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Falcoz MT, Falvo N, Aho-Glélé S, Demaistre E, Galland C, Favelier S, Pottecher P, Chevallier O, Bonnotte B, Audia S, Samson M, Terriat B, Midulla M, Loffroy R. Endovascular stent placement for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions: a single-center study of safety, efficacy and quality-of-life improvement. Quant Imaging Med Surg 2016; 6:342-352. [PMID: 27709070 DOI: 10.21037/qims.2016.07.07] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a frequent complication of deep vein thrombosis (DVT) despite adequate treatment. Venous angioplasty and stent placement has been progressively used to restore and maintain venous patency in PTS patients. This study reports our single-center experience with the use of endovascular treatment for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions. METHODS A prospective mono-centric observational cohort study of PTS patients with chronic symptomatic ilio-femoral venous obstructive lesions referred for endovascular treatment was conducted from March 2012 to April 2016. Procedure consisted in recanalization, pre-dilation and self-expandable stenting of stenotic or occluded iliac and/or femoral veins. Severity of PTS, quality-of-life and treatment outcomes were assessed using Villalta scale and Chronic Venous Insufficiency Questionnaire (CIVIQ-20) at baseline and 3 months after the procedure. Imaging follow-up was based on duplex ultrasound (US) and computed tomography (CT). RESULTS Twenty-one patients (11 females, 10 males; median age, 41 years; range, 32-60) were included. Recanalization and stenting was successfully accomplished in all prime procedures, 4 patients benefitted from an additional procedure. Immediate technical success rate was 96% considering 25 procedures, performed without any complications. Median follow-up was 18 months (range, 6-30 months) with a 90.5% stent patency rate. Villalta score significantly decreased from baseline compared with 3 months after the procedure [14 (range, 11-22) and 5 (range, 1-10), respectively, P<0.0001], showing a significant decrease in the severity of PTS. CIVIQ-20 score significantly decreased from baseline compared with 3 months after stenting [48.5 (range, 39-73) and 26.5 (range, 21-45), respectively, P<0.0001] thus showing a significant improvement of quality-of-life. Post-procedural CIVIQ-20 score was significantly associated with Villalta score (95% CI, 1.53-2.95; P<0.0001). CONCLUSIONS Our results confirm the high clinical success rate and safety of endovascular PTS treatment and highlight the significant impact of stenting on the quality of life of patients with chronic symptomatic ilio-femoral venous obstructive lesions.
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Affiliation(s)
- Marie-Tiphaine Falcoz
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Nicolas Falvo
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Serge Aho-Glélé
- Department of Epidemiology, Statistics and Clinical Research, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Emmanuel Demaistre
- Department of Biological Haemostasis and Thrombosis Treatment, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Christophe Galland
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Sylvain Favelier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Pierre Pottecher
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Béatrice Terriat
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, BP 77908, 21079 Dijon Cedex, France
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Razavi MK, Jaff MR, Miller LE. Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction: Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2016; 8:e002772. [PMID: 26438686 DOI: 10.1161/circinterventions.115.002772] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Endovenous recanalization of iliofemoral stenosis or occlusion with angioplasty and stent placement has been increasingly used to maintain long-term venous patency in patients with iliofemoral venous outflow obstruction. The purpose of this systematic review and meta-analysis was to determine safety and effectiveness of venous stent placement in patients with iliofemoral venous outflow obstruction. METHODS AND RESULTS We searched MEDLINE and EMBASE for studies evaluating safety or effectiveness of stent placement in patients with iliofemoral venous outflow obstruction. Data were extracted by disease pathogenesis: nonthrombotic, acute thrombotic, or chronic post-thrombotic. Main outcomes included technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years. A total of 37 studies reporting 45 treatment effects (nonthrombotic, 8; acute thrombotic, 19; and chronic post-thrombotic, 18) from 2869 patients (nonthrombotic, 1122; acute thrombotic, 629; and chronic post-thrombotic, 1118) were included. Technical success rates were comparable among groups, ranging from 94% to 96%. Complication rates ranged from 0.3% to 1.1% among groups for major bleeding, from 0.2% to 0.9% for pulmonary embolism, from 0.1% to 0.7% for periprocedural mortality, and from 1.0% to 6.8% for early thrombosis. Patient symptom relief data were reported inconsistently. At 1 year, primary and secondary patency were 96% and 99% for nonthrombotic, 87% and 89% for acute thrombotic, and 79% and 94% for chronic post-thrombotic. CONCLUSIONS Stent placement for iliofemoral venous outflow obstruction results in high technical success and acceptable complication rates regardless of cause of obstruction.
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Affiliation(s)
- Mahmood K Razavi
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.).
| | - Michael R Jaff
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.)
| | - Larry E Miller
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.)
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Saha P, Black S, Breen K, Patel A, Modarai B, Smith A. Contemporary management of acute and chronic deep venous thrombosis. Br Med Bull 2016; 117:107-20. [PMID: 26893407 DOI: 10.1093/bmb/ldw006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This review aims to provide an update on the management of deep vein thrombosis (DVT). SOURCES OF DATA A systematic search of PubMed, Google Scholar and Cochrane databases was carried out. AREAS OF AGREEMENT Direct oral anticoagulants (DOACs) are as effective and easier to use than vitamin K antagonists for the treatment of DVT. Catheter-directed thrombolysis can reduce post thrombotic syndrome in patients with iliofemoral DVT. Compression bandaging can help heal a venous ulcer. AREAS OF CONTROVERSY Compression hosiery to prevent post thrombotic syndrome. Long-term evidence to show clinical benefit of using endovenous therapies to restore deep vein patency. GROWING POINTS Developing imaging methods to identify patients who would benefit from venous thrombolysis. The evolution of dedicated venous stents. AREAS TIMELY FOR DEVELOPING RESEARCH Understanding the mechanisms that lead to stent occlusion and investigation into the appropriate treatments that could prevent in-stent thrombosis is required.
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Affiliation(s)
- Prakash Saha
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Stephen Black
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Karen Breen
- Department of Thrombosis and Haemostasis, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, London SE1 7EH, UK
| | - Ashish Patel
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Bijan Modarai
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Alberto Smith
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
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Yim NY, Kim JK, Kim HO, Kang YJ, Jung HD. Iliac Vein Stent Fracture Due to a Migrated Retrievable Vena Cava Filter. Vasc Endovascular Surg 2016; 50:94-7. [PMID: 26912396 DOI: 10.1177/1538574416628653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of iliac vein stent fracture due to hooking by a migrated retrievable inferior vena cava filter in a 55-year-old woman with acute deep venous thrombosis related to May-Thurner syndrome.
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Affiliation(s)
- Nam Yeol Yim
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
| | - Jae Kyu Kim
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
| | - Hyoung Ook Kim
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
| | - Yang Jun Kang
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
| | - Hye Doo Jung
- Department of Radiology, Chonnam National University Hospital, Jebong-ro, Dong-gu, Gwangju, Korea
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Endovascular Stent Placement for May–Thurner Syndrome in the Absence of Acute Deep Vein Thrombosis. J Vasc Interv Radiol 2016; 27:167-73. [DOI: 10.1016/j.jvir.2015.10.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/09/2015] [Accepted: 10/31/2015] [Indexed: 12/25/2022] Open
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Shi WY, Gu JP, Liu CJ, He X, Lou WS. Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis: A retrospective study on mid-term in-stent patency from a single center. Eur J Radiol 2016; 85:7-14. [DOI: 10.1016/j.ejrad.2015.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
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Marston WA, Chinubhai A, Kao S, Kalbaugh C, Kouri A. In vivo evaluation of safety and performance of a nitinol venous stent in an ovine iliac venous model. J Vasc Surg Venous Lymphat Disord 2016; 4:73-9. [DOI: 10.1016/j.jvsv.2015.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/29/2015] [Indexed: 10/22/2022]
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Klitfod L, Just S, Foegh P, Baekgaard N. Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome. Acta Radiol Open 2015; 4:2058460115592164. [PMID: 26445677 PMCID: PMC4580121 DOI: 10.1177/2058460115592164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022] Open
Abstract
Background Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired quality of life in more than 50%. Endovascular treatment for iliac vein obstruction using stents is known to alleviate PTS symptoms in selected patients. Purpose To report the Danish long-term results of endovascular treatment with iliac stenting. Material and Methods From 2000 to 2013 consecutive patients were evaluated and 19 patients with severe venous claudication were identified and subsequently underwent angioplasty and stenting. AC treatment was prescribed for 6 months, and knee-high class II compression stocking recommended for 1 year. Scheduled follow-up was done in the outpatient clinic at 6 weeks, 3 months, and annually thereafter. Results Nineteen patients, all women, all with left-sided iliac vein obstruction, and all with severe PTS symptoms were included. The median follow-up time was 81 months (range, 1–146 months; mean, 69 months). Primary patency rate of the inserted iliac stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. Conclusion Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS.
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Affiliation(s)
- Lotte Klitfod
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Sven Just
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Pia Foegh
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Niels Baekgaard
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
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Fatima J, AlGaby A, Bena J, Abbasi MN, Clair DG. Technical considerations, outcomes, and durability of inferior vena cava stenting. J Vasc Surg Venous Lymphat Disord 2015; 3:380-388. [DOI: 10.1016/j.jvsv.2015.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
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Adam L, Wyss TR, Do DD, Baumgartner I, Kucher N. Endovascular stent reconstruction of a chronic total occlusion of the inferior vena cava using bidirectional wire access and a balloon puncture by a re-entry device. J Vasc Surg Venous Lymphat Disord 2015; 3:442-445. [DOI: 10.1016/j.jvsv.2015.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/30/2015] [Indexed: 11/16/2022]
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O'Sullivan GJ, Waldron D, Mannion E, Keane M, Donnellan PP. Thrombolysis and iliofemoral vein stent placement in cancer patients with lower extremity swelling attributed to lymphedema. J Vasc Interv Radiol 2015; 26:39-45. [PMID: 25541444 DOI: 10.1016/j.jvir.2014.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 10/08/2014] [Accepted: 10/12/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess the effects of iliofemoral vein stent placement on symptomatic lower extremity swelling (LES), presumed to be lymphedema, in patients with cancer. MATERIALS AND METHODS During the period 2005-2013, 62 patients (38 female; age, 60.4 y ± 15.4) with histology-proven metastatic disease and LES resistant to standard therapies were evaluated and found to have venous outflow obstruction. Stents were placed in the iliofemoral veins or inferior vena cava, or both, and evaluated by color Doppler ultrasound or contrast-enhanced computed tomography during the follow-up period. Patient symptoms were assessed using the Venous Disability Score (VDS) and the Galway Limb Swelling score, a patient-directed, 5-question symptom scoring system. RESULTS Stents were successfully placed in all patients. During the follow-up period, in-stent thrombosis occurred in 13 patients, and additional stents were placed in 3 patients to treat luminal narrowing. The mean VDS improved significantly (P < .05): from 3.0 ± 0 on the day of the procedure to 2.95 ± 0.22 on day 3, 2.0 ± 0.33 on day 7, and 1.87 ± 0.34 on day 30. The mean Galway Limb Swelling score also improved significantly (P < 0.001): from 3.6 ± 0.74 on the day of the procedure to 1.96 ± 0.91 on day 3, 1.06 ± 0.78 on day 7, and 0.6 ± 0.66 on day 30. During the follow-up period, 60 patients died as a result of their underlying malignancy (mean, 230 d; range, 5-1,080 d). CONCLUSIONS Iliofemoral or iliocaval venous stent placement may have a valuable role in patients with metastatic disease and symptomatic LES associated with venous obstruction.
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Affiliation(s)
- Gerard J O'Sullivan
- Department of Interventional Radiology, Galway University Hospitals, Newcastle Road, Galway, Ireland..
| | - Dymphna Waldron
- Department of Palliative Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Eileen Mannion
- Department of Palliative Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Maccon Keane
- Department of Oncology, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Paul P Donnellan
- Department of Oncology, Galway University Hospitals, Newcastle Road, Galway, Ireland
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Liu XL, Zu QQ, Wang B, Zhou CG, Zhao LB, Xia JG, Gu M, Shi HB, Liu S. Minimally invasive salvage therapy for transplanted renal allografts. Ren Fail 2015; 37:1470-5. [PMID: 26335729 DOI: 10.3109/0886022x.2015.1074492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of interventional therapy for complications of transplanted renal allografts. MATERIALS AND METHODS Between January 2009 and March 2014, 14 patients underwent interventional therapy for complications of renal allografts. Complications included transplant renal artery stenosis (TRAS), TRAS combined with pseudoaneurysms, transplant renal venous kinking and ureteral obstruction (UO). Serum creatinine (S.Cr) levels were evaluated before and after procedure. The characteristics and procedure outcomes of these patients with vascular and nonvascular complications were also analyzed. RESULTS All primary procedures were successfully performed, which included percutaneous transluminal angioplasty (PTA) for TRAS (n = 4), stenting and coil embolization for TRAS combined with pseudoaneurysms (n = 1), stenting for renal vein kinking (n = 2), and percutaneous nephrostomy (PCN) for UO (n = 7) and secondary antegrade stent placement in six UO patients after 1 week of PCN. No major procedure related complications occurred. S.Cr level subsequently improved from 6.0 ± 3.6 to 2.6 ± 2.1 mg/dL (p < 0.001), as well as patients' clinical features within 1 week after procedure. In our study, the onset time of vascular complications was earlier (<6 months) than nonvascular complications with significant difference (p < 0.001). During follow-up, the patient with TRAS and pseudoaneurysms suffered acute rejection 1 month after treatment and received transplant renal artery embolization. One patient with TRAS showed restenosis 4 months after procedure, and was retreated successfully with stenting. Thirteen cases reserved their transplanted renal allografts. CONCLUSION Interventional therapy could be prior considered for transplanted renal allograft complications as its effectiveness and minimal invasiveness in saving the transplanted renal grafts.
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Affiliation(s)
- Xing-Long Liu
- a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and
| | - Qing-Quan Zu
- a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and
| | - Bin Wang
- a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and
| | - Chun-Gao Zhou
- a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and
| | - Lin-Bo Zhao
- a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and
| | - Jin-Guo Xia
- a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and
| | - Min Gu
- b Urology Surgery , The First Affiliated Hospital of Nanjing Medical University , Nanjing , P.R. China
| | - Hai-Bin Shi
- a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and
| | - Sheng Liu
- a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and
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Langwieser N, Bernlochner I, Wustrow I, Dirschinger RJ, Jaitner J, Dommasch M, Bradaric C, Laugwitz KL, Ibrahim T. Combination of factor Xa inhibition and antiplatelet therapy after stenting in patients with iliofemoral post-thrombotic venous obstruction. Phlebology 2015; 31:430-7. [PMID: 26183668 DOI: 10.1177/0268355515596289] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Studies addressing optimal postprocedural pharmacological management after endovascular stenting of iliofemoral post-thrombotic venous obstruction are lacking. We report our early clinical experience with a combination of rivaroxaban and clopidogrel in patients after iliofemoral post-thrombotic venous obstruction stenting. METHODS Demographic, procedural, and follow-up data of nine patients (seven women; mean age of 32 ± 11 years) undergoing 10 procedures for iliofemoral post-thrombotic venous obstruction performed between August 2012 and January 2014 were retrospectively reviewed. After endovascular intervention, all patients were administered 20 mg rivaroxaban once daily (s.i.d.) and 75 mg clopidogrel s.i.d. or every second day depending on the individual drug responsiveness for at least six months. The adenosine diphosphate-induced platelet aggregation (platelet aggregation, in aggregation units × min) was assessed on a Multiplate analyzer. Patency was verified venographically at procedure end and was evaluated with duplex ultrasound in regular follow-ups. RESULTS Iliofemoral venous flow was successfully re-established by percutaneous endovascular angioplasty and stent implantation in nine left-sided and one bilateral iliofemoral post-thrombotic venous obstruction. Under dual treatment strategy of rivaroxaban and clopidogrel with platelet aggregation control (median (range): 285 aggregation units × min (192; 402)), none of the patients experienced restenosis or stent thrombosis, respectively. After a median follow-up of 14 months (range: 6-26 months), the primary patency rate was 100% and no in-stent restenosis, stent occlusion or relevant minor or major bleeding occurred. CONCLUSION Combined factor Xa inhibition and tailored antiplatelet therapy after stenting of iliofemoral post-thrombotic venous obstruction were safe and performed favorably in terms of vessel patency.
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Affiliation(s)
- Nicolas Langwieser
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Isabell Bernlochner
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Isabel Wustrow
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ralf J Dirschinger
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Juliane Jaitner
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Dommasch
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Christian Bradaric
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany DZKH (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Short-Term Clinical Experience with a Dedicated Venous Nitinol Stent: Initial Results with the Sinus-Venous Stent. Eur J Vasc Endovasc Surg 2015; 50:518-26. [PMID: 26187656 DOI: 10.1016/j.ejvs.2015.05.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 05/22/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Deep venous stenting has become the primary treatment option for chronic venous obstructive disease, both for iliac vein compression and post-thrombotic venous lesions. Until recently, only stents aimed at arterial pathology were used, because no dedicated venous stents were available. However, three such stents have now become available. These venous stents are characterized by increased length, diameter, flexibility, and radial force. This study reports an early experience with one of these devices; the sinus Venous stent (OptiMed GmbH, Ettlingen, Germany). METHODS Between March 2012 and July 2014, 75 patients were treated with the sinus Venous stent: 35 cases of iliac vein compression syndrome and 40 cases of unilateral chronic obstruction in post-thrombotic syndrome (PTS). Diagnosis of relevant obstruction was made using clinical evaluation, duplex ultrasound, and magnetic resonance venography. Patency during follow up was assessed with duplex ultrasound. Clinical improvement was assessed by VCSS, Villalta score, rate of ulcer healing, and improvement of venous claudication. RESULTS The cumulative patency rates at 3, 6, and 12 months were 99%, 96%, and 92%, respectively. The cumulative assisted primary patency rates were 99% at 3, 6, and 12 months. The cumulative secondary patency rate at 12 months was 100%. Differences exist in patency rate between the subgroups of non-thrombotic and post-thrombotic, with the first showing no re-occlusions. All re-thromboses in the PTS group were treated by ancillary treatment modalities. VCSS and Villalta score decreased significantly after stenting, as did venous claudication. Morbidity was low without clinically relevant pulmonary embolism, and mortality was nil. Although two out of seven ulcers healed temporarily, no ulcer remained healed at 12 months follow up. CONCLUSION Short-term clinical results using the sinus Venous stent are excellent, with significant symptom reduction, low morbidity rates, and no mortality. Loss of stent patency is seen less often compared with arterial stents described in the literature.
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Coleman DM, Obi A, Henke PK. Update in venous thromboembolism pathophysiology, diagnosis, and treatment for surgical patients. Curr Probl Surg 2015; 52:233-59. [PMID: 26071037 DOI: 10.1067/j.cpsurg.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 04/20/2015] [Indexed: 11/22/2022]
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Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 505] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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67
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Venous In-stent Thrombosis Treated by Ultrasound Accelerated Catheter Directed Thrombolysis. Eur J Vasc Endovasc Surg 2015; 49:440-7. [DOI: 10.1016/j.ejvs.2015.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/16/2015] [Indexed: 11/22/2022]
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Bozkaya H, Cinar C, Ertugay S, Korkmaz M, Guneyli S, Posacioglu H, Parıldar M. Endovascular Treatment of Iliac Vein Compression (May-Thurner) Syndrome: Angioplasty and Stenting with or without Manual Aspiration Thrombectomy and Catheter-Directed Thrombolysis. Ann Vasc Dis 2015; 8:21-8. [PMID: 25848427 DOI: 10.3400/avd.oa.14-00110] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/18/2014] [Indexed: 12/26/2022] Open
Abstract
PURPOSE May-Thurner syndrome (MTS) is a rare clinical entity featuring venous obstruction of the left lower extremity. The aim of the present study was to report our experience with MTS and to evaluate the utility of treatment using endovascular techniques. MATERIALS AND METHODS We retrospectively analyzed data on 23 MTS patients (21 females, two males; mean age 44 ± 15 years). Eighteen patients presented with deep vein thrombosis (DVT) and five with symptoms associated with chronic venous hypertension (CVH). DVT patients were treated via thromboaspiration, catheter-directed thrombolysis, and angioplasty; followed by stent placement. CVH patients were treated with angioplasty and stent placement alone. All patients were followed-up using Doppler ultrasonography and computed tomography venography. RESULTS Complete left common iliac vein patency was achieved in 21 of the 23 patients (technical success rate: 91,3%). Complete thrombolysis was attained by 14 of the 18 DVT patients (77.7%). The mean clinical and radiological follow-up time was 15.2 ± 16.1 months. Upon follow-up, complete symptomatic regression was observed in 19 of the 23 patients (82.6%). Stent patency was complete in 19 of the 21 patients (90.4%) who received stents. Restenosis occurred in two patients. No treatment-related mortality or morbidity was observed. CONCLUSION Endovascular treatment of MTS is safe and effective and reduces symptoms in most patients, associated with high medium-term patency rates.
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Affiliation(s)
- Halil Bozkaya
- Division of Interventional Radiology, Department of Radiology, Ege University, School of Medicine, Izmir, Turkey
| | - Celal Cinar
- Division of Interventional Radiology, Department of Radiology, Ege University, School of Medicine, Izmir, Turkey
| | - Serkan Ertugay
- Department of Cardiovascular Surgery, Ege University, School of Medicine, Izmir, Turkey
| | - Mehmet Korkmaz
- Department of Radiology, Dumlupinar University, Faculty of Medicine, Kutahya, Turkey
| | - Serkan Guneyli
- Department of Radiology, Bulent Ecevit University, Faculty of Medicine Zonguldak, Turkey
| | - Hakan Posacioglu
- Department of Cardiovascular Surgery, Ege University, School of Medicine, Izmir, Turkey
| | - Mustafa Parıldar
- Division of Interventional Radiology, Department of Radiology, Ege University, School of Medicine, Izmir, Turkey
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Affiliation(s)
- Ronald LG Flumignan
- Universidade Federal de São Paulo; Department of Surgery, Discipline of Vascular and Endovascular Surgery; Rua Borges Lagoa, 754 São Paulo SP Brazil 04038-001
| | - Carolina DQ Flumignan
- Universidade Federal de São Paulo; Department of Surgery, Discipline of Vascular and Endovascular Surgery; Rua Borges Lagoa, 754 São Paulo SP Brazil 04038-001
| | - Jose CC Baptista-Silva
- Universidade Federal de São Paulo; Surgery and Evidence Based Medicine, Brazilian Cochrane Centre; Rua Borges Lagoa, 564, cj 124 São Paulo São Paulo Brazil 04038-000
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Birn J, Vedantham S. May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med 2014; 20:74-83. [PMID: 25502563 DOI: 10.1177/1358863x14560429] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Acute and chronic venous disorders of the lower extremities affect millions of people and cause substantial disability. Long ago, surgeons and pathologists identified the presence of 'spur-like' abnormalities of the left common iliac vein; these abnormalities were hypothesized to result from compression and/or irritation from the adjacent crossing right common iliac artery. In the 1990s, physicians, starting to perform catheter-directed thrombolysis to treat extensive deep vein thrombosis (DVT), observed that about 50% of patients had an iliac vein stenosis. Vascular physicians have become aware of the occasional patient with otherwise-unexplained extremity swelling and/or pain but without a DVT history who is subsequently found to have an iliac vein abnormality. These 'lesions' have been hypothesized to elevate ambulatory venous pressures and thereby produce lower-extremity symptoms, increase the risk of initial and recurrent DVT episodes, and increase the risk of treatment failure with medical and endovascular therapies for thrombotic and non-thrombotic venous conditions. As a result, many practitioners now actively seek iliac venous obstructive 'lesions' when evaluating patients with known or suspected venous disease. However, for many patients, it continues to be unclear what degree of obstruction to venous blood flow is being caused by such lesions, how clinically significant they are, how much emphasis should be placed on identifying them, and when they should be treated. This article seeks to improve the knowledge base of vascular practitioners who make clinical decisions about the diagnosis and treatment of obstructive iliac vein lesions.
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Affiliation(s)
- Jeffrey Birn
- Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Suresh Vedantham
- Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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71
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Venous stenting after deep venous thrombosis and antithrombotic therapy: A systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rvm.2014.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Crowner J, Marston W, Almeida J, McLafferty R, Passman M. Classification of anatomic involvement of the iliocaval venous outflow tract and its relationship to outcomes after iliocaval venous stenting. J Vasc Surg Venous Lymphat Disord 2014; 2:241-5. [DOI: 10.1016/j.jvsv.2014.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/05/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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73
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Caliste XA, Clark AL, Doyle AJ, Cullen JP, Gillespie DL. The incidence of contralateral iliac venous thrombosis after stenting across the iliocaval confluence in patients with acute or chronic venous outflow obstruction. J Vasc Surg Venous Lymphat Disord 2014; 2:253-9. [DOI: 10.1016/j.jvsv.2013.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/03/2013] [Accepted: 12/22/2013] [Indexed: 12/01/2022]
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Gastambide Norbis M, Martín Pedrosa M, Gutiérrez Alonso V, San Norberto E, Vaquero Puerta C. Tratamiento endovascular de trombosis venosa iliocava secundaria a compresión por mioma gigante. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2013.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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75
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Jalaie H, Arnoldussen CWKP, Barbati ME, Kurstjens RLM, de Graaf R, Grommes J, Greiner A, de Wolf MA, Wittens CHA. What predicts outcome after recanalization of chronic venous obstruction: hemodynamic factors, stent geometry, patient selection, anticoagulation or other factors? Phlebology 2014; 29:97-103. [DOI: 10.1177/0268355514529510] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review we evaluated the effect of different suggested factors associate with the outcome after recanalization of chronic venous obstruction (CVO). Hemodynamic factors: Based upon literature no clear suggestions can be made to identify the risk of stent occlusion in association with the hemodynamic effects. However it is evident that ensuring optimal in- and outflow of the stented tract is key in maintaining the patency. Patient selection: Noninvasive imaging modalities are used to divide patients in three subgroups based on the place and extension of post-thrombotic changes. Moreover it should be noted that AV fistula in selected patients can reduce the risk of thrombosis or re-occlusion. Geometry: Excessive oversizing of the stent and stent compression from outside are considered to be associated with stent occlusion. Additionally, overlapping rigid stents, unnatural angel between stents and in-stent kinking are other geometrical factors related to worse outcome after venous recanalization. Anticoagulation: Adequate peri-and postoperative anticoagulation has a crutial role in stent patency. There is no data regarding the duration of anticoagulation therapy and recommendations vary between 6 weeks to 6 months. Result: impaired inflow or outflow, presence of a hypercoagulability, total number of treated segments and use of stents designed for implantation in arterial system are associated with decreased stent patency.
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Affiliation(s)
- H Jalaie
- European Vascular Center Aachen-Maastricht, University Hospital of the RWTH Aachen, Germany
| | - CWKP Arnoldussen
- Department of Diagnostic and Interventional Radiology, Maastricht University Medical Center, The Netherlands
- Department of Radiology, Viecuri Medical Centre, Venlo, The Netherlands
| | - ME Barbati
- European Vascular Center Aachen-Maastricht, University Hospital of the RWTH Aachen, Germany
| | - RLM Kurstjens
- European Vascular Center Aachen-Maastricht, Maastricht University Medical Centre, The Netherlands
| | - R de Graaf
- Department of Diagnostic and Interventional Radiology, Maastricht University Medical Center, The Netherlands
| | - J Grommes
- European Vascular Center Aachen-Maastricht, University Hospital of the RWTH Aachen, Germany
| | - A Greiner
- European Vascular Center Aachen-Maastricht, University Hospital of the RWTH Aachen, Germany
| | - MA de Wolf
- European Vascular Center Aachen-Maastricht, Maastricht University Medical Centre, The Netherlands
| | - CHA Wittens
- European Vascular Center Aachen-Maastricht, University Hospital of the RWTH Aachen, Germany
- European Vascular Center Aachen-Maastricht, Maastricht University Medical Centre, The Netherlands
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76
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Catheter-directed Thrombolysis and Stenting in the Treatment of Iliac Vein Compression Syndrome with Acute Iliofemoral Deep Vein Thrombosis: Outcome and Follow-up. Ann Vasc Surg 2014; 28:957-63. [DOI: 10.1016/j.avsg.2013.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 11/17/2013] [Accepted: 11/25/2013] [Indexed: 01/20/2023]
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77
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Mahnken AH, Thomson K, de Haan M, O'Sullivan GJ. CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Intervent Radiol 2014; 37:889-97. [PMID: 24633533 DOI: 10.1007/s00270-014-0875-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/02/2013] [Indexed: 02/07/2023]
Abstract
Chronic venous insufficiency (CVI) as an advanced stage of chronic venous disease is a common problem that occurs in approximately 1-5 % of the adult population. CVI has either a nonthrombotic (primary) or postthrombotic (secondary) cause involving reflux, obstruction, or a combination of both. The role of venous obstruction is increasingly recognized as a major cause of CVI, with obstructive lesions in the iliocaval segment being markedly more relevant than lesions at the levels of the crural and femoral veins. Approximately 70-80 % of iliac veins develop a variable degree of obstruction following an episode of acute deep venous thrombosis. Nonthrombotic iliac vein obstruction also known as May-Thurner or Cockett's syndrome is the most common cause of nonthrombotic iliac vein occlusion. While compression therapy is the basis of therapy in CVI, in many cases, venous recanalization or correction of obstructive iliac vein lesions may result in resolution of symptoms. This document reviews the current evidence on iliocaval vein recanalization and provides standards of practice for iliocaval stenting in primary and secondary causes of chronic venous disease.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital, Philipps-Marburg, Baldingerstraße, D-35043, Marburg, Germany,
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78
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Warner CJ, Goodney PP, Wallaert JB, Nolan BW, Rzucidlo EM, Powell RJ, Walsh DB, Stone DH. Functional outcomes following catheter-based iliac vein stent placement. Vasc Endovascular Surg 2014; 47:331-4. [PMID: 23867783 DOI: 10.1177/1538574413487443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although previous reports have demonstrated the efficacy of catheter-directed thrombolytic therapy and iliac vein stent placement for the management of iliofemoral deep vein thrombosis (DVT), functional outcomes remain undefined. The purpose of this study was to determine midterm outcomes and functional quality of life among patients treated with iliac vein stenting. METHODS Records of all the patients treated with iliac vein stent placement between March 2004 and March 2011 were examined for primary patency, assisted primary patency, and secondary patency. Midterm functional outcomes were measured quantitatively, including ongoing symptoms and return to work status. RESULTS Over the study interval, 32 patients (33 limbs) underwent iliac vein stent placement. In all, 72% (n = 23) of these patients were female, with an average age of 43 years. In all, 78% (n = 25) of the patients were diagnosed with acute DVT, 89% of which occurred in the left leg. Catheter-directed thrombolysis was utilized in 92% (23 of 25) of the patients with acute DVT. All patients treated with thrombolysis and stent placement presented with pain and edema in the affected limb. One-year primary, assisted primary, and secondary patencies were 75%, 96%, and 96%, respectively. Freedom from reintervention at 1 year was 83%. Treatment was associated with a sustained significant reduction in pain (91% vs 6%, P < .001) and edema (97% vs 12%, P < .001) at a mean follow-up of 29 months (range 5-83 months), at which time 89% of the patients reported to be at their pre-DVT functional status. CONCLUSIONS Aggressive therapy of symptomatic iliac vein stenosis or occlusion with venography, catheter-directed thrombolysis, and iliac vein stent placement provides durable patency and freedom from reintervention. Most patients can anticipate good functional recovery with decreased pain, decreased edema, and high likelihood of returning to work.
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Affiliation(s)
- Courtney J Warner
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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79
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Azarbal A, Santo V, Moneta G. How should we treat May–Thurner syndrome and other causes of iliac vein obstruction? Examining the evidence. Interv Cardiol 2014. [DOI: 10.2217/ica.13.85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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de Wolf MAF, Arnoldussen CWKP, Wittens CHA. Indications for endophlebectomy and/or arteriovenous fistula after stenting. Phlebology 2013; 28 Suppl 1:123-8. [PMID: 23482547 DOI: 10.1177/0268355513477063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endovenous recanalization with percutaneous transluminal angioplasty and stenting in post-thrombotic syndrome patients with iliocaval obstruction is a treatment modality quickly gaining popularity. Studies show good patency and clinical success rates. If the obstruction extends distally, below the inguinal ligament, stenting remains controversial. Without adequate inflow, the patency of stented iliocaval segments drops dramatically. This suggests that treatment of diseased common femoral, femoral and profunda femoral veins is required to ensure adequate inflow. Endophlebectomy, the removal of synechiae and septae from the common femoral vein, is a viable option in these cases. Another option, which can be done concurrently with the endophlebectomy, is the creation of an arteriovenous fistula. Selecting patients for these interventions however remains difficult, as precise preoperative prediction of inflow into the stented segments is difficult. In this paper we describe our experience in using duplex ultrasonography, magnetic resonance venography and conventional venography to assess the patency of the inflow trajectory. We believe this approach is essential in dealing with cases of complex post-thrombotic disease extending below the inguinal ligament. There is a great need to establish criteria to accurately assess pre- and postinterventional flow through treated vein segments.
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Affiliation(s)
- M A F de Wolf
- Department of General Surgery, Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
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81
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Hager ES, Yuo T, Tahara R, Dillavou E, Al-Khoury G, Marone L, Makaroun M, Chaer RA. Outcomes of endovascular intervention for May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2013; 1:270-5. [DOI: 10.1016/j.jvsv.2012.11.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 11/05/2012] [Accepted: 11/25/2012] [Indexed: 10/26/2022]
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82
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Endovascular Management of Nonmalignant Iliocaval Venous Lesions. Ann Vasc Surg 2013; 27:577-86. [DOI: 10.1016/j.avsg.2012.05.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 05/11/2012] [Accepted: 05/23/2012] [Indexed: 11/22/2022]
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83
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Park JY, Ahn JH, Jeon YS, Cho SG, Kim JY, Hong KC. Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May–Thurner syndrome. Phlebology 2013; 29:461-70. [DOI: 10.1177/0268355513491724] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction This study aims to evaluate the primary patency and clinical outcomes after stenting for residual iliac venous stenosis during catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis arising from May–Thurner syndome. Methods A retrospective study was done for the all patients who underwent iliac vein stenting after catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis due to May–Thurner syndrome from January 2005 to April 2011 in Inha University Hospital. Patient information was assembled from the electronic medical records, imaging and interview. The patency of iliac vein stent was evaluated with serial computed tomography. Results Fifty-one patients were enrolled. The median age was 70 years (range 44–86). There were 37 females (72.5%). The duration of symptoms of acute deep vein thrombosis before catheter-directed thrombolysis treatment was 6 days (median, range 1–33). Self-expanding stent was used for iliac vein stenting. Initial technical success rate was 94.1%. There were two complications (3.9%): an arteriovenous fistula formation in left popliteal area and a right inguinal hematoma. Mean follow-up was 15.6 months (range 6 days–80.8 months). Primary patency rate after iliac vein stenting was 95.8% at 6 months, 87.5% at 12 months and 84.3% at 24 months. Four patients had recurrent thrombotic occlusion (7.8%) during the follow-up. Conclusion Iliac vein stenting showed good primary patency rate with few complications. Iliac vein stenting is a durable option for residual stenosis after catheter-directed thrombolysis treatment of acute deep vein thrombosis in May–Thurner syndrome.
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Affiliation(s)
- Jae Young Park
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Jong Hyuk Ahn
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Jang Yong Kim
- Division of Vascular Surgery, Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
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Foit NA, Chen QM, Cook B, Hammerberg EM. Iliofemoral deep vein thrombosis after tibial plateau fracture fixation related to undiagnosed May-Thurner syndrome: a case report. Patient Saf Surg 2013; 7:12. [PMID: 23628366 PMCID: PMC3879220 DOI: 10.1186/1754-9493-7-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/02/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND May-Thurner Syndrome (MTS) represents an anatomic variation of the iliac vessels, in which the left common iliac vein is compressed by an overriding iliac artery. Patients with this abnormality are predisposed to the formation of a left-sided iliofemoral deep venous thrombosis (DVT). While DVT is a familiar complication in the setting of lower extremity trauma, there are no previous reports of MTS complicating the care of patients requiring orthopaedic surgery. CASE PRESENTATION We present the case of an extensive limb-threatening DVT in a patient with previously undiagnosed MTS, resulting after internal fixation of a left tibial plateau fracture. Four days after surgery, despite standard prophylactic anticoagulation, the patient developed an extensive occlusive DVT, extending from the common iliac vein to the popliteal vein. Successful diagnosis required a CT venogram in addition to standard lower extremity ultrasound exam. Severe lower extremity edema continued to worsen despite formal anticoagulation. Urgent mechanical thrombolysis was undertaken, followed by staged catheter-directed thrombolysis with recombinant tissue plasminogen activator (rTPA) and intraluminal stenting. Following this treatment, the patient was noted to have gradual but dramatic resolution of his lower extremity edema and swelling. CONCLUSION The present case demonstrates the potential danger that may accompany MTS in the setting of lower extremity trauma. When an extensive left lower extremity DVT complicates the care of a patient with extremity trauma, clinicians should have a low threshold to pursue the diagnosis of MTS with advanced imaging studies. Venography remains the gold standard in diagnosis, but CT and MRI venography are less invasive and should allow for accurate diagnosis. In this case, formal anticoagulation proved to be ineffective, and endovascular intervention was required.
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Affiliation(s)
| | | | | | - Eric Mark Hammerberg
- Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock Street, MC 0188, Denver, CO 80204, USA.
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85
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Minimally invasive treatment of chronic iliofemoral venous occlusive disease. J Vasc Surg Venous Lymphat Disord 2013; 1:146-53. [DOI: 10.1016/j.jvsv.2012.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/22/2012] [Accepted: 07/15/2012] [Indexed: 11/19/2022]
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86
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Abstract
Intravascular ultrasound is an invaluable tool, necessary for treating patients with venous occlusive disease. The combination of adequate preoperative imaging using duplex ultrasound and axial imaging with computed tomography and/or magnetic resonance allows preoperative identification of extravascular anatomic issues, which may lead to venous obstructive symptoms. During performance of the venous intervention, reliance upon contrast venography alone will lead to frequently missed intravascular pathology which inevitably will lead to inadequate treatment and higher overall failure rates than necessary.
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Affiliation(s)
- D Clair
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
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87
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Bouras AF, Truant S, Beregi JP, Sergent G, Delemazure O, Liddo G, Lebuffe G, Zerbib P, Pruvot FR, Boleslawski E. Atrial embolism caused by portal vein embolization: Treatment by percutaneous withdrawal and stenting. World J Hepatol 2012; 4:412-4. [PMID: 23355922 PMCID: PMC3554808 DOI: 10.4254/wjh.v4.i12.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/04/2011] [Accepted: 11/14/2012] [Indexed: 02/06/2023] Open
Abstract
Hepatectomy remains the only curative treatment for many primary and secondary liver cancers. Portal vein embolization (PVE) has been used to increase the volume of the future liver remnant and thus lower the risk of small-for-size syndrome and postoperative liver failure. This technique has proven its safety, with a low post-procedure morbidity rate. Here, we describe a very rare case in which a young patient suffered a glue embolism to the right atrial cavity following PVE in preparation for a major hepatectomy for colorectal metastasis. The foreign body was withdrawn from the heart with a femoral, percutaneous device and trapped against the wall of the femoral vein with a self-expanding metal stent. Our report shows that this previously unknown complication of PVE can be resolved without recourse to sternotomy and open heart surgery.
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Affiliation(s)
- Ahmed Fouad Bouras
- Ahmed Fouad Bouras, Stéphanie Truant, Guido Liddo, Philippe Zerbib, François-René Pruvot, Emmanuel Boleslawski, Service de Chirurgie Digestive et Transplantation, CHU, Univ Nord de France, F-59000 Lille, France
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88
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Abstract
Iliofemoral DVT constitutes approximately 20-25% of lower limb DVT and represents a specific subgroup of patients at highest risk for post-thrombotic syndrome (PTS). Anticoagulation alone has no significant thrombolytic activity and has not impact on PTS prevention. Early thrombus removal has reduced PTS in uncontrolled reports and reviews but major trials are awaited. The optimal timing for treatment appear to be thrombus <2 weeks old and, methods for thrombus removal include direct open or suction thrombectomy, catheter directed thrombolysis (CDT), with or without percutaneous mechanical thrombectomy (PMT) devices. Three principle types of PMT device are in use (rotational, rheolytic and ultrasound enhanced devices) and are combined with CDT in pharmocomechanical thrombolysis (PhMT) to enhance early thrombus removal. These devices have individual device specific attributes and side effects that are additional to the bleeding complications of thrombolysis. A number of additional interventions may be utilised to the improve results of CDT and PhMT. IVC filter deployment to reduce periprocedural PE, is supported by little evidence unless an indication for its use already exists. However, balloon venoplasty and vein stents undoubtedly vein patency after treatment. Early thrombus removal comes with additional upfront costs derived from devices, imaging and critical care bed usage. However, significant potential savings from reduction in PTS and rethrombosis rates may reduce overall societal costs. This review focuses on iliofemoral thrombosis, however, the less commonly encountered but clinically important subclavian vein thrombosis is also discussed.
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Affiliation(s)
- I Nyamekye
- Worcestershire Royal Hospital, Charles Hastings Way, Worcester, UK.
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89
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Kurklinsky AK, Bjarnason H, Friese JL, Wysokinski WE, McBane RD, Misselt A, Moller SM, Gloviczki P. Outcomes of venoplasty with stent placement for chronic thrombosis of the iliac and femoral veins: single-center experience. J Vasc Interv Radiol 2012; 23:1009-15. [PMID: 22698971 DOI: 10.1016/j.jvir.2012.04.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 04/06/2012] [Accepted: 04/14/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To assess retrospectively 30-day, 1-year, and 3-year patency of chronically occluded iliofemoral venous thrombotic lesions treated with stent placement in a case series from a single institution. MATERIALS AND METHODS Records of 189 consecutive patients treated by interventional radiology for iliofemoral venous occlusions between March 1, 2003, and December 1, 2008, were retrospectively reviewed. A total of 89 patients (27 men; median age, 46.2 y) with chronic iliac or iliofemoral deep vein thrombosis without involvement of the inferior vena cava met criteria for analysis. RESULTS All patients (91 limbs) successfully underwent placement of venous self-expanding stents. Patency rate at discharge was 100%. Following the index procedure, mean pressure gradient across the lesion decreased from 5.63 mm Hg (95% CI, 3.51-7.75) to 0.71 mm Hg (95% CI, 0.08-1.34; P < .0001). There were no bleeding complications. Median follow-up was 11.3 months (range, 0.8-72.4 mo). Follow-up at 30 days demonstrated 90 of 91 limbs to be patent. Primary patency rates of treated limbs at 1 and 3 years were 81% and 71%, respectively. Primary patency was lost in 17 cases (19.1%); interventions to maintain or restore stent patency were performed in 13 cases (14.6%). Primary assisted limb patency rates at 1 and 3 years were 94% and 90%, respectively; secondary patency rate was 95%. CONCLUSIONS Angioplasty with stent placement for treatment of chronically thrombosed iliofemoral veins is a low-risk procedure with acceptable patency rates for as long as 3 years. The outcomes in patients treated in a quaternary referral center are similar to those reported by other centers.
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Affiliation(s)
- Andrew K Kurklinsky
- Division of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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90
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Meissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Lohr JM, McLafferty RB, Murad MH, Padberg F, Pappas P, Raffetto JD, Wakefield TW. Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2012; 55:1449-62. [DOI: 10.1016/j.jvs.2011.12.081] [Citation(s) in RCA: 285] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 12/08/2011] [Accepted: 12/27/2011] [Indexed: 11/26/2022]
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91
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De Wolf MAF, Wittens CHA, Kahn SR. Incidence and Risk Factors of the Post-thrombotic Syndrome. Phlebology 2012; 27 Suppl 1:85-94. [DOI: 10.1258/phleb.2011.012s06] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Annually 1–2 in every 1000 adults will develop a deep venous thrombosis of the lower extremity. A third to half of these patients will develop the post-thrombotic syndrome (PTS). However, predicting which patients will develop the PTS remains elusive. Ipsilateral thrombosis recurrence seems to be the most important risk factor. Moreover, residual venous occlusion and valvular reflux seem to predict PTS incidence to some degree. Laboratory parameters, including D-dimers and inflammatory markers, have shown promise in predicting development of the PTS in patients and are currently under investigation. Creating a model based on all combined risk factors and patient characteristics might aid in risk stratification in individual patients.
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Affiliation(s)
- M A F De Wolf
- Department of Surgery, Maastricht University Medical Centre
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - C H A Wittens
- Department of Surgery, Maastricht University Medical Centre
- Department of Vascular Surgery, Aachen University Hospital, Aachen, Germany
| | - S R Kahn
- Division of Internal Medicine, McGill University and Center for Clinical Epidemiology, Jewish General Hospital, Montreal, Canada
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92
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Sharp Recanalization for Chronic Left Iliac Vein Occlusion. Cardiovasc Intervent Radiol 2012; 35:938-41. [DOI: 10.1007/s00270-012-0346-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/29/2011] [Indexed: 12/01/2022]
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