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Kasus Iskemia Tungkai Akut yang Tidak Terduga pada Pasien Sindrom Nefrotik Erickatulistiawan, Gallusena; Tjahjono, Cholid; Kurnianingsih, Novi
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.9

Abstract

Background: Acute Limb Ischemia ALI requires urgent intervention to avert irreversible tissue damage, with treatment complexity increasing in patients with nephrotic syndrome. Case Presentation: A 23-year-old female with nephrotic syndrome presented acute right leg pain. Examination showed erythema and a cold sensation in the affected leg. Ultrasound revealed no blood flow in certain leg arteries. Despite multiple thrombectomies and heparin treatment, only minimal improvement was observed. The patient underwent a below-knee amputation after unsuccessful attempts to restore blood flow. Her condition worsened with new vascular occlusions, requiring Catheter Direct Thrombolysis CDT. Post-CDT, she suffered severe bleeding, hemorrhagic shock, cardiac arrest, and multi-organ complications, leading to her death on treatment day 35. Discussion: This case illustrates the complexities of managing ALI in patients with nephrotic syndrome, which increases hypercoagulability and vascular complication risks. It highlights the need for an integrated nephrology and vascular approach, considering the high risks of hemorrhagic and thrombotic complications. A comprehensive and multidisciplinary treatment strategy is crucial, especially with vigilant monitoring for severe complications like infection and sepsis, to enhance treatment outcomes in similar cases. Conclusion: This case of a 23-year-old woman with ALI and nephrotic syndrome presented significant treatment challenges. Despite numerous interventions, including thrombectomies and CDT, severe complications ensued, emphasizing the need for comprehensive management and further research in similar complex conditions.
Correlation Between Smoking and Il-1 Level and Arterial Stiffness as Measured By Cavi in the Young Adult Population Without other Cardiovascular Risk Factors. Galih Prakosa, Ardani; Tjahjono, Cholid Tri; Kurnianingsih, Novi; Sargowo, Djanggan; Anjarwani, Setyasih
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.5

Abstract

Background: Recent studies have shown that arterial stiffness is a strong predictor of cardiovascular events and all-cause mortality, with CAVI (Cardio-Ankle Vascular Index) as a non-invasive arterial stiffness testing method indaily practice.Objective: This study was conducted to examine the relationship between smoking -as a risk factor for arterial stiffness- and CAVI values, as well as levels of IL-1β (Interleukin 1β) as a cytokine that plays a role in the pathophysiology of arterial stiffness.Methods: Eighty-four participants, including smokers and non-smokers without other cardiovascular risk factors, were included in the study. Demographic data, medical history, and smoking behavior were taken using a questionnaire, then IL-1β and CAVI levels were examinedResults: The mean level of IL-1β in smoking subjects was significantly higher (15.09 ± 0.48) than in non-smoking subjects (5.53 ± 0.79; p=0.001). CAVI values in smoking subjects were also significantly higher (8.0 ± 0.06) than in non-smoking subjects (6.9 ± 0.02; p=0.001). Further analysis showed a strong positive correlation between smoking and IL-1β levels (r=+0.776; p=0.001) and CAVI values (r=+0.759; p=0.001).Conclusion: This study shows that smoking significantly correlates with IL-1β levels and CAVI values. The greater number of cigarettes used per day and the longer duration of smoking, there was a positive correlation between IL-1β levels and arterial stiffness as measured by CAVI.
Troubleshooting for Kinked Coronary Catheter: How to Manage? ; A Case Series Noverike, Nikhen; Satrijo, Budi; Widito, Sasmojo; Kurnianingsih, Novi; Abusari, Muchamad
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.7

Abstract

Background: Catheter entrapment and knotting are two problems that might arise during coronary angiography, regardless of the method used. It is not uncommon for the catheter shaft to become kinked during diagnostic or interventional procedures. Still, if the manipulation fails, an invasive retrieval method is usually necessary for cases with extensive catheter kinking.Case Illustration: We present two cases illustrating how different angiography approaches could lead to severe catheter kinking. Because of the significant tortuosity of the vasculature, even a gentle opposite rotation maneuver and the antegrade advancement of multiple guidewires failed to untwist the guide catheter. Once a twisted catheter has been identified via fluoroscopy, the twist can be eased by gently twisting the catheter in the opposite direction. It is not always easy. It could lead to using other interventional techniques such as snare, balloon, or surgical procedures. In our cases, we used a snare to snag the catheter's tip and untied the loop's knot. This prevented the need for unscheduled surgical intervention. We evaluated from angiography. There were no further complications. The patients were released from the hospital the following day.Conclusion: Although a kinked catheter could become entrapped, various approaches can be taken to deal with this difficulty and prevent the need for surgical intervention.
An alternative retrograde access puncture for EVLA: a case report Kurniawan, Catur Rizky; Kurnianingsih, Novi; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.18

Abstract

Background: CVI manifests with a variety of clinical symptoms, spanning from varicose veins to venous ulcers, significantly impacting patients' daily lives. While traditional treatments such as compression therapy and surgery remain options, on endovenous laser treatment (EVLT) has emerged as a viable alternative.  This article delves into the management of CVI, with a particular focus EVLT as a minimally invasive intervention. Through two case illustrations, it sheds light on the difficulties encountered when accessing the great saphenous vein (GSV) using the conventional antegrade approach, particularly in cases involving obesity and vasospasm. Consequently, a retrograde EVLT technique utilizing proximal GSV access, resulting in successful vein ablation with minimal complications. Overall, this approach presents a promising addition to the management of CVI, offering enhanced patient care and improved outcomes. Case Presentation: Two patients with CVI and challenging antegrade GSV access underwent retrograde EVLT using proximal GSV access. Despite initial difficulties, including obesity and vasospasm, successful vein ablation was achieved with minimal complications. Post-procedural evaluations demonstrated significant symptomatic improvement, highlighting the efficacy of the retrograde technique. Conclusion: Retrograde EVLT utilizing proximal GSV access proves to be a safe and effective alternative in cases where antegrade access is challenging. The technique offers simplicity, minimal complications, and high patient satisfaction, with outcomes comparable to traditional approaches. Extended follow-up studies are needed to confirm the long-term effectiveness of retrograde EVLT compared to antegrade methods. Overall, retrograde EVLT presents a valuable option for managing CVI, particularly in patients with anatomical complexities or vasospasm, contributing to improved patient care and outcomes.
Technical procedure of endovenous laser ablation for chronic venous insufficiency Suprayoga, Imam Mi'raj; Kurnianingsih, Novi
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.5

Abstract

Venous insufficiency is an often-encountered medical issue. In recent years, a number of procedures have been developed for the treatment of venous insufficiency within the context of minimally invasive surgery. Endovenous laser ablation (EVLA) is a commonly used contemporary method. The ultimate outcome is the formation of fibrotic tissue that seals the lumen of the treated vein. Vein ablation procedures are often performed with local-tumescent anaesthesia, allowing patients to be treated in an office environment and resume full activity immediately afterwards. The use of EVLA is strongly recommended above surgical intervention or foam sclerotherapy, as indicated by a 1A class recommendation. The approach seems to possess significant attributes and benefits in terms of safety and efficacy. This article provides an overview of the technical technique involved in EVLA for the treatment of venous insufficiency. Additionally, it emphasises the significance of EVLA in managing venous insufficiency.
Navigating backward, healing forward: The impact of retrograde EVLT in venous ulcer management: A case report Sekarsari, Calysta Citra; Kurnianingsih, Novi; Kurniawan, Dea Arie
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.19

Abstract

Background: Chronic venous insufficiency (CVI) is a condition caused by venous reflux (backward flow) or obstruction, leading to significant morbidity and negatively impacting patients' quality of life (QoL). One recognized treatment for CVI is Endovenous Laser Treatment (EVLT). The antegrade conventional approach of EVLT is typically straightforward, but distal vein access can sometimes be difficult to achieve. Case Illustration: A 50-year-old man presented with bilateral lower extremity swelling and a chronic ulcer on his left leg that had persisted for one year without improvement. Doppler ultrasonography confirmed CVI in both lower extremities, with a great saphenous vein (GSV) reflux time exceeding 1500 ms. The patient was diagnosed with CVI C6EpAsPr and underwent EVLT. However, the small diameter of the distal GSV and vasospasm made antegrade access challenging. A retrograde approach was employed for EVLT on his left lower extremity, resulting in a successful outcome. Conclusion: This case highlights the use of the retrograde approach in EVLT as a viable alternative for accessing distal lesions when antegrade access is difficult, leading to successful wound healing. The retrograde technique can be considered a valuable option for CVI patients facing such challenges.
Precision in practice, save the limb, save the life: Early detection of grade IIA acute limb ischemia and management using catheter-directed thrombolysis - A case report Niazta, Nisa Amnifolia; Kurnianingsih, Novi; Kurniawan, Dea Arie
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.20

Abstract

Background: Acute limb ischemia is an emergency condition that causes high morbidity and mortality. Endovascular revascularization in acute limb ischemia showed better in-hospital clinical outcomes than surgical revascularization. Case illustration: A 67-year-old man was referred by internal medicine at the rural area hospital with a diagnosis of acute limb ischemia. He complained of sudden left leg pain and numbness of the left leg 2 days prior to hospital admission. He was a heavy smoker and had a predisposition for atrial fibrillation. He received heparinization at the previous hospital. Upon arriving at Saiful Anwar Hospital, a physical examination showed severe left leg pain and was difficult to move. His left leg was pulseless, paresthesia and poikilothermia. Duplex ultrasound revealed a thrombus in the left popliteal artery with no flow downwards. We diagnosed the patient with Acute Limb Ischemia Rutherford IIA left inferior extremity. We decided to perform catheter-directed thrombolysis with the Alteplase regiment. Post catheter-directed thrombolysis angiography evaluation showed TIMI flow II at the left leg after 24-hour catheter-directed thrombolysis. The patient did not complain of leg pain or numbness anymore. Conclusion: Good outcomes in this patient were obtained through the ability to make correct initial diagnosis, early administration of heparin, and immediate referral to a cardiovascular center that can provide endovascular treatment. Catheter-directed thrombolysis is the right choice for grade IIA acute limb ischemia
Rapid heparinization as a decisive strategy for acute upper limb ischemia: a case report Veliawan, Zhafran; Kurnianingsih, Novi
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.21

Abstract

Background: Acute upper limb ischemia is a rare clinical presentation of thromboembolism, mostly known in patients with atrial fibrillation. Both conservative and surgical procedures are available as alternatives to therapy. In this case report, a patient who had been diagnosed with acute upper limb ischemia received immediate heparin administration in order to protect the upper limb and restore its functional capabilities. Case Illustration: A 60-year-old male presented with acute pain and numbness, along with bluishness and a cold sensation in the right hand. He has unrestricted arm mobility. The patient has a medical background of atrial fibrillation for over 11 years. The right hand exhibited reduced peripheral saturation, pulselessness, pain, pallor, and poikilothermy, but neither paresthesia nor paralysis. Duplex ultrasonography showed no detectable blood flow from the right brachial artery up to the distal arteries. However, the vein remained audible. The patient received heparinization immediately. Conclusion: Immediate identification and administration of heparin in instances of acute upper limb ischemia (AULI) are crucial for achieving favorable outcomes and a good prognosis. Continued treatment with anticoagulants is necessary for the therapeutic intervention in order to enhance limb preservation, minimize complications, and ensure patients have an excellent quality of life subsequent to conservative treatment.