Apparent Diffusion Coefficient in the Resolution of Renal Ischemia after Angioplasty on Diffusion-weighted Imaging: A Case of Renal Artery Stenosis Caused by Progressive Thrombosis in Residual Chronic Aortic Dissection.
We report a case in which diffusion-weighted magnetic resonance imaging (DWI) demonstrated renal artery stenosis-related renal ischemia and the therapeutic efficacy of revascularization. The patient was a 73-year-old man, who underwent descending thoracic aortic replacement due to DeBakey IIIb chronic aortic dissection, and who showed progressive renal dysfunction due to right renal artery stenosis caused by false lumen thrombosis. DWI demonstrated a decreased apparent diffusion coefficient (ADC) in the right kidney, indicating renal ischemia. Angioplasty with stenting restored renal perfusion and improved the renal function, resulting in the normalization of the decreased ADC in the treated kidney. Thus, DWI can be used to monitor renal ischemia in cases involving advanced renal artery stenosis. PMID: 31956203 [PubMed - as supplied by publisher]
ConclusionHigh index of suspicion for thrombophilic disorders is required in postpartum patients presenting with respiratory distress as prompt diagnosis and urgent intervention can save patient’s life.
We thank Takagi et al for their additional analyses related to the systematic review we reported.1 Abdominal aortic aneurysm (AAA) size has previously been shown to be strongly correlated with intraluminal thrombus (ILT) volume and we agree this is an important confounding factor when examining the association betwe en ILT volume and AAA rupture.2 We therefore performed a subanalysis that included studies that matched for AAA size.1 That analysis actually included a total of 181 participants, not 77 as stated by Takagi et al.
We read with great interest a systematic review and meta-analysis by Singh et al1 of the relation of volume of intramural thrombus (IMT) to rupture of abdominal aortic aneurysm (AAA). The authors1 identified greater volume of IMT in ruptured AAA (RAAA) than in intact AAA (IAAA) (finding A) and no difference in IMT volume between RAAA and IAAA in patients matched for AAA dia meter or other covariates (finding B). The latter finding, however, was derived from only three studies2,3 enrolling 77 patients.
During the past decade, major advances in the treatment of acute deep venous thrombosis (DVT) have been achieved through the availability of oral direct thrombin/anti-Xa inhibitors and additional understanding gained in the use of pharmacomechanical catheter-directed thrombolysis in iliofemoral DVT through the results of the ATTRACT (Acute venous Thrombosis: Thrombus Removal with Adjunctive Catheter-directed Thrombolysis) prospective clinical trial. During this same period, Dr Henke and his colleagues have made important contributions to our understanding of the pathogenesis of DVT and, in particular, the role of inflammation in this process.
To determine the efficacy and safety of transjugular intrahepatic portosystemic shunt and portal vein recanalization (TIPS-PVR) for portal vein thrombosis (PVT) in patients without cirrhosis.
To characterize the creation of TIPS in patients with difficult anatomy due to portal venous thrombosis including indications for TIPS, technical feasibility, and adjunctive techniques.
To study the efficacy of the Jeti thrombectomy device in patients with acute DVT.
The ClotTriever Outcomes (CLOUT) Registry evaluates real-world outcomes following treatment of acute and non-acute lower extremity proximal deep vein thrombosis (DVT) with the ClotTriever System. The ClotTriever System (Inari Medical, Irvine, CA) is a mechanical thrombectomy system cleared for the non-surgical removal of soft thrombi and emboli from peripheral blood vessels.
The EkoSonic Endovascular System has been used to clear blood clots in patients with pulmonary embolism, deep vein thrombosis or peripheral arterial occlusions by applying ultrasound (US) in combination with lytic drugs. It is believed that clots exposed to acoustic pulses undergo structural changes in the fibrin network. To better understand this US effect, changes to fibrinogen and plasma clots treated with US were investigated using clot turbidity measurements and scanning electron microscopy (SEM) images.
To determine the clinical outcomes of patients with underlying acquired or congenital thrombophilia who underwent lower extremity venous catheter-directed thrombolysis (CDT) for treatment of deep vein thrombosis.