis: a novel technique of source control in sepsis. Br J Anaesth 2010; 106:65-8. [PMID: 20952425 DOI: 10.1093/bja/aeq276] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A young i.v. drug abuser presented with an extensive iliofemoral deep vein thrombosis and signs of severe sepsis. Subsequent investigations revealed multiple septic emboli in his lungs originating from infected thrombus in his leg. Despite systemic anti-coagulation and appropriate parenteral antibiotics, he continued to show signs of worsening acute infection. Percutaneous mechanical thrombectomy was performed successfully and resulted in an immediate improvement in his condition. In this report, we discuss the novel use of this technique for source control in a patient with septic shock secondary to infected thrombus.
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Affiliation(s)
- L Sulaiman
- East Cheshire NHS Trust, Macclesfield, UK.
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20
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Mylona E, Vadala C, Antypa E, Skoutelis A. Air inclusion in suppurative deep venous thrombosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1247-1249. [PMID: 20660461 DOI: 10.7863/jum.2010.29.8.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Eleni Mylona
- Fifth Department of Internal Medicine, Evangelismos Hospital, Athens, Greece.
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21
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Catheter-related septic thrombophlebitis of the superior vena cava involving the atrial septum: a case report. CASES JOURNAL 2008; 1:272. [PMID: 18950511 PMCID: PMC2584086 DOI: 10.1186/1757-1626-1-272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 10/24/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intravascular catheters provide necessary vascular access, for intravenous therapy, blood sampling and pressure monitoring. However, their use is often associated with serious local and systemic complications including local site infection, intravascular catheter-related bloodstream infections, septic thrombophlebitis, and endocarditis. CASE PRESENTATION We present a case of a 72 year old postoperative patient presented with persistent fever. Transthoracic and transesophageal echocardiograms demonstrated a lesion in the superior vena cava, protruding into the right atrium and infiltrating the atrial septum. Candida albicans grew in blood cultures as well as in the subclavian catheter tip culture. Anti-fungal and antithrombotic therapy was initiated. After 2 weeks treatment the lesion was diminished. CONCLUSION Transthoracic and transesophageal echocardiography has been proved efficient and cost-effective in guiding therapy in cases of catheter related infections. In the presented case the lesions in vena cava and the involvement of the endocardium were early identified by echocardiography. Moreover, a follow-up echocardiogram confirmed the efficiency of the therapeutic approach.
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Saito T, Asano M, Nomura N, Ishida M, Mizuno A, Nakayama T, Okada Y, Mishima A. Surgical Treatment for Infected Thrombus in the Superior Vena Cava Using an Off-Pump Venoatrial Shunt. Ann Thorac Surg 2008; 85:1113-4. [DOI: 10.1016/j.athoracsur.2007.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 06/08/2007] [Accepted: 08/14/2007] [Indexed: 11/25/2022]
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Mertz D, Khanlari B, Viktorin N, Battegay M, Fluckiger U. Less than 28 days of intravenous antibiotic treatment is sufficient for suppurative thrombophlebitis in injection drug users. Clin Infect Dis 2008; 46:741-4. [PMID: 18233950 DOI: 10.1086/527445] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Data about the required duration of intravenous therapy for suppurative thrombophlebitis is lacking. Among 36 episodes of proven suppurative thrombophlebitis requiring hospital admission, no relapses occurred when treatment was given for >7 days intravenously and followed by oral therapy. A <4-week course of intravenous antibiotics may be sufficient.
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Affiliation(s)
- Dominik Mertz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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Falagas ME, Vardakas KZ, Athanasiou S. Intravenous heparin in combination with antibiotics for the treatment of deep vein septic thrombophlebitis: a systematic review. Eur J Pharmacol 2006; 557:93-8. [PMID: 17222406 DOI: 10.1016/j.ejphar.2006.11.068] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 11/17/2006] [Accepted: 11/24/2006] [Indexed: 01/03/2023]
Abstract
Antibiotics, heparin, and several surgical interventions have been used in various combinations for the treatment of septic thrombophlebitis, but the optimal management remains unclear. There are limited data from comparative trials studying this issue. Specifically, only one randomized controlled trial was conducted, while the rest of the evidence comes from case series and case reports. The results of this systematic review of septic thrombophlebitis suggest that the use of heparin in combination with antibiotics is associated with low mortality in patients with this serious type of infection. In addition, adverse effects related to heparin were limited in the reported literature. Although data from comparative trials are required to draw definitive conclusions, the available evidence suggests that the administration of heparin should be considered early in the management of patients with septic thrombophlebitis.
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Volkow P, Cornejo-Juárez P, Arizpe-Bravo AB, García-Méndez J, Baltazares-Lipp E, Pérez-Padilla R. Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials. Thromb J 2005; 3:11. [PMID: 16111500 PMCID: PMC1236965 DOI: 10.1186/1477-9560-3-11] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 08/22/2005] [Indexed: 12/03/2022] Open
Abstract
Background Septic thrombophlebitis is an iatrogenic life-threatening disease associated with use of central venous devices and intravenous (IV) therapy. In cancer patients receiving chemotherapy, vein resection or surgical thrombectomy in large central venous lines is time-consuming, can delay administration of chemotherapy, and therefore can compromise tumor control. Experience with thrombolysis has been published for catheter-related thrombosis but for septic thrombosis, this experience is scarce. Results We describe three patients with cancer and septic thrombophlebitis of central veins caused by Staphylococcus aureus treated with catheter removal, thrombolysis, and intravenous (IV) antibiotics. In our reported cases, an initial bolus of 250,000 international units (IU) of streptokinase administered during the first h followed by an infusion of 20,000–40,000 IU/h for 24–36 h through a proximal peripheral vein was sufficient to dissolve the thrombus. After thrombolyisis and parenteral antibiotic for 4–6 weeks the septic thrombosis due to Staphylococcus aureus solved in all cases. No surgical procedure was needed, and potential placement of a catheter in the same vein was permitted. Conclusion Thrombolysis with streptokinase solved symptoms, cured infection, prevented embolus, and in all cases achieved complete thrombus lysis, avoiding permanent central-vein occlusion.
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Affiliation(s)
- Patricia Volkow
- Mexican National Institute of Cancer (INCan), Mexico City, Mexico
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Syed FF, Beeching NJ. Lower-limb deep-vein thrombosis in a general hospital: risk factors, outcomes and the contribution of intravenous drug use. QJM 2005; 98:139-45. [PMID: 15655094 DOI: 10.1093/qjmed/hci020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Much of the morbidity associated with deep-vein thrombosis (DVT) is absent from the evidence base used to define best clinical practice. Intravenous (IV) drug use is an increasingly frequent cause of DVT. AIM To obtain a profile of DVT patients in routine clinical care, and determine the contribution of IV drug use. DESIGN Retrospective case-note review. METHODS We reviewed 232 episodes of lower-limb DVT in a large district general hospital during 1996. RESULTS Patients had mean (range) age 62.8 (21-97) years, with 43.9% aged > 70 years. A large proportion would have been excluded from prospective studies that have contributed to current DVT guidelines. Risk factors included smoking (33.0%), immobility (26.5%), previous DVT (23.6%), surgery in the last 3 months (18.2%), malignancy (16.5%), varicose veins (10.5%) and IV drug use (6.9%). Forty-five (19.4%) had multiple risk factors. Postsurgical DVT commonly presented from the community following initial hospital discharge. Intravenous drug use accounted for 48.4% of episodes in patients aged < or =40 years. Thrombosis was right-sided in 68.8% of IV drug users, compared to 38.2% in others (p = 0.034). DISCUSSION Our patients differed from those in most of the prospective studies used to develop routine clinical care pathways for DVT. Intravenous drug use is an important cause of community-acquired DVT in young adults.
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Affiliation(s)
- F F Syed
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
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Miceli M, Atoui R, Thertulien R, Barlogie B, Anaissie E, Walker R, Jones-Jackson L. Deep Septic Thrombophlebitis: An Unrecognized Cause of Relapsing Bacteremia in Patients With Cancer. J Clin Oncol 2004; 22:1529-31. [PMID: 15084634 DOI: 10.1200/jco.2004.99.289] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Krauthamer R, Milefchik E. Endovascular treatment of upper extremity septic thrombophlebitis without thrombolysis. AJR Am J Roentgenol 2004; 182:471-2. [PMID: 14736684 DOI: 10.2214/ajr.182.2.1820471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Richard Krauthamer
- Department of Radiology, Torrance Memorial Medical Center, 3330 Lomita Blvd., Torrance, CA 90505, USA
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Lin D, Reeck JB, Murr AH. Internal Jugular Vein Thrombosis and Deep Neck Infection from Intravenous Drug Use: Management Strategy. Laryngoscope 2004; 114:56-60. [PMID: 14709995 DOI: 10.1097/00005537-200401000-00009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Internal jugular vein thrombosis (IJVT) manifests in multiple clinical scenarios including traumatic, neoplastic, and infectious processes. No clear management algorithm exists for IJVT in the setting of deep neck infections. This study examines the cause, diagnosis, and treatment strategy for IJVT in the setting of deep neck infections caused by intravenous drug use (IVDU). STUDY DESIGN Retrospective chart review. METHODS The clinical, radiographic, and laboratory data of 11 IVDU patients with deep neck infections and IJVT are reviewed in a retrospective fashion. The patients were seen in a university tertiary care facility. RESULTS Eleven patients with deep neck infections, recent history of IVDU, and concurrent IJVT were identified. All patients underwent computed tomography (CT) scanning. Antibiotic therapy was instituted in all cases, abscesses were treated invasively with aspiration or incision and drainage, and no veins were ligated or resected. Three patients received anticoagulation. One patient had bilateral IJVT with thrombus extension through the sigmoid sinus to the lateral sinus. This patient received anticoagulation and developed bacteremia. No further IJVT complications have been diagnosed at an average of 14 months postintervention. CONCLUSION IJVT and deep neck infection caused by IVDU constitute a clinical entity present even in the modern day era of antibiotic therapy. Aggressive antibiotic therapy and surgical intervention for the deep neck infection is recommended. The indications for anticoagulation remain variable. Although anticoagulation is often recommended in the presence of thrombus progression or septic emboli, the very presence of IJVT does not mandate the need for anticoagulation. Ligation or resection of the thrombosed vein may be reserved for selected cases, but was not necessary in our series.
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Affiliation(s)
- Doris Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA
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Affiliation(s)
- Craig D Newgard
- Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Torrance, USA.
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Blasco-Navalpotro M, Jordán M, Camarena JJ, Borrás S. Clinical microbiological case: thermointolerant microorganism growth in blood cultures and catheter tip. Clin Microbiol Infect 2001; 7:273-4, 285. [PMID: 11422255 DOI: 10.1046/j.1198-743x.2001.00257.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
This report of a recreational athlete who had arm discomfort, fever, headache, and emesis frames a discussion of the diagnosis and treatment for primary upper-extremity deep vein thrombosis (PUEDVT). An unusual aspect of the case was sepsis without typical risk factors. Treatment of PUEDVT usually involves immediate anticoagulation and local thrombolysis followed by evaluation for postthrombosis management; septic thrombophlebitis usually responds to intravenous antibiotics. Postthrombosis management is somewhat controversial, but first-rib resection is frequently recommended for patients who have thoracic outlet compression. This patient returned to unrestricted athletics without surgical intervention.
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Affiliation(s)
- K Deweber
- US Army Health Clinic, Schweinfurt, DE
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Freedman MD, Young M. Venous thrombosis: diagnosis and treatment; new methods and strategies for management. COMPREHENSIVE THERAPY 1999; 25:13-9. [PMID: 9987588 DOI: 10.1007/bf02889830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Venous thrombosis most often attacks patients who have had alterations of venous stasis, endothelial damage, and/or hypercoagulability. Diagnosis generally depends on venography or duplex doppler ultrasonography; treatment is usually started with heparin and may proceed to warfarin alone.
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Affiliation(s)
- M D Freedman
- Johns Hopkins University School of Medicine, Childrens Hospital & Center for Reconstructive Surgery, Baltimore, Md., USA
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Abstract
Thrombosis of the inferior vena cava (IVC) is a rare disease. It has been reported in the literature in association with a variety of noninfectious diseases, particularly carcinoma of the kidney and liver, as well as abdominal trauma and percutaneous IVC filter placement. We report a case of IVC thrombosis in a young nonpregnant patient after laparoscopic pelvic surgery. We believe it is the first case in the literature of laparoscopic-induced IVC thrombosis.
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Affiliation(s)
- K E Peck
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501, USA
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