Liposuction for lymphedema has emerged as a promising lymphedema treatment. Lymphedema is obviously primarily a disease of abnormal lymphatic flow. However as lymphedema progresses, secondary changes occur. These changes include thickening and dryness of the skin as well as abnormal fat deposition. In many lymphedema patients, the edema is mainly due to accumulation of protein…
Extra-Corporeal Membrane Oxygenation (ECMO) has been used to stabilize patients who are hemodynamically unstable for various reasons. Examples include septic patients and patients post massive myocardial infarction. Indeed, some pulmonary embolism (PE) patients require immediate hemodynamic stabilization. Often, these are the sickest of PE patients and without stabilization mortality is high. The idea behind using…
Yup. You read the title correctly. True. There is a large body of data regarding IVC filter misuse, lack of proven benefit, and associated complications. I agree. Completely. I too think that IVC filters are being overutilized, placed for the wrong indications, and do not benefit most patients. I also agree that there is evidence,…
Patients who have experienced a non-traumatic artery dissection have basically proven that their arteries are weak. Thus, there is a more than theoretical risk that another dissection can happen. It can occur either at the same location or at a new one. Of course, some locations might not be the same as others. Patients obviously…
Imagine the following clinical situation: A young patient presents with a stroke. Investigation into the cause reveals a carotid artery dissection. The patient is not known to be hypertensive. They are not found to have used any drugs (prescription or otherwise). No other family members have ever had anything even remotely similar. They want to…
A vital part of the vascular physical examination is the pulse examination. It is not uncommon to see medical charts in which only specific pulses are palpated (e.g. the radial pulse). It is even more common to see charts with inaccurate descriptions of the pulse examination. For instance the term ‘pedal pulses intact’ may be…
Pulmonary embolism is one of the leading causes of death in the modern world. It is estimated that millions of people in the United States suffer from a pulmonary embolism each year. Despite this fact there is surprisingly little data to guide treatment of patients who present with moderate- and high-risk pulmonary embolism. This results…
Estimating procedural outcomes relies on both patient and procedural features. Many critical limb ischemia (CLI) patients will not achieve clinical improvement despite a successful intervention [ref]. The converse is also true: limb salvage rates may exceed arterial patency rates in certain patients [ref]. Thus, we need to take into account factors other than traditional medical…
A free floating deep vein thrombosis is a deep vein thrombus that is seen moving on real time ultrasonography. In theory, this may post a higher risk of embolization. But should treatment be different for a free floating deep vein thrombosis than for a stationary DVT? Treatment of any deep vein thrombosis (DVT) is meant…
Direct oral anticoagulants (DOAC) are a tempting option in the treatment of patients with pulmonary embolism. Advantages of DOAC for pulmonary embolism patients include ease of administration, no need for monitoring and relatively few drug interactions. These advantages potentially allow for patients who had a pulmonary embolism to be treated as outpatients or at least…
