Acute cerebral infarction in a patient with an epidural catheter after left upper lobectomy: a case report

Risk Factor Analysis of Postoperative Venous Thromboembolism in Patients After Thoracoscopic Lobectomy

OBJECTIVE

To analyze independent risk factors for postoperative venous thromboembolism (VTE) in patients after thoracoscopic lobectomy and establish a risk model for predicting thrombosis.

METHODS

We selected 135 patients who underwent thoracoscopic lobectomy and assigned them to a VTE group (n = 31) and a non-VTE group (n = 104) according to the presence or absence of postoperative VTE. Univariate and multivariate logistic regression models were built to identify independent risk factors for postoperative thrombosis. A nomogram to predict the risk of thrombosis was generated, with the predictive performance of the model being evaluated by plotting calibration curve and the receiver operating characteristic (ROC) curve.

RESULTS

D-dimer on the first postoperative day and Caprini scores were independent high-risk factors for VTE after thoracoscopic lobectomy as revealed by univariate and multivariate logistic regression analyses (p < .05). The nomogram was evaluated, and the fitting degree of calibration curve indicated good accuracy of the model in predicting thrombosis. The area under the curve (AUC) value was 0.8654, suggesting favorable diagnostic efficacy of the model.

CONCLUSION

The D-dimer on the first postoperative day and Caprini scores were independent risk factors for VTE after thoracoscopic lobectomy. The nomogram that was generated to predict the risk of thrombosis had good accuracy and diagnostic efficacy, which can guide individual risk assessment and management decisions in clinical practice.

Dyspnea after discharge from hospital due to pulmonary vein thrombosis after video-assisted left upper lobectomy: a case report

Background

Thrombus formation at the pulmonary vein transection site is more common in left upper lobectomy than other lobectomies. We report a case of dyspnea and contrast-enhanced computed tomography (CT) findings of pulmonary vein thrombosis after left upper lobectomy.

Case presentation

A 68-year-old man with left lung cancer underwent video-assisted thoracoscopic left upper lobectomy under general anesthesia with thoracic epidural analgesia. He had no postoperative complications and was discharged home on the 5th day postoperatively. He visited the outpatient clinic at 8 days after surgery because of dyspnea and underwent contrast-enhanced CT, which revealed a thrombus at the resected edge of the left upper pulmonary vein. Anticoagulation therapy was started. Thereafter, the thrombus shrank, and the patient’s dyspnea improved.

Conclusions

Left upper lobe resection is particularly associated with pulmonary venous thrombosis, and dyspnea due to pulmonary venous thrombus may develop late after surgery. Postoperative management methods such as anticoagulation and postoperative pain management should be reexamined.

Severe acute ischaemic stroke early after wedge resection in middle-aged patients: analysis and endovascular treatment

Severe acute ischaemic stroke early after wedge resection is very rare in healthy middle-aged patients. Here, we reviewed the data and characteristics of 9 cases. The infarction resulted from embolism in intracranial arteries, severely impacting the quality of life. In the first 2 patients, the onset symptom was confused with residual anaesthetic effects early after surgery. Drawing from the initial 2 cases, the following 7 patients received accurate diagnosis and emergent endovascular thrombus aspiration with good outcome due to immediate reperfusion. Furthermore, we discuss the principal causes of severe acute stroke in healthy middle-aged patients and the efficacy of endovascular thrombus aspiration.

Effect of intravenous thrombolysis combined with mechanical thrombectomy on neurological function and short-term prognosis of patients with acute cerebral infarction

OBJECTIVE

This study was to assess the effect of intravenous thrombolysis combined with mechanical thrombectomy on neurological function and the short-term prognosis of patients with acute cerebral infarction (ACI).

METHODS

A total of 120 patients with ACI admitted to our hospital from January 2019 to January 2020 were selected as research objects, and randomized into Group A (n=60) or Group B (n=60). Patients in both groups were treated with intravenous thrombolysis. Group B received ACI conventional treatment and intravenous thrombolysis, while Group A was additionally given mechanical thrombectomy. Then the neurological function scores, serum factor levels, vascular recanalization rate, incidence of adverse reactions, Thrombolysis in Myocardial Infarction (TIMI) grade flow, and effective rate of treatment were compared between the two groups. The clinical trial is available at https://clinicaltrials.gov/, ClinicalTrials.gov Identifier: NCT03502411.

RESULTS

The neurological function scores of Group A were apparently lower than those of Group B one month after treatment (P<0.001). After treatment, Group A yielded a superior serum factor level compared to Group B (P<0.001), and also showed a higher recanalization rate of blood vessels and a notably lower adverse reaction rate (all P<0.05).

CONCLUSION

Intravenous thrombolysis combined with mechanical thrombectomy can accelerate the recovery of neurological function in patients with ACI, and yield a more promising outcome in terms of the patient's vascular recanalization rate compared with the monotherapy. It can also reduce the adverse reaction rate of patients to ensure a better short-term prognosis.

Cerebral infarction After Laparoscopic Right Lung Wedge or Segment Resection: A Report of Four Cases

Several cases have been reported of patients who experienced cerebral infarction following thoracoscope left lobectomy. Compared with right lung surgery, the pulmonary veins stump after left lobe surgery were longer and thrombosis was more likely. Besides, cases of cerebral infarction after right lung surgery are rarely reported. Left lobectomy is therefore considered as the main risk factor for postoperative cerebral infarction. However, here we report four cases of cerebral infarction after thoracoscopic wedge or segment resection of right lobe, which cause less damage to the pulmonary vein compared with lobectomy. Magnetic resonance imaging and computed tomography scan reveal intracranial vascular obstruction and cerebral infarction. The case 1 had a poor prognosis because doctors lacked experience treating such complications. In the case 2, the sequela of cerebral infarction was obvious due to the large cerebral infarction area. Benefiting from timely treatment, the rest recovered better.

Acute limb ischemia by a pulmonary vein stump thrombus after left lower lobectomy: a case report

Background

Cases of systemic thromboembolism due to thrombus formation in the pulmonary vein stump after lobectomy have been reported recently. Cerebral infarction after left upper lobectomy is a common symptom in these cases. We encountered a rare case of acute limb ischemia caused by a thrombus formed in the left inferior pulmonary vein stump after left lower lobectomy.

Case presentation

A 62-year-old man underwent video-assisted left lower lobectomy under general anesthesia with epidural anesthesia. On postoperative day 2, he suddenly developed pain in the left calf. Contrast-enhanced computed tomography showed left popliteal artery occlusion and thrombus formation in the left inferior pulmonary vein stump. Anticoagulant therapy was started immediately, and emergent endovascular thrombectomy was performed. The patient recovered without complications.

Conclusions

Left lower lobectomy can cause thrombus formation in the pulmonary vein stump, leading to systemic thromboembolism. Early detection and treatment are the keys to minimize complications.

Pulmonary vein thrombosis and cerebral infarction after video-assisted thoracic surgery of the left upper lobe: a case series

BACKGROUND

Pulmonary vein thrombosis (PVT) and cerebral infarction are rare but critical complications after video-assisted thoracic surgery (VATS).

CASE PRESENTATION

We experienced two cases of massive middle cerebral artery infarction after VATS for the left upper lobe. Although the precise source of their embolus was never identified, both cases were clinically suspected PVT. Unfortunately, case 2 died because of progressive cerebral herniation. We decided to perform contrast-enhanced computed tomography routinely after VATS for the left upper lobectomy (VATS-LUL) after these cases. Case 3, a 79-year-old female patient, underwent VATS-LUL for lung cancer. She developed PVT in the stump of the left upper pulmonary vein on postoperative day 4. Anti-coagulation therapy was begun immediately and continued for 3 months. She was free of complications 7 months after the operation.

CONCLUSION

PVT and cerebral infarction may occur after VATS-LUL. Appropriate postoperative management is required to recognize PVT and to prevent life-threatening stroke.