Transcatheter aortic valve replacement through the carotid artery in a 60-year-old man with aortic stenosis and chronic dialysis: a case report

Case Study

Abstract

Transcatheter aortic valve replacement (TAVR) through the carotid artery in middle-aged patients with severe aortic stenosis and chronic hemodialysis has been a challenge in clinical practice because of the complex technique. A 60-year-old man was admitted to our hospital because of his symptomatic severe aortic stenosis. With the high risk of open surgery due to chronic hemodialysis, TAVR was selected after an in-depth discussion between the heart team and the patient. The transfemoral access route was not appropriate due to severe calcifications and tortuous iliofemoral arteries, therefore, the left carotid route was chosen. A 29-mm CoreValve Evolut R system was successfully implanted without any complications. His symptoms significantly improved at 12- month follow-up, without any major cardiovascular adverse events. TAVR via the carotid artery thus demonstrates the feasibility, safety, and effectiveness in such complex conditions. 

Graphical abstract

Cancer-related thrombosis among older patients in a hospital in Vietnam: A retrospective study

Original Research

Abstract

Introduction: Venous thromboembolism (VTE), a highly prevalent complication in cancer patients, causes prolonged hospitalization and mortality. This study aimed to investigate the characteristics of VTE in older patients with cancer.

Methods: This was a retrospective study. Data were extracted from electronic medical records at the Geriatrics-Palliative Care Department of University Medical Center Ho Chi Minh City. Inclusion criteria included: aged ≥ 60 years, confirmed or newly diagnosed with cancer, and new VTE diagnosis. Exclusion criteria included lacking any information on demographics, laboratories, or treatments. Pulmonary embolism (PE) was confirmed using chest computerized tomography scans, while deep vein thrombosis (DVT), and other types of venous thrombosis were confirmed based on a doppler or abdominal ultrasound. Data were analyzed using Stata 15.0, with p <0.05 signifying statistical significance.

Results: Data of 151 patients were extracted from 1170 medical records (median age: 67, range 60 to 89 years). The three most frequent types of VTE were portal vein thrombosis (48.3%), PE (30.5%), and DVT (29.1%). Stage IV cancer was found in 74.2% of VTE patients. Leg pain was presented in 59.1% of the patients with DVT, and dyspnea was confirmed in 80.4% of the patients with PE. Anticoagulant therapy was the most common treatment for VTE (33.8%) and no major bleeding was recorded.

Conclusions: VTE was highly common among older patients with advanced cancer. Leg pain was an indicator of DVT and dyspnea was a warning sign of PE in older patients with cancer. No major bleeding was recorded in those receiving anticoagulants. 

Graphical abstract

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