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Reynolds KB. Intraprocedural Use of the Novel Protrieve Sheath Removes Embolus During Mechanical Thrombectomy of a Complex Iliocaval Deep Vein Thrombosis. Vasc Endovascular Surg 2024; 58:326-330. [PMID: 37752813 DOI: 10.1177/15385744231204226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Extension of proximal deep vein thrombosis (DVT) into the inferior vena cava (IVC) complicates treatment with mechanical thrombectomy, as the presence of IVC thrombus increases embolization risks. In the case of a 39-year-old man with left-sided iliocaval DVT, the novel Protrieve sheath (Inari Medical, Irvine, California) was intraprocedurally placed in the IVC to ensure such complications would not outweigh the benefits of intervention. During successful thrombectomy, the sheath's wall-apposing funnel trapped and removed procedural embolus from the IVC, with no complications occurring. Studies to determine whether the device can broadly improve the safety of complex DVT procedures are warranted.
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Affiliation(s)
- Kyle B Reynolds
- Department of Vascular Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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2
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Ali F, Arshad K, Ullah A, Latif R, Bilal M, Zafrullah F. Aspiration Thrombectomy Using Inari FlowTriever System for Inferior Vena Cava Tumor Thrombus: A Case Report. Cureus 2024; 16:e58380. [PMID: 38756297 PMCID: PMC11097704 DOI: 10.7759/cureus.58380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Pharmacomechanical therapy and catheter-directed thrombolysis are potent treatments for venous thromboembolism. However, limited data exist regarding the management of thrombi in the inferior vena cava (IVC). IVC thrombus resulting from tumors is a particularly uncommon condition. Managing IVC tumor thrombi poses even greater challenges, as conventional therapies such as systemic anticoagulation and thrombolysis are often ineffective. In this report, we present the case of a 73-year-old male with an inferior vena cava tumor thrombus successfully managed through aspiration thrombectomy utilizing the Inari FlowTriever system.
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Affiliation(s)
- Farman Ali
- Medicine, St. John Hospital and Medical Center, Detroit, USA
| | - Khurram Arshad
- Internal Medicine, Corewell Health East Dearborn, Dearborn, USA
| | - Aman Ullah
- Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, USA
| | - Rabia Latif
- Internal Medicine, Mclaren Flint, Flint, USA
| | - Muhammad Bilal
- Internal Medicine, Merit Health Wesley, Hattiesburg, USA
| | - Fnu Zafrullah
- Interventional Cardiology, Ascension Borgess Hospital, Kalamazoo, USA
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3
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Chadow D, Haser P, Aggarwal A, Perezgrovas-Olaria R, Soletti G, Lau C, Castillo R, Jaswani V, Gaudino M, Chadow H. Aspiration thrombectomy for inferior vena cava tumor thrombus arising from hepatocellular carcinoma. J Vasc Surg Cases Innov Tech 2022; 8:538-541. [PMID: 36081743 PMCID: PMC9445887 DOI: 10.1016/j.jvscit.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Pharmacomechanical therapy and catheter-directed thrombolysis have been shown to be very effective in the treatment of venous thromboembolism; however, there is much less data regarding inferior vena cava thrombi. Tumor thrombi pose an even greater clinical challenge as anti-coagulation and thrombolysis are not effective. We present the case of a 61-year-old male who presented with an inferior vena cava thrombus emanating from an accessory right hepatic vein, treated with aspiration thrombectomy.
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A Retrospective Comparison of Catheter-Directed Thrombolysis versus Pharmacomechanical Thrombolysis for Treatment of Acute Lower Extremity Deep Venous Thrombosis. Ann Vasc Surg 2021; 74:306-314. [PMID: 33508461 DOI: 10.1016/j.avsg.2020.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pharmacomechanical thrombolysis (PMT) and catheter-directed thrombolysis (CDT) are frequently employed for treating deep venous thrombosis (DVT). However, there have been relatively few studies comparing PMT outcomes to those associated with CDT. The present study was thus designed to compare short- and mid-term PMT and CDT patient outcomes following the treatment of DVT of the lower extremities. METHODS This study was a retrospective analysis of 98 patients treated at the 3rd Affiliated Hospital of Shenzhen University (Shenzhen, China) and Beijing Chao Yang Hospital (Beijing, China). All patients had undergone treatment for symptomatic DVT of the lower legs via either CDT or PMT. Clinical records and outcome data between the patients in these 2 treatment groups were compared. RESULTS Of the 98 patients analyzed in this retrospective study, 50 had been treated via CDT while 48 had undergone PMT. These PMT and CDT operations were associated with mean treatment durations of 0.97 ± 0.20 hr and 32.48 ± 7.46 hr, respectively (P < 0.0001). Complete lysis was achieved in 78 patients (42 and 36 in the PMT and CDT groups, respectively P = 0.057), while effective lysis was achieved in 96 patients (48 and 48 in the PMT and CDT groups, respectively P = 0.162), with lysis being ineffective in the 2 remaining patients. PMT was associated with a significantly decreased length of hospital stay, usage of UK dose, and treatment duration relative to CDT(P < 0.0001). No major complications or MACE incidence were noted in either group, although 18 patients in the PMT group suffered from bradyarrhythmia (P = 0.007). Clinical efficacy was achieved in 96 patients (48 in each treatment group) at time of discharge (P = 0.162). A Kaplan-Meier analysis revealed that 2-year primary patency rates did not differ significantly between these 2 groups (P = 0.442). CONCLUSION PMT is an effective treatment modality in patients with symptomatic DVT. Relative to CDT it is associated with high treatment success rates, reduced treatment duration, and reduced hospitalization duration, although it is also associated with higher rates of systemic complications.
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Steen EH, Lasa JJ, Nguyen TC, Keswani SG, Checchia PA, Anders MM. Central Venous Catheter-Related Deep Vein Thrombosis in the Pediatric Cardiac Intensive Care Unit. J Surg Res 2019; 241:149-159. [PMID: 31026793 DOI: 10.1016/j.jss.2019.03.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/08/2019] [Accepted: 03/22/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Central venous catheter (CVC) use is common in the management of critically ill children, especially those with congenital heart disease. CVCs are known to augment the risk of deep vein thrombosis (DVT), but data on CVC-associated DVTs in the pediatric cardiac intensive care unit (CICU) are limited. In this study, we aim to identify the incidence of and risk factors for CVC-related DVT in this high-risk population, as its complications are highly morbid. MATERIALS AND METHODS The PC4 database and a radiologic imaging database were retrospectively reviewed for the demographics and outcomes of patients admitted to the Texas Children's Hospital CICU requiring CVC placement, as well as the incidence of DVT and its complications. RESULTS Between January 2017 and December 2017, 1215 central lines were placed over 851 admissions. DVT was diagnosed in 8% of admissions with a CVC, 29% of which demonstrated thrombus in the inferior vena cava. The risk factors significantly associated with DVT included the presence of >1 line, higher total line hours, longer intubation times, and extended CICU stay. A diagnosis of low cardiac output syndrome, sepsis, central line-associated bloodstream infection, and cardiac catheterization were also significant risk factors. Interestingly, cardiac surgery with cardiopulmonary bypass appeared to be protective of clot development. DVT was a highly significant risk factor for mortality in these patients. CONCLUSIONS CVC-related DVTs in critically ill children with congenital heart disease are associated with higher risks of morbidity and mortality, highlighting the need for well-designed studies to determine the best preventative and treatment strategies and to establish guidelines for appropriate monitoring and follow-up of these patients.
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Affiliation(s)
- Emily H Steen
- Department of Surgery, Baylor College of Medicine, Houston, Texas; Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Javier J Lasa
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Trung C Nguyen
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Sundeep G Keswani
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Paul A Checchia
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Marc M Anders
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
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6
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Wang W, Sun R, Chen Y, Liu C. Meta-analysis and systematic review of percutaneous mechanical thrombectomy for lower extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2018; 6:788-800. [DOI: 10.1016/j.jvsv.2018.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/05/2018] [Indexed: 01/01/2023]
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7
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Jacobs B, Henke PK. Evidence-Based Therapies for Pharmacologic Prevention and Treatment of Acute Deep Vein Thrombosis and Pulmonary Embolism. Surg Clin North Am 2018; 98:239-253. [PMID: 29502769 DOI: 10.1016/j.suc.2017.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Venous thromboembolism (VTE) remains a significant mortal and morbid disease. The major risks have not changed and many patients present with unprovoked VTE disease. Prevention of VTE in hospitalized patients depends on comprehensive risk factor assessment, with an individual risk score. Proper and timely prophylaxis with mechanical, pharmacologic, or both is then effective. Treatment of VTE with parenteral anticoagulation followed by either a direct oral anticoagulant or warfarin is standard to reduce risk of VTE recurrence and death. Selected cases of iliofemoral deep vein thrombosis may be treated by pharmacomechanical thrombolysis, but more data are needed before this is standard of care.
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Affiliation(s)
- Ben Jacobs
- Section of Vascular Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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8
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Effectiveness of catheter directed thrombolysis and stent implantation on iliofemoral vein thrombosis caused by iliac vein compression. J Thromb Thrombolysis 2017; 44:254-260. [DOI: 10.1007/s11239-017-1515-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Shi W, Dowell JD. Etiology and treatment of acute inferior vena cava thrombosis. Thromb Res 2016; 149:9-16. [PMID: 27865097 DOI: 10.1016/j.thromres.2016.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 11/17/2022]
Abstract
Inferior vena cava thrombosis (IVCT) is a rare but severe disease that is associated with a high rate of mortality. IVCT can be categorized into primary versus secondary thrombosis dependent upon the underlying pathophysiology. The diagnosis includes both clinical probability assessment as well as the imaging evaluation. The optimal therapeutic strategy remains the target of continued research. Although anticoagulation therapy remains fundamental in treating IVCT, its inherent limitations have led to the use of minimally invasive, endovascular treatment options, including transcatheter thrombolysis, mechanical thrombectomy or a combination of these techniques. This review focuses on the etiology, diagnostic assessment, and endovascular treatment options for IVCT.
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Affiliation(s)
- Wanyin Shi
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, United States
| | - Joshua D Dowell
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, United States.
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10
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Karageorgiou J, Fowler K, Vedantham S, Saad N. Endovascular intervention for deep venous thrombosis in patients with inferior vena cava filters. Vasc Med 2016; 21:459-466. [PMID: 27178760 DOI: 10.1177/1358863x16649678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with inferior vena cava (IVC) filter-associated deep venous thrombosis (DVT) are a challenging subset of patients for endovascular intervention. Given the lack of available data pertaining to this clinical scenario, the purpose of this study was to evaluate the authors' experience with the use of endovascular treatment for DVT in patients with IVC filters. Primary aims included assessing the technical and clinical success, complications, and clinical patency in these patients. This was a retrospective single-center review of adult patients with IVC filters undergoing endovascular treatment of DVT between 1/2005 and 4/2014. Patient electronic medical records were reviewed for demographic data, anticoagulation status, symptoms, symptomatic extremities, extent of thrombosis, therapies received, technical and clinical success, and complications. Query yielded 82 patients (mean 53 years, range 18-96; 66% male), all of whom were included in our analysis. The majority of patients presented with lower extremity pain and swelling, with extensive clot burden despite the use of anticoagulant medication. Treatment elements utilized included pharmacologic lysis in 92%, mechanical thrombectomy in 77%, angioplasty in 63% and stent placement in 50% of patients. Interventions were technically successful in restoring flow in 87% of patients, and clinically successful in improving presenting symptoms in 79% of patients. By SIR criteria, 24% of patients experienced complications (categorized as 10% minor and 14% major). There were two deaths from intracranial hemorrhage. The probability of thrombosis-free survival at 1, 3, 6, 9 and 12 months was 0.85 (CI 0.74-0.93), 0.81 (CI 0.69-0.89), 0.74 (CI 0.62-0.83), 0.70 (CI 0.57-0.8) and 0.70 (CI 0.57-0.8), respectively. Endovascular interventions are usually effective in relieving symptoms in patients with DVT and pre-existing IVC filters. However, these outcomes are achieved with significant complication rates that may exceed those observed when endovascular therapy is provided for other DVT populations.
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Affiliation(s)
- John Karageorgiou
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA
| | - Kathryn Fowler
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA
| | - Suresh Vedantham
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA
| | - Nael Saad
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA
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11
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Pulse-spray catheter-directed thrombolysis with urokinase and argatroban for thrombo-occlusion of an inferior vena cava filter due to heparin-induced thrombocytopenia with thrombosis. J Cardiol Cases 2016; 13:112-116. [DOI: 10.1016/j.jccase.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/10/2015] [Accepted: 12/16/2015] [Indexed: 11/22/2022] Open
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12
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Ishigami N, Nagai T, Arakawa J, Hisadome H, Tabata H. Successful Endovascular Removal of a Perforated Inferior Vena Cava Filter Complicated by a Large Retroperitoneal Hematoma: Pitfall of Catheter-Directed Thrombolysis. Int J Angiol 2016; 25:70-4. [PMID: 26900315 DOI: 10.1055/s-0035-1551794] [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: 01/30/2023] Open
Abstract
Symptomatic caval perforation is rare complication after inferior vena cava (IVC) filter insertion. A 44-year-old woman developed back pain after the placement of retrieval IVC filter during catheter-directed thrombolysis (CDT). Her computed tomography showed a large right-sided retroperitoneal hematoma. After 2 weeks, endovascular removal of the perforated filter was successfully performed without complication. Because thrombolytic agents can accelerate bleeding caused by endovascular procedures, the bleeding rate of the IVC filter deployment during CDT might be higher than expected.
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Affiliation(s)
- Norio Ishigami
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Setagaya-ku, Tokyo, Japan
| | - Tomoo Nagai
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Setagaya-ku, Tokyo, Japan
| | - Junko Arakawa
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Setagaya-ku, Tokyo, Japan
| | - Hideki Hisadome
- Department of Cardiology, KKR Mishuku Hospital, Meguro-ku, Japan
| | - Hirotsugu Tabata
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Setagaya-ku, Tokyo, Japan
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13
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Yamada N. Editorial: Endovascular treatment for acute proximal deep vein thrombosis. J Cardiol Cases 2015; 11:127-128. [PMID: 30546548 PMCID: PMC6279978 DOI: 10.1016/j.jccase.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Pharmacomechanical Thrombolysis in the Management of Acute Inferior Vena Cava Filter Occlusion Using the Trellis-8 Device. J Endovasc Ther 2015; 22:99-104. [DOI: 10.1177/1526602814564369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate the performance and safety of the Trellis-8 system, a pharmacomechanical thrombolysis infusion catheter, and adjunctive therapies in the treatment of symptomatic inferior vena cava (IVC) filter–related acute thrombotic occlusion. Methods: Eight consecutive patients (6 men; mean age 57.4 years, range 34–78 years) with acute thrombotic occlusion of the IVC in the presence of an IVC filter underwent percutaneous venous thrombectomy using the Trellis-8 thrombectomy system and adjunctive techniques between January 2009 and November 2013. Demographics, clinical data, procedures, and outcomes were retrospectively reviewed. All patients had clinical signs of lower extremity venous hypertension on presentation. The median time between IVC filter placement and occlusion was 25 months. Patients were followed for the development of thromboembolic complications to the last clinic visit or until they died. Results: The procedure was technically successful in 6 patients, whereas it could not be performed in 2 due to failure to cross the occlusion. The median follow-up period was 7.8 months, at which time all patients undergoing successful Trellis-8 thrombectomy had relief of symptoms without thromboembolic or bleeding complications. Conclusion: In this limited performance and safety evaluation, the Trellis-8 thrombectomy system combined with adjunctive therapies, such as mechanical thrombectomy and balloon angioplasty, was effective in 75% of patients with IVC filter–related acute caval occlusion.
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15
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Real clinical practice of catheter therapy for deep venous thrombosis: periprocedural and 6-month outcomes from the EDO registry. Cardiovasc Interv Ther 2015; 30:251-9. [DOI: 10.1007/s12928-014-0314-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 12/30/2014] [Indexed: 12/29/2022]
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16
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Vedantham S, Sista AK, Klein SJ, Nayak L, Razavi MK, Kalva SP, Saad WE, Dariushnia SR, Caplin DM, Chao CP, Ganguli S, Walker TG, Nikolic B. Quality Improvement Guidelines for the Treatment of Lower-Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. J Vasc Interv Radiol 2014; 25:1317-25. [DOI: 10.1016/j.jvir.2014.04.019] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 02/07/2023] Open
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17
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Zhang QQ, Xu H, Zu MH, Gu YM, Shen B, Wei N, Xu W, Liu HT, Wang WL, Gao ZK. Strategy and long-term outcomes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis. Eur J Vasc Endovasc Surg 2014; 47:550-7. [PMID: 24560649 DOI: 10.1016/j.ejvs.2014.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/19/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the strategy and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis. METHODS The treatment strategy and outcomes of BCS complicated by IVC thrombosis were retrospectively evaluated in a single-center study. The treatment was aimed at the IVC thrombus, not hepatic vein occlusion. All 133 patients with BCS complicated by IVC thrombosis from February 2003 to March 2013 underwent endovascular treatment. For the fresh thrombus group (n=75) recanalization was performed after transcatheter thrombolysis with urokinase. For the mixed thrombus group (n=19) a small balloon pre-dilation of the IVC was performed first, followed by transcatheter thrombolysis using urokinase and a large balloon dilation of the IVC. For the old thrombus group (n=39) a large balloon dilation or/and stent placement was performed directly. Pre- and post-treatment follow-ups were recorded. RESULTS The endovascular treatment was successful in 131 out of 133 patients (98.5%). Thirty seven patients had synchronous hepatic vein occlusion. The incidence of serious complications was 4.5% (6/133). Symptomatic pulmonary embolism occurred in three cases, cerebral hemorrhage in two, and cardiac tamponade in one. The cumulative 1-, 5-, and 10-year primary patency rate was 96.3%, 84.0%, and 64.6%, respectively. The cumulative 1-, 5-, and 10-year secondary patency rate was 99.0%, 96.1% and 91.3%, respectively. Segmental occlusion of the IVC and duration of anticoagulant therapy less than 6 months were independent risk factors for reocclusion. CONCLUSIONS For patients with BCS complicated by IVC thrombosis, an individualized treatment strategy based on the property of the thrombus can result in excellent long-term patency.
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Affiliation(s)
- Q Q Zhang
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
| | - H Xu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - M H Zu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Y M Gu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - B Shen
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - N Wei
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - W Xu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - H T Liu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - W L Wang
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Z K Gao
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
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18
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O'Donnell ME, Coan KE, Naidu SG, Shamoun FE, Money SR. Percutaneous thrombolysis of acute-on-chronic inferior vena cava thrombosis after previous insertion of an Adams-DeWeese clip. Vasc Endovascular Surg 2014; 48:342-5. [PMID: 24518364 DOI: 10.1177/1538574414522330] [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: 11/17/2022]
Abstract
We describe the successful percutaneous treatment of acute-on-chronic IVC thrombosis 30 years following previous placement of Adams-DeWeese clip.
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Affiliation(s)
- Mark E O'Donnell
- Divisions of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
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19
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Matsuda A, Yamada N, Ogihara Y, Tsuji A, Ota S, Ishikura K, Nakamura M, Ito M. Early and Long-Term Outcomes of Venous Stent Implantation for Iliac Venous Stenosis After Catheter-Directed Thrombolysis for Acute Deep Vein Thrombosis. Circ J 2014; 78:1234-9. [DOI: 10.1253/circj.cj-13-1247] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akimasa Matsuda
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Yoshito Ogihara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Satoshi Ota
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Ken Ishikura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Mashio Nakamura
- Clinical Cardiovascular Research, Mie University Graduate School of Medicine
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
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20
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McAree BJ, O'Donnell ME, Fitzmaurice GJ, Reid JA, Spence RAJ, Lee B. Inferior vena cava thrombosis: a review of current practice. Vasc Med 2013; 18:32-43. [PMID: 23439778 DOI: 10.1177/1358863x12471967] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Inferior vena cava (IVC) thrombosis remains under-recognised as it is often not pursued as a primary diagnosis. The aetiology of IVC thrombosis can be divided into congenital versus acquired, with all aetiological factors found among Virchow's triad of stasis, injury and hypercoagulability. Signs and symptoms are related to aetiology and range from no symptoms to cardiovascular collapse. Painful lower limb swelling combined with lower back pain, pyrexia, dilatation of cutaneous abdominal wall veins and a concurrent rise in inflammatory markers are suggestive of IVC thrombosis. Following initial lower limb venous duplex, magnetic resonance imaging (MRI) is the optimal non-invasive imaging tool. Aetiology directs treatment, which ranges from anticoagulation and lower limb compression to open surgery, with endovascular therapies increasingly favoured. The objective of this review is to assess current literature on the aetiology, presentation, investigation, treatment, prognosis and other factors pertaining to IVC thrombosis.
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Affiliation(s)
- B J McAree
- Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Belfast, Northern Ireland
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Kota SK, Kota SK, Meher LK, Jammula S, Panda S, Modi KD. Coexistence of pheochromocytoma with uncommon vascular lesions. Indian J Endocrinol Metab 2012; 16:962-971. [PMID: 23226643 PMCID: PMC3510968 DOI: 10.4103/2230-8210.103000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pheochromocytoma/paragangliomas have been described to be associated with rare vascular abnormalities like renal artery stenosis. Coexistence of physiologically significant renal artery lesions is a compounding factor that alters management and prognosis of pheochromocytoma patients. Apart from individual case reports, data on such association in Indian population is not available. The aim of this study is to find the nature and prevalence of associated vascular abnormalities. MATERIALS AND METHODS From 1990 to 2010, a total of 50 patients were diagnosed with pheochromocytoma/paragangliomas. Hospital charts of these patients were reviewed retrospectively to identify those with unusual vascular abnormalities. Available literature was also reviewed. RESULTS Of the 50 patients with pheochromocytoma, 7 (14%) had coexisting vascular lesions including renal artery stenosis in 4, aortoarteritis in 1, aortic aneurysm in 1 and inferior vena cava thrombosis in 1. Pheochromocytoma was adrenal in 42 and extra adrenal in 8. Laparoscopic adrenalectomy was done in the patients. One patient with renal artery stenosis due to intimal fibrosis was subjected to percutaneous balloon angioplasty; the other three improved after adrenalectomy and lysis of fibrous adhesive bands. The patient with aortoarteritos was treated with oral steroids. Inferior vena cava thrombosis was reversed with anticoagulants. The patient with abdominal aortic aneurysm was advised for annual follow-up on account of its size of 4.5 cm and asymptomatic presentation. CONCLUSION There are multiple mechanisms that can lead to renal artery stenosis and other vascular abnormalities in a case of pheochromocytoma. A high index of suspicion is necessary to enable both entities to be diagnosed preoperatively and allow proper planning of surgical therapy. Incomplete diagnosis may lead to persistent hypertension postoperatively in a case of associated renal artery stenosis.
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Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
| | - Siva Krishna Kota
- Department of Anesthesia, Central Security hospital, Riyadh, Saudi Arabia
| | - Lalit Kumar Meher
- Department of Medicine, MKCG Medical College, Berhampur, Orissa, India
| | - Sruti Jammula
- Department of Pharmaceutics, Roland Institute of Pharmaceutical Sciences, Berhampur, Orissa, India
| | - Sandip Panda
- Department of Cardiology, JIPMER, Puducherry, India
| | - Kirtikumar D. Modi
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
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Kota SK, Kota SK, Jammula S, Meher LK, Modi KD. Pheochromocytoma with inferior vena cava thrombosis: An unusual association. J Cardiovasc Dis Res 2012; 3:160-4. [PMID: 22629039 PMCID: PMC3354464 DOI: 10.4103/0975-3583.95375] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pheochromocytomas have been described in association with vascular abnormalities like renal artery stenosis. A 48-year-old man was admitted to our hospital with the complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and hypertension. For last several days, he was having a dull aching abdominal pain. Abdominal computed tomography (CT) revealed the presence of a left adrenal pheochromocytoma. An inferior vena cava (IVC) venogram via the right jugular vein demonstrated occlusion of the IVC inferior to the right atrium. Surgical removal of pheochromocytoma was done, followed by anticoagulant treatment for IVC thrombosis, initially with subcutaneous low molecular weight heparin, and then with oral warfarin, resulting in restoration of patency. To the best of our knowledge, the occurrence of pheochromocytoma in IVC thrombosis has not been reported so far from India. Possible mechanisms of such an involvement are discussed.
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Affiliation(s)
- Sunil K Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
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Removing vascular obstructions: a challenge, yet an opportunity for interventional microdevices. Biomed Microdevices 2012; 14:511-32. [PMID: 22331446 DOI: 10.1007/s10544-011-9627-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiovascular diseases are the leading cause of death worldwide; they are mainly due to vascular obstructions which, in turn, are mainly caused by thrombi and atherosclerotic plaques. Although a variety of removal strategies has been developed for the considered obstructions, none of them is free from limitations and conclusive. The present paper analyzes the physical mechanisms underlying state-of-art removal strategies and classifies them into chemical, mechanical, laser and hybrid (namely chemo-mechanical and mechano-chemical) approaches, while also reviewing corresponding commercial/research tools/devices and procedures. Furthermore, challenges and opportunities for interventional micro/nanodevices are highlighted. In this spirit, the present review should support engineers, researchers active in the micro/nanotechnology field, as well as medical doctors in the development of innovative biomedical solutions for treating vascular obstructions. Data were collected by using the ISI Web of Knowledge portal, buyer's guides and FDA databases; devices not reported on scientific publications, as well as commercial devices no more for sale were discarded. Nearly 70% of the references were published since 2006, 55% since 2008; these percentages respectively raise to 85% and 65% as regards the section specifically reviewing state-of-art removal tools/devices and procedures.
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Xiao L, Wang M, Huang DS, Shen J, Tong JJ. Introducer curving technique to reduce tilting of transfemoral Gunther Tulip IVC filter: in vitro study. Acta Radiol 2012; 53:759-64. [PMID: 22821956 DOI: 10.1258/ar.2012.110722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Severe tilting of Günther Tulip filter (GTF) may be associated with difficulty in retrieval. PURPOSE To determine if an introducer curving technique of GTF can decrease the tilting degree of GTF in a caval model. MATERIAL AND METHODS The model was constructed by placing Dacron grafts in bifurcated glass tubes. The study included three groups: Right Straight Group (G(1)), Left Straight Group (G(2)), and Left Curved Group (G(3)). In G(3), a 10-20° angle was curved on the metal introducer before insertion to decrease the angle between inferior vena cava axes and metal introducer (A(CM)). Before GTF was released, the distance between the caval right wall and the apical hook (D(CH1)), and A(CM) were measured. The tilt angle of GTF (A(CF)) was also measured. RESULTS In G(1), GTF apex tended to center compared to G(2) (59% vs. 36%, P < 0.01). In G(3), GTF apex tended to center compared to G(2) (71% vs. 36%, P < 0.01). The differences of A(CF) between G(1) and G(2) (2.66 ± 1.80 vs. 4.13 ± 2.07, P < 0.01) and between G(2) and G(3) (4.13 ± 2.07 vs. 2.39 ± 1.79, P < 0.01) were statistically significant. There were significant positive correlations between A(CM) and A(CF), whereas significant negative correlations were detected between D(CH1) and A(CF) in each group. CONCLUSION The oblique course of GTF delivery system relative to the axis of the cava causes filter tilt, and thus, curving the introducer prior to its introduction helps to reduce the filter tilt. We recommend a clinical study to determine whether the introducer curving technique improves filter centering and its retrievability.
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Affiliation(s)
- Liang Xiao
- Department of Radiology, First Hospital of China Medical University, Liaoning
| | - Man Wang
- Department of Psychiatry, First Hospital of China Medical University, Liaoning
| | - De-sheng Huang
- Department of Mathematics, College of Basic Medical Science, China Medical University, Liaoning, China
| | - Jing Shen
- Department of Radiology, First Hospital of China Medical University, Liaoning
| | - Jia-jie Tong
- Department of Radiology, First Hospital of China Medical University, Liaoning
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Tsuji A, Yamada N, Ota S, Ishikura K, Nakamura M, Ito M. Early Results of Rheolytic Thrombectomy in Patients With Proximal Deep Vein Thrombosis. Circ J 2011; 75:1742-6. [PMID: 21597205 DOI: 10.1253/circj.cj-10-0617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiro Tsuji
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Norikazu Yamada
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Satoshi Ota
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Ken Ishikura
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Mashio Nakamura
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Masaaki Ito
- Department of Cardiology, Mie University Graduate School of Medicine
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Ota S, Yamada N, Tsuji A, Ishikura K, Nakamura M, Isaka N, Ito M. The Günther-Tulip Retrievable IVC Filter. Circ J 2008; 72:287-92. [DOI: 10.1253/circj.72.287] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Ota
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Norikazu Yamada
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Akihiro Tsuji
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Ken Ishikura
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Mashio Nakamura
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Naoki Isaka
- Department of Cardiology, Mie University Graduate School of Medicine
| | - Masaaki Ito
- Department of Cardiology, Mie University Graduate School of Medicine
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Hokimoto S, Saito T, Oshima S, Ogawa H. Initial and mid-term outcomes of pulse infusion thrombolysis using a unique pump system and stent placement for deep vein thrombosis. Intern Med 2008; 47:1663-7. [PMID: 18827413 DOI: 10.2169/internalmedicine.47.1024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the initial and mid-term results of pulse infusion thrombolysis (PIT) using a unique pump system and stent placement for proximal deep vein thrombosis (DVT) in Japanese. METHODS Among the patients who were admitted to our institute under diagnosis of proximal DVT between April 2001 and March 2005, 11 patients (4 men, mean age 61 years) who underwent PIT and angioplasty followed by stent placement were enrolled in this retrospective analysis. Urokinase or monteplase was used as a thrombolytic agent. Venous or stent patency was assessed by color Doppler ultrasound or enhanced computed tomography for a mean follow-up duration of 54 months. RESULTS Sites of thrombus were left lower limbs in 10 cases and left upper limb in one case. Initial technical (complete venous flow recovery) and clinical (disappearance of pain and swelling of diseased leg or arm) success was achieved in all patients. Two of 11 patients showed stent occlusion with leg swelling and pain one month later and 3 years later, respectively. These patients had associated protein S deficiency. CONCLUSION PIT and stent deployment for DVT is safe and effective with favorable initial and mid-term clinical results and without major complications in Japanese, except for cases of congenital coagulation abnormality.
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Affiliation(s)
- Seiji Hokimoto
- Department of Interventional Cardiology, Division of Coronary Intensive Care Unit, Kumamoto University Hospital.
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