Massage-induced delayed venous stent migration

Axillary massage induced lateral thoracic artery pseudoaneurysm rupture: Case report

INTRODUCTION AND IMPORTANCE

Massage is a form of health care, but incorrect techniques can potentially harm the human body (Qin et al., 2023 [1]). While there have been no reported cases of lateral thoracic artery pseudoaneurysm and rupture induced by axillary massage, it is important to further explore how to address and prevent such potential risks.

CASE PRESENTATION

This case study highlights a rare occurrence where a 61-year-old female patient experienced a lateral thoracic artery pseudoaneurysm and ruptured as a result of an axillary massage. The patient, self-taught in Chinese medicine and massage, regularly rubbed the Jiquan points in her armpits to promote heart health, with each session lasting 30-60 min for two years. She presented with symptoms such as dizziness, palpitations, left armpit pain, and oedema, leading to her admission to a nearby hospital. Despite receiving blood transfusions, her symptoms did not improve, necessitating her to refer to our hospital. A CT angiography scan of her upper limb arteries revealed the presence of a left lateral thoracic artery pseudoaneurysm and rupture, resulting in subcutaneous hematoma in the left axilla, chest, and back. Following angiography, successful embolisation was performed. Three months after surgery, the patient regained full mobility and was free from pain in her left upper limb.

CLINICAL DISCUSSION

The armpit region contains a high concentration of nerves and blood vessels, making it crucial to have a thorough understanding of its anatomy and to use precise massage techniques. Damage to the axillary arteries can result in severe complications, which can be addressed through either open or endovascular interventional procedures. This article reviews existing literature and guides in managing these specific scenarios.

CONCLUSION

Caution should be exercised when performing an armpit massage, as a thorough understanding of the anatomy of the axillary area is crucial. Injury to the lateral thoracic artery is a potential risk during axillary massage, and in such cases, endovascular intervention may be considered.

Endovascular Strategy for Inferior Vena Cava Thrombosis Secondary to Deep Venous Thrombosis of the Lower Extremities: Early Experience From Two Centres

PURPOSE

To evaluate the safety, feasibility and technical aspects of endovascular treatments for inferior vena cava (IVC) thrombosis secondary to deep venous thrombosis of the lower extremities.

MATERIALS AND METHODS

A retrospective study of patients from two centres who received endovascular treatment for IVC thrombosis from January 2015 to December 2020. Under the protection of the IVC filter, all lesions were treated with manual aspiration thrombectomy (MAT) followed by catheter-directed thrombolysis (CDT). Technical aspects, complications, IVC patency, Venous Clinical Severity Score (VCSS) score and Villalta score were recorded during the follow-up observation.

RESULTS

Endovascular procedures including MAT and CDT were performed successfully in 36 patients (97.3%). The average duration of the endovascular procedure was 71 minutes (range: 35-152 min). To protect against fatal pulmonary artery embolism, 33 filters (91.7%) were deployed in the inferior renal IVC, while three patients (8.3%) received filter implantation in the retrohepatic IVC. No severe complications occurred during the procedure. In the follow-up observations, the cumulative primary and secondary patency rates in IVC were 95% and 100%, respectively. The patency rates for the iliac vein were as follows: a primary patency rate of 77% and a secondary patency rate of 85%. The average VCSS score was 5.9 ± 2.6, and the Villalta score was 3.9 ± 2.2. The rate of post thrombotic syndrome is 22% in our study as assessed by the villalta score (Villalta score>4).

CONCLUSIONS

Endovascular treatment for IVC thrombosis secondary to DVT of the lower extremities is feasible, safe, and effective. This strategy alleviates venous insufficiency and results in a high patency rate in IVC.

Silent Migration of a Left Common Iliac Venous Stent to the Right Atrium: A Case Report and Review of Literature

In the past decade, percutaneous endovenous stenting has emerged as the primary procedure for treating symptomatic venous outflow obstruction. Stent migration is a rare but serious and well-recognized complication of venous stenting. Cardiopulmonary complications following stent migration can manifest in a number of ways, including damage to the valves, arrhythmias, endocarditis, tamponade, and acute heart failure. Both extracardiac and intracardiac dislodgement of stents may be treated with catheter-directed extraction, stent redeployment, or surgical extraction. The decision on the type of procedure depends on multiple factors including the location of the stent, the size and accessibility of the stent, the symptoms, the extent of damage to the vital structures, and the overall health of the patient. We present the case of a 68-year-old male who presented with tachycardia. On further evaluation and workup, he was found to have an iliac venous stent that had migrated to the right atrium.

Bilateral common iliac vein stent migration

Venous stent migration to the heart is considered to be a rare complication of a common procedure. Therefore, many physicians do not include this complication in their differential diagnosis. We explain why this complication is likely more common than currently thought and why it should be considered as a potential diagnosis. This case describes migration of bilateral iliac vein stents into the right ventricular outflow tract and right interlobar pulmonary artery. We provide multiple imaging modalities demonstrating the migrated stents. We believe radiologists should be cognizant of this complication and consider it as a potential diagnosis. Hopefully, this will create a greater awareness of this life-threatening complication of venous stent placement.

An Unusual Cause of Acute Heart Failure: A Case Report of Iliocaval Venous Stent Migration

Stent migration is an uncommon complication of endovascular stenting procedures. It could cause serious cardiovascular complications. In this article, we describe an interesting case of acute heart failure as a result of stent embolization from the left common iliac vein into the right ventricle and how it was identified and managed.

Novel Compliant Scaffold with Specific Design for Venous System: Results of a Porcine Model Study

Background

Stenting has become the first-line treatment of obstructive venous disease because of poor results of balloon angioplasty. This preclinical study aimed to investigate the safety and efficacy profile of a novel compliant venous scaffold (CVS) denominated Petalo CVS, specifically designed for venous diseases.

Materials and Methods

Twelve healthy pigs weighing 90 kg were used to test Petalo CVS. The devices were implanted into the internal jugular veins (IJVs) using a femoral vein percutaneous approach. The safety profile including the success rate of device releasing, anchoring, and positioning was evaluated immediately. Fracture, migration, primary patency, and endothelial response were assessed at 1, 2, 3, and 6 months after the study procedure.

Results

A total of 32 devices were successfully released in both IJVs. No procedure- or device-related complications were reported, and all pigs successfully completed the different scheduled follow-up periods. The primary patency rate was 100%, and no fracture or migration of the device into the brachiocephalic trunk was reported. Histological examination revealed only minimal lesions with minimal or absent inflammatory reaction surrounding the incorporated metallic rods.

Conclusions

This porcine model study showed a promising safety and efficacy profile of Petalo CVS, a novel endovenous device based on specific concepts.

Severe tricuspid regurgitation due to valvular entrapment of an inferior vena cava stent

Endovascular venous stenting is increasingly performed for a variety of conditions. Inferior vena cava stent migration has been reported up to 6 months after placement; stent migration 6 months after implantation is uncommon. To our knowledge, this is only the second reported case of late stent migration with valve entrapment 1.

Interdisciplinary management of deep vein thrombosis during rehabilitation of acute rupture of the anterior cruciate ligament: a case report

OBJECTIVE

The purpose of this case report is to describe a patient who experienced deep venous thrombosis (DVT) during pre-operative rehabilitation of an acute rupture of an anterior cruciate ligament (ACL) reconstruction graft, to increase awareness of DVT occurring in a healthy individual after periodic immobilization, and to describe the interdisciplinary management for this patient.

CLINICAL FEATURES

A 30-year-old male was referred to a chiropractic clinic for presurgical treatment of a left ACL rupture and medial meniscus tear confirmed at magnetic resonance imaging. During the course of preoperative rehabilitation, the patient became limited in ambulation and presented for a routine rehabilitation visit. During this visit, he experienced increased leg swelling, pain and tenderness. The patient was assessed for DVT and was referred to the local emergency department for further evaluation where multiple DVTs were found in the left popliteal, posterior tibial, and peroneal veins.

INTERVENTION/OUTCOME

The patient was treated with a 17-week course of warfarin during which time the clinical signs and symptoms of DVT resolved. Meanwhile, the patient completed the rehabilitation treatment plan in preparation for ACL reconstruction without further complications.

CONCLUSIONS

This case raises awareness that DVT may occur in a healthy individual after periodic immobilization. While there may be controversy regarding the appropriate application of pharmaceutical anticoagulants in patients with DVT of the leg, the most risk averse strategy is for a short duration prescription medication with compression stockings. Through interdisciplinary management, the patient experienced a successful outcome.