Akutní plicní embolie (PE) je časté a život ohrožující onemocnění, jehož mortalita je stále nepřiměřeně vysoká. Katetrizační léčba plicní embolie patří mezi rychle se rozvíjející oblasti intervenční medicíny a již nyní je na některých specializovaných pracovištích dostupná. Cílem přehledového článku je stručné představení intervenční léčby akutní PE širší odborné veřejnosti, informování o jejím současném postavení ve světle platných Doporučených postupů a v neposlední řadě také nastínění budoucího možného rozvoje této oblasti.
Acute pulmonary embolism (PE) is a common and life-threatening condition with inappropriately high mortality rates. Catheter-directed treatment (CDT) for acute PE is a rapidly evolving field of interventional medicine and is already available in some specialized centers. The aim of this review article is to briefly introduce CDT for acute PE to a wider professional community, to provide information on its status in the light of current guidelines, and, last but not least, to outline possible further development in this field.
- MeSH
- katetrizace metody MeSH
- lidé MeSH
- plicní embolie * terapie MeSH
- trombektomie metody MeSH
- trombolytická terapie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- anamnéza metody MeSH
- antihypertenziva terapeutické užití MeSH
- antikoagulancia terapeutické užití MeSH
- diagnostické zobrazování MeSH
- diferenciální diagnóza MeSH
- dyspnoe etiologie MeSH
- kašel etiologie MeSH
- lidé MeSH
- myokarditida komplikace MeSH
- plicní embolie * diagnóza etiologie terapie MeSH
- plicní hypertenze * etiologie klasifikace terapie MeSH
- trombolytická terapie MeSH
- vrozené srdeční vady * komplikace patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
The current treatment algorithm for chronic thromboembolic pulmonary hypertension (CTEPH) as depicted in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnosis and treatment of pulmonary hypertension (PH) includes a multimodal approach of combinations of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapies to target major vessel pulmonary vascular lesions, and microvasculopathy. Today, BPA of >1700 patients has been reported in the literature from centers in Asia, the US, and also Europe; many more patients have been treated outside literature reports. As BPA becomes part of routine care of patients with CTEPH, benchmarks for safe and effective care delivery become increasingly important. In light of this development, the ESC Working Group on Pulmonary Circulation and Right Ventricular Function has decided to publish a document that helps standardize BPA to meet the need of uniformity in patient selection, procedural planning, technical approach, materials and devices, treatment goals, complications including their management, and patient follow-up, thus complementing the guidelines. Delphi methodology was utilized for statements that were not evidence based. First, an anatomical nomenclature and a description of vascular lesions are provided. Second, treatment goals and definitions of complete BPA are outlined. Third, definitions of complications are presented which may be the basis for a standardized reporting in studies involving BPA. The document is intended to serve as a companion to the official ESC/ERS guidelines.
- MeSH
- arteria pulmonalis chirurgie MeSH
- balónková angioplastika * metody MeSH
- chronická nemoc MeSH
- funkce pravé komory srdeční MeSH
- kardiologie * MeSH
- lidé MeSH
- plicní embolie * komplikace terapie diagnóza MeSH
- plicní hypertenze * etiologie terapie diagnóza MeSH
- plicní oběh MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Venózní tromboembolismus (TEN) je častou příčinou morbidity a mortality u hospitalizovaných nemocných. Ačkoli většinu pacientů lze bezpečně léčit antikoagulací, filtry dolní duté žíly (KF) představují u malé podskupiny pacientů důležitou alternativu k antikoagulaci. Po zavedení dočasných KF počet implantací má stoupající trend. Indikace pro zavedení KF se liberalizovaly i přes omezené důkazy podporující tuto praxi. Navíc KF jsou spojeny s řadou závažných komplikací. V tomto článku jsme komplexně zhodnotili celou problematiku KF, včetně indikací, techniky umístění a komplikací.
Venous thromboembolism (VTE) is a frequent cause of morbidity and mortality in hospitalized patients. Although most patients can be treated safely with anticoagulation, inferior vena cava filters (IVCF) represent an important alternative to anticoagulation in a small subset of patients. After the introduction of temporary IVC filters, the number of implantations has had an upward trend. Indications for IVCF insertion have been liberalized despite limited evidence supporting the practice. In addition, IVC filters are associated with a number of serious complications. In this article, we comprehensively review the entire issue of IVCF, including indications, placement technique, and complications.
- MeSH
- kardiovaskulární chirurgické výkony metody MeSH
- kavální filtry * klasifikace škodlivé účinky MeSH
- klinická studie jako téma MeSH
- kontraindikace léčebného výkonu MeSH
- lidé MeSH
- plicní embolie terapie MeSH
- vena cava inferior diagnostické zobrazování patologie MeSH
- výsledek terapie MeSH
- žilní tromboembolie terapie MeSH
- žilní trombóza terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Chronická tromboembolická plicní hypertenze je závažná komplikace akutního žilního tromboembolismu, která nepoznaná a neléčená vede ke smrti nemocného. Na kazuistice prezentujeme rozvoj plicní hypertenze u nemocného po atace plicní embolie.
Chronic thromboembolic pulmonary hypertension is a serious complication of acute venous thromboembolism which, if unrecognized and untreated, leads to death. This case report presents the development of pulmonary hypertension in a patient after pulmonary embolism.
- MeSH
- arteria pulmonalis diagnostické zobrazování patologie MeSH
- chybná diagnóza MeSH
- dospělí MeSH
- lidé MeSH
- plicní embolie * diagnostické zobrazování farmakoterapie patologie terapie MeSH
- plicní hypertenze diagnostické zobrazování etiologie patologie terapie MeSH
- progrese nemoci MeSH
- rizikové faktory MeSH
- žilní tromboembolie * diagnóza komplikace patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
Kazuistika pojednává o 16leté dívce vyšetřované pro bolesti břicha, u které byla prokázaná trombóza pánevních žil vlevo a dolní duté žíly navazující na femoropopliteální trombózu. Její stav komplikoval rozvoj plicní embolie. Pacientka byla léčena nízkomolekulárním heparinem s následnou warfarinizací a lokální trombolýzou se zavedením kaválního filtru.
The case report deals with 16-year-old girl examined for abdominal pain who was diagnosed with thrombosis of the left iliac veins and inferior vena cava connected to femoropopliteal thrombosis. Her condition was complicated by the development of pulmonary embolism. The patient was treated with low-molecular-weight heparin followed by oral anticoagulation vitamin K agonist and local thrombolysis with the insertion of caval filter.
- MeSH
- bolesti břicha etiologie MeSH
- lidé MeSH
- mladiství MeSH
- plicní embolie diagnóza terapie MeSH
- počítačová rentgenová tomografie MeSH
- výsledek terapie MeSH
- žilní tromboembolie diagnóza terapie MeSH
- žilní trombóza * diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
INTRODUCTION: Cardiovascular diseases (CVDs) are the leading cause of cardiovascular mortality and a major contributor to disability worldwide. The prevalence of CVDs is continuously increasing, and from 1990 to 2019, it has doubled. Global cardiovascular mortality has increased from 12.1 million in 1990 to 18.6 million cases in 2019. The development of therapeutic options for these diseases is at the forefront of interest concerning the extensive socio-economic consequences. Modern endovascular transcatheter therapeutic options contribute to the reduction of cardiovascular morbidity and mortality. AREAS COVERED: The article concentrates on the triad of the most common causes of acute cardiovascular mortality and morbidity - myocardial infarction, ischemic stroke, and pulmonary embolism. Current evidence-based indications, specific interventional techniques, and remaining unsolved issues are reviewed and compared. A personal perspective on the possible implications for the future is provided. EXPERT OPINION: Primary angioplasty for ST-segment elevation myocardial infarction is a well-established therapeutic option with proven mortality benefits. We suppose that catheter-based interventions for acute stroke will spread quickly from centers of excellence to routine clinical practice. We believe that ongoing research will provide a basis for the expansion of interventional treatment of pulmonary embolism soon.
BACKGROUND: Chronic immobility is prevalent, especially as people age. However, little is known about venous thromboembolism (VTE) outcomes in this population. OBJECTIVE: To compare the presentation, treatment, and outcomes in chronically immobile (>8 weeks) patients older vs. younger than 75 who presented with VTE. DESIGN: An observational international registry of patients with VTE. PARTICIPANTS: Patients with acute VTE from the "Registro Informatizado Enfermedad TromboEmbolica" (RIETE) registry who were chronically immobile. MAIN MEASURES: Baseline characteristics, presenting signs and symptoms, treatment and outcomes including major bleeding, recurrent VTE, and mortality. KEY RESULTS: Among 4612 immobile patients (mean age 75.7 years, 34% male), 2127 (46%) presented with pulmonary embolism (PE). Patients >75 years presented more often with dyspnea (44% vs. 38%) or altered mental status (23% vs. 8.1%) and less often with chest pain (13% vs. 18%). The median duration of anticoagulation was shorter in older compared with younger patients [126 vs. 169 days]. During the first 90 days of anticoagulation, major bleeding (4.0% vs. 2.2%), PE-related death (2.5% vs. 1.1%), and bleeding-related death (0.78% vs. 0.26%) occurred more frequently among older patients. In 3550 patients who received anticoagulation beyond 90 days, older patients had more major bleeding [4.23 vs. 2.21 events per 100 patient years]. After anticoagulation discontinuation, recurrent VTE and major bleeding occurred in 11.8 and 9.25 and 1.49 and 0.69 events per 100 patient years, respectively, both in similar rates in both groups. In multivariable analysis, after stopping anticoagulation, VTE recurrence was inversely associated with long-term facility residence [OR 0.51 (0.28-0.92)], anemia [OR 0.63 (0.42-0.95)], and anticoagulation duration < 90 days [OR 0.38 (0.27-0.54)]. CONCLUSIONS: Chronically immobilized patients older than 75 years presenting with VTE experience a high rate of adverse events including major bleeding and recurrent VTE. When considering treatment beyond 90 days, we should account for bleeding, recurrence risk, and associated mortality.
- MeSH
- antikoagulancia škodlivé účinky MeSH
- krvácení chemicky indukované epidemiologie komplikace MeSH
- lidé MeSH
- plicní embolie * diagnóza epidemiologie terapie MeSH
- recidiva MeSH
- registrace MeSH
- senioři MeSH
- žilní tromboembolie * diagnóza farmakoterapie epidemiologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: Intermediate-high risk acute pulmonary embolism (PE) remains associated with substantial mortality despite anticoagulation therapy. AIMS: The aim of this randomised pilot study was to compare catheter-directed thrombolysis to standard anticoagulation therapy. METHODS: Intermediate-high risk acute PE patients were admitted to a tertiary care centre (November 2019 to April 2021) and randomised in a 1:1 ratio to catheter-directed thrombolysis (CDT) or standard anticoagulation. Two catheters were used for the infusion of alteplase (1 mg/hr/catheter; total dose 20 mg) in the CDT group. The primary efficacy endpoint targeted improvement of right ventricular (RV) function, a decrease in pulmonary pressure, and a reduction of thrombus burden. RESULTS: Twenty-three patients were included (12 in the CDT group and 11 in the standard care group). The primary efficacy endpoint was achieved more frequently in the CDT group than in the standard care group (7 of 12 patients vs 1 of 11 patients, p=0.0004). An RV/left ventricular ratio reduction ≥25% (evident on computed tomography angiography) was achieved in 7 of 12 patients in the CDT group vs 2 of 11 patients in the standard care group (p=0.03). A systolic pulmonary artery pressure decrease of ≥30% or normotension at 24 hrs after randomisation was present in 10 of 12 patients in the CDT group vs 2 of 11 patients in the standard care group (p=0.001). There was no intracranial or life-threatening bleeding (type 5 or 3c bleeding, according to the Bleeding Academic Research Consortium classification). CONCLUSIONS: CDT for intermediate-high risk acute PE appears to be safe and effective. Further research is warranted to assess clinical endpoints.
- MeSH
- akutní nemoc MeSH
- antikoagulancia terapeutické užití MeSH
- fibrinolytika terapeutické užití MeSH
- katétry MeSH
- krvácení chemicky indukované MeSH
- lidé MeSH
- pilotní projekty MeSH
- plicní embolie * terapie MeSH
- tkáňový aktivátor plazminogenu * terapeutické užití MeSH
- trombolytická terapie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
