- Email: [email protected]
TCTAP A-106 Effect of Timely Salvage on the Outcome of Thrombosed Vascular Access for Hemodialysis
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
RESULTS 515 patients (n¼266 OF, n¼249 LF, outpatients 35%) were included. 257 patients underwent coronary angiography; the remainder underwent coronary angiography with ad hoc percutaneous coronary intervention (PCI). More patients in the LF group requiring sedation than the OF group (6.8% vs 2.6%, p¼0.04) due to anxiety or radial spasm. More patients in the OF group required fluid bolus for hypotension (4% vs. 9.4%, p¼0.02). 2 patients in the OF group reported feeling nauseous post procedure, unrelated to the use of sedatives and did not lead to complications. Resting SaO2 did not drop below 92% in any patient.
S59
TCTAP A-107 Honey Intoxication: A Unique Cause of Sudden Cardiac Collapse Shekhar Rajbhandari1 Norvic International hospital, Nepal
1
BACKGROUND The honey produced by the bees fed on Rhododendron species containing grayanotoxin is known as mad honey. Grayanotoxin is found in honey obtained from the nectar of Rhododendron species growing on the mountains of the Black Sea region of Turkey and also in Japan, Nepal, Brazil, and parts of North America and Europe. Although the incidence of grayanotoxin poisoning is rare, there is concern that the number of cases per year will rise with the increasing demand for organic products. Mad honey intoxication might present with mild symptoms of cardiovascular, gastrointestinal and neurological systems or might also present with the life-threatening form with AV block and cardiovascular collapse. METHODS In this article, we describe the summary of five cases, who came to our hospital with mad honey related cardiac complications. In last one year, five cases presented in the emergency department with sudden onset of Loss of consciousness, dizziness, and shortness of breath. They felt difficulty after the consumption of 1-3 teaspoonful of wild honey. The honey was brought from most of the rural parts of Nepal like Khotang. Some of them brought the honey from the local market outside in Kathmandu. Some of them also came with vomiting, dizziness and loose stool. On examination, most of them had severe bradycardia and low blood pressure. No abnormalities were detected on systemic examinations. In one patient, ECG and cardiac enzymes showed features of the acute coronary syndrome, but his treadmill test done few days later was normal. All patients were managed with inj. Atropine, I/V normal saline and other supportive measures and discharged in a stable condition within one or two days.
CONCLUSION Allowing patients to eat and drink up until 2 hours before cardiac catheterization appeared to be well tolerated and safe and may avoid pre-procedural hypotension. Larger cohorts need to be studied to confirm these preliminary findings. TCTAP A-106 Effect of Timely Salvage on the Outcome of Thrombosed Vascular Access for Hemodialysis Dao-Ming Chen,1 Mu-Yang Hsieh,1 Chih-Cheng Wu1 National Taiwan University Hospital, Hsinchu Branch, Taiwan
1
BACKGROUND The urgency of salvage attempts on thrombosed vascular access for dialysis remains unknown. Only data from observational studies are available. We examined the effect of a timely thrombectomy approach on the outcome of vascular access for dialysis. METHODS A retrospective before-and-after study was conducted with patients who had undergone endovascular thrombectomy. A timely thrombectomy initiative, namely salvage within 24 hours after diagnosis, was started from July 2015 in our institution. Data of thrombectomy procedures within one year before and one year after the initiative were abstracted from an prospectively-followed electronic database. The immediate and patency outcomes before and after the initiative were compared. RESULTS During the study period, 329 patients were enrolled, including 165 patients before and 164 patients after the qualityimprovement initiative. The after-initiative group had fewer late thrombectomies than the before-initiative group (7.3% vs. 45.5%, p<0.01). No difference in technical success rate or clinical success rate was observed. At three months, 154 out of the 329 patients had experienced recurrent access dysfunction (primary patency rate, 53.2%). The after-initiative group had higher primary patency rate than the before-initiative group (52.1% vs. 41.5%, P¼0.06). After stratification into native or graft accesses, the difference of patency rate was only observed in the native access group (after vs. before: 68% vs. 50%, P¼0.03) but not in the graft access group (after vs. before: 50% vs. 46%, P¼0.68). After adjustment for potential confounders, a timely thrombectomy initiative remained an independent predictor of patency failure for native accesses. CONCLUSION Our results suggest that a timely thrombectomy approach within 24 hours is effective in improving patency rate of native accesses for dialysis, but not for graft accesses.
RESULTS All patients were managed with inj. Atropine, I/V normal saline and other supportive measures and discharged in a stable condition within one or two days. Though patient was very unstable when they came to the hospital. In the beginning, we assumed that they may be having some cardiac problems so they were admitted in CCU and all the basic investigations related to the cardiac cause were done. But after taking proper history we were sure of honey intoxications. They were kept for observations and all patients were managed with inj. Atropin, I/V normal saline and other supportive measures and discharged in a stable condition within one or two days. CONCLUSION Rhododendrons is the national flower of Nepal. The specific species of rhododendron found in Nepal which contains the toxin is not known. Bees feeding on these rhododendrons are known to transfer the grayanotoxin to the honey they produce. Most symptoms are mild and resolve themselves without medical intervention. Signs and symptoms of grayanotoxin poisoning rarely last more than 24 hours and are usually not fatal. Some signs of mad honey poisoning include Bradycardia, Cardiac arrhythmia, Hypotension, Nausea, and Vomiting. They respond to close monitoring and appropriate supportive treatment. Normally patients recover completely with no residual damage to the heart or its conduction system. In Nepal, many patients consume local honey brought from outside the capital even at extra cost thinking that its pure and organic. TCTAP A-108 Comparison of Procedural Time of Endomyocardial Biopsy to Jugular Vein Versus Femoral Vein Access Yusuke Nakano,1 Tomofumi Mizuno,1 Kentaro Mukai,1 Toru Niwa,1 Hirokazu Wakabayashi,1 Atsushi Watanabe,1 Hirohiko Ando,1 Hiroaki Takashima,1 Katsuhisa Waseda,1 Tetsuya Amano1 1 Aichi Medical University, Japan BACKGROUND Endomyocardial biopsy (EMB) is widely used for assessment of cardiac allograft rejection and for the diagnosis of unexplained ventricular dysfunction. EMB is usually performed through the jugular or femoral veins; however, each vascular access has advantage and disadvantage. Therefore, the aim of this study was to evaluate procedural time obtaining specimens between jugular and femoral vein. METHODS From February 2014 to May 2016, patients requiring EMB were prospectively enrolled in this study and EMB was performed by 3 preidentified technical experts. Vascular access either jugular or femoral vein were randomly assigned. Each case proposed to obtain 3 specimens. EMB procedural times and its related factors were analyzed.
RESULTS 515 patients (n¼266 OF, n¼249 LF, outpatients 35%) were included. 257 patients underwent coronary angiography; the remainder underwent coronary angiography with ad hoc percutaneous coronary intervention (PCI). More patients in the LF group requiring sedation than the OF group (6.8% vs 2.6%, p¼0.04) due to anxiety or radial spasm. More patients in the OF group required fluid bolus for hypotension (4% vs. 9.4%, p¼0.02). 2 patients in the OF group reported feeling nauseous post procedure, unrelated to the use of sedatives and did not lead to complications. Resting SaO2 did not drop below 92% in any patient.
S59
TCTAP A-107 Honey Intoxication: A Unique Cause of Sudden Cardiac Collapse Shekhar Rajbhandari1 Norvic International hospital, Nepal
1
BACKGROUND The honey produced by the bees fed on Rhododendron species containing grayanotoxin is known as mad honey. Grayanotoxin is found in honey obtained from the nectar of Rhododendron species growing on the mountains of the Black Sea region of Turkey and also in Japan, Nepal, Brazil, and parts of North America and Europe. Although the incidence of grayanotoxin poisoning is rare, there is concern that the number of cases per year will rise with the increasing demand for organic products. Mad honey intoxication might present with mild symptoms of cardiovascular, gastrointestinal and neurological systems or might also present with the life-threatening form with AV block and cardiovascular collapse. METHODS In this article, we describe the summary of five cases, who came to our hospital with mad honey related cardiac complications. In last one year, five cases presented in the emergency department with sudden onset of Loss of consciousness, dizziness, and shortness of breath. They felt difficulty after the consumption of 1-3 teaspoonful of wild honey. The honey was brought from most of the rural parts of Nepal like Khotang. Some of them brought the honey from the local market outside in Kathmandu. Some of them also came with vomiting, dizziness and loose stool. On examination, most of them had severe bradycardia and low blood pressure. No abnormalities were detected on systemic examinations. In one patient, ECG and cardiac enzymes showed features of the acute coronary syndrome, but his treadmill test done few days later was normal. All patients were managed with inj. Atropine, I/V normal saline and other supportive measures and discharged in a stable condition within one or two days.
CONCLUSION Allowing patients to eat and drink up until 2 hours before cardiac catheterization appeared to be well tolerated and safe and may avoid pre-procedural hypotension. Larger cohorts need to be studied to confirm these preliminary findings. TCTAP A-106 Effect of Timely Salvage on the Outcome of Thrombosed Vascular Access for Hemodialysis Dao-Ming Chen,1 Mu-Yang Hsieh,1 Chih-Cheng Wu1 National Taiwan University Hospital, Hsinchu Branch, Taiwan
1
BACKGROUND The urgency of salvage attempts on thrombosed vascular access for dialysis remains unknown. Only data from observational studies are available. We examined the effect of a timely thrombectomy approach on the outcome of vascular access for dialysis. METHODS A retrospective before-and-after study was conducted with patients who had undergone endovascular thrombectomy. A timely thrombectomy initiative, namely salvage within 24 hours after diagnosis, was started from July 2015 in our institution. Data of thrombectomy procedures within one year before and one year after the initiative were abstracted from an prospectively-followed electronic database. The immediate and patency outcomes before and after the initiative were compared. RESULTS During the study period, 329 patients were enrolled, including 165 patients before and 164 patients after the qualityimprovement initiative. The after-initiative group had fewer late thrombectomies than the before-initiative group (7.3% vs. 45.5%, p<0.01). No difference in technical success rate or clinical success rate was observed. At three months, 154 out of the 329 patients had experienced recurrent access dysfunction (primary patency rate, 53.2%). The after-initiative group had higher primary patency rate than the before-initiative group (52.1% vs. 41.5%, P¼0.06). After stratification into native or graft accesses, the difference of patency rate was only observed in the native access group (after vs. before: 68% vs. 50%, P¼0.03) but not in the graft access group (after vs. before: 50% vs. 46%, P¼0.68). After adjustment for potential confounders, a timely thrombectomy initiative remained an independent predictor of patency failure for native accesses. CONCLUSION Our results suggest that a timely thrombectomy approach within 24 hours is effective in improving patency rate of native accesses for dialysis, but not for graft accesses.
RESULTS All patients were managed with inj. Atropine, I/V normal saline and other supportive measures and discharged in a stable condition within one or two days. Though patient was very unstable when they came to the hospital. In the beginning, we assumed that they may be having some cardiac problems so they were admitted in CCU and all the basic investigations related to the cardiac cause were done. But after taking proper history we were sure of honey intoxications. They were kept for observations and all patients were managed with inj. Atropin, I/V normal saline and other supportive measures and discharged in a stable condition within one or two days. CONCLUSION Rhododendrons is the national flower of Nepal. The specific species of rhododendron found in Nepal which contains the toxin is not known. Bees feeding on these rhododendrons are known to transfer the grayanotoxin to the honey they produce. Most symptoms are mild and resolve themselves without medical intervention. Signs and symptoms of grayanotoxin poisoning rarely last more than 24 hours and are usually not fatal. Some signs of mad honey poisoning include Bradycardia, Cardiac arrhythmia, Hypotension, Nausea, and Vomiting. They respond to close monitoring and appropriate supportive treatment. Normally patients recover completely with no residual damage to the heart or its conduction system. In Nepal, many patients consume local honey brought from outside the capital even at extra cost thinking that its pure and organic. TCTAP A-108 Comparison of Procedural Time of Endomyocardial Biopsy to Jugular Vein Versus Femoral Vein Access Yusuke Nakano,1 Tomofumi Mizuno,1 Kentaro Mukai,1 Toru Niwa,1 Hirokazu Wakabayashi,1 Atsushi Watanabe,1 Hirohiko Ando,1 Hiroaki Takashima,1 Katsuhisa Waseda,1 Tetsuya Amano1 1 Aichi Medical University, Japan BACKGROUND Endomyocardial biopsy (EMB) is widely used for assessment of cardiac allograft rejection and for the diagnosis of unexplained ventricular dysfunction. EMB is usually performed through the jugular or femoral veins; however, each vascular access has advantage and disadvantage. Therefore, the aim of this study was to evaluate procedural time obtaining specimens between jugular and femoral vein. METHODS From February 2014 to May 2016, patients requiring EMB were prospectively enrolled in this study and EMB was performed by 3 preidentified technical experts. Vascular access either jugular or femoral vein were randomly assigned. Each case proposed to obtain 3 specimens. EMB procedural times and its related factors were analyzed.