Cases reported "Postoperative Hemorrhage"

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1/3. Interventional therapy of vascular complications caused by the hemostatic puncture closure device angio-seal.

    The hemostatic puncture closure device Angio-Seal is a quick, safe, and easy-to-use system, allowing rapid sealing of the vascular access site following coronary angiography and interventional procedures. It is advantageous for patients in whom early mobilization is desired and may therefore decrease hospital costs. Despite the documented low complication rate, there are some specific problems. Reporting on five cases, we describe problems in diagnosis and possible interventional therapy of Angio-Seal-associated complications such as stenosis, occlusion, or peripheral embolism. Our experience led to the concept of precise diagnosis in any patient with leg symptoms and early interventional treatment with the aim of complete removal of the intra-arterial parts of the Angio-Seal device. Any delay in diagnosis and treatment increases the risk of additional thrombotic occlusion. Spontaneous dissolution of the Angio-Seal sponge limits interventional possibilities of complete removal. Cathet. Cardiovasc. Intervent. 49:142-147, 2000.
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ranking = 1
keywords = vascular complication
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2/3. Access site management after aortic valvuloplasty using a suture mediated closure device: clinical experience in 4 cases.

    Management of the femoral access site following percutaneous balloon aortic valvuloplasty is often associated with significant vascular morbidity. In an effort to reduce vascular complications, a novel method of suture mediated closure device deployment was employed in four patients that underwent aortic valvuloplasty at our institution. Delivery of the sutures to the access site took place prior to the intervention in all patients. This pre-close technique allowed the sutures to be placed utilizing the 10 French (Fr) closure device prior to expanding the access site to a 14 Fr size. This was done to facilitate adequate tissue capture, thereby assuring successful hemostasis following sheath removal. The technique was successful in all patients and none of the patients suffered vascular complications. This new access site management method was successful in achieving hemostasis and provided improved patient recovery in this small group of patients as compared to our usual experience.
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ranking = 0.5
keywords = vascular complication
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3/3. Unusual late vascular complications of sagittal split osteotomy of the mandibular ramus.

    Intraoperative or early postoperative vascular complications are not uncommon problems in sagittal split osteotomies of the mandibular ramus; however, reports of late complications are considerably rarer. Here, we present two patients who sustained late vascular complications after the sagittal split osteotomy. The first patient had a delayed bleeding, which presented itself as a rapidly expanding swelling of the left cheek from the left external carotid artery 18 days postoperatively. During exploration, a 2 mm laceration of the external carotid artery located just proximal to the bifurcation of the internal maxillary artery and the superficial temporal artery was successfully repaired. The prominent bony spike of the cut end of medial cortex of the set-back mandibular ramus was found against the arterial wall and could possibly have caused the progressive necrosis of the wall with subsequent spontaneous rupture. The second patient suffered from a mild noise in the right ear 2 weeks after the initial surgery; however, a pre-auricular arteriovenous fistula between the right external carotid artery and the external jugular vein was discovered 1 year postoperatively. The diagnosis was confirmed by angiography, and the lesion was treated successfully by therapeutic embolization at that time. To avoid vascular injury, sufficient protection of the soft tissue during exposure of the mandibular ramus is mandatory. In addition, the direction of the cut of medial cortex is suggested to avoid the cranialward inclination that creates a sharp, bony end against the artery. awareness of the possible late vascular complications to facilitate early detection and management is also important.
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ranking = 1.75
keywords = vascular complication
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