Post-embolisation syndrome (PES) is a prevalent complication that occurs in patients following uterine artery embolisation (UAE) for the treatment of uterine fibroids. The aetiology of PES remains incompletely understood, although postulated to result secondary to tissue infarction resulting in release of inflammatory mediators. We followed PRISMA guidelines and performed a systematic review of studies of PES following UAE from inception to October 2022. Our published protocol was prospectively registered. Our search yielded 54 results. We reviewed 22 full texts, and nine articles were included. Observational studies comprised 6/9 relevant studies, with 5/9 retrospective design. The rate of PES was documented in 5/8 studies (excluding case report) with a reported incidence ranging from 4–34.6%. Five of the nine studies studies postulated that the aetiological basis of PES is inflammatory related. Further research is necessary to advance our understanding of PES to define the biological basis of the syndrome with more certainty and gain a consensus on peri-procedure management to reduce incidence and improve patient outcomes.
We report the case of a non‐cirrhotic 25‐year‐old female patient with cryptogenic portal hypertension who underwent cyanoacrylate injection for acute gastroesophageal variceal bleeding with a subsequent embolic stroke via a previously unrecognised portopulmonary venous anastomosis.
Pulmonary embolism (PE) secondary to trauma is the third most common cause of death in trauma patients who have survived 24 hours following injury. We describe a case of PE diagnosed within 3 hours of a major trauma in a previously well adolescent female. The early occurrence of PE in this case is at odds with what is generally reported (3–5 days) after major trauma. General consensus is that patients who suffer major trauma move from an initial hypocoaguable state, with increased risk of bleeding, to normocoagulable or hypercoaguable state, with a subsequent increased risk of venothromboembolism. However, Sumislawski et al recently demonstrated that a marginally greater proportion of trauma patients were in fact hypercoaguable rather than hypocoaguable on arrival to hospital and that trauma-induced coagulopathy tended to resolve within 24 hours; such data cause us to re-evaluate when to commence thromboprophylaxis for major trauma patients.
27 May 2022 in Journal of Vascular and Interventional Radiology
Background: External compression, thrombosis, or stenosis of the superior vena cava can lead to superior vena cava syndrome, a diagnosis that should be considered swiftly in patients presenting with classic symptoms such as facial and neck swelling, plethora, and distended neck veins. Case Presentation: We report a case of acute port-a-cath associated superior vena cava thrombosis in a longstanding, previously uncomplicated vascular access device in a patient with stable ER+/PR+/HER2+ metastatic breast cancer. After initial treatment, there was limited clinical improvement with subcutaneous low molecular weight heparin (LMWH). Following multidisciplinary team discussion, catheter-directed thrombolysis was performed, which resulted in complete symptom resolution. Conclusion: The recognition of signs and symptoms is crucial in diagnosing acute superior vena cava syndrome, particularly in patients with a malignancy history or a central venous access device in situ. The thrombotic complications of port-a-cath symptoms can occur at any time and management should be guided by multidisciplinary discussion. In appropriately selected patients, catheter-directed thrombolysis can be successful and can lead to rapid symptom resolution.