1
|
Ge J, Weng C, Zhao J, Yuan D, Wang T. Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report. Front Cardiovasc Med 2024; 11:1351358. [PMID: 38385133 PMCID: PMC10880184 DOI: 10.3389/fcvm.2024.1351358] [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] [Received: 12/06/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Phlegmasia cerulea dolens (PCD) is a rare yet severe complication of deep vein thrombosis (DVT), characterized by a high amputation rate and mortality. Early diagnosis and treatment are crucial in managing this condition. PCD predominantly affects the lower extremities rather than the upper extremities. We herein present a rare upper extremity PCD case accompanied with supra vena cava and pulmonary embolism in a cervical cancer patient, who presented to our institution with severe pain, edema and irreversible venous gangrene of right upper limb with no response to anticoagulation therapy. Emergency fasciotomy and amputation were performed due to the progressed venous gangrene, however, the patient developed severe infection and coagulation disorders, gastrointestinal bleeding and disseminated intravascular coagulation after the surgery. Despite medical interventions, her family chose to withdraw treatment and the patient died in ICU at the fourth day following emergency surgery.
Collapse
Affiliation(s)
| | | | | | | | - Tiehao Wang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Jung G, Breiding PS, Schmitz-Rixen T, Hakimi M. [Pelvic vein thrombosis : Current treatment options and importance of recanalization procedures]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:87-98. [PMID: 37792045 DOI: 10.1007/s00104-023-01964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 10/05/2023]
Abstract
Venous thrombosis is a frequent disorder. A distinction is made between an acute phase of the disease and a chronic manifestation, the postthrombotic syndrome. In particular, proximal venous thrombosis/pelvic vein thrombosis can cause a life-threatening pulmonary embolism during the acute phase of the disease. The postthrombotic syndrome is characterized by the remodeling of the affected venous section, which is often caused by inflammation. Locally, the typical clinical finding is caused by scarred stricture of the vein with restricted drainage and peripheral venous hypertension. Acute thrombosis should be primarily treated by therapeutic anticoagulation and compression therapy of the affected extremity. The duration of these measures depends on clinical presentation, cause (provoked, unprovoked) and risk factors for venous thrombosis/recurrent thrombosis. Venous revascularization procedures are important both in the acute phase of the disease and in the treatment of postthrombotic syndrome. The recanalization treatment is mostly carried out as an endovascular or hybrid intervention and venous bypass procedures are reserved for special situations.
Collapse
Affiliation(s)
- G Jung
- Klinik für Gefässchirurgie, Luzerner Kantonsspital, Spitalstr., 6000, Luzern 16, Schweiz.
| | - P S Breiding
- Radiologie, Sektion interventionelle Radiologie, Luzerner Kantonsspital, Spitalstr., 6000, Luzern 16, Schweiz
| | - T Schmitz-Rixen
- Deutsche Gesellschaft für Chirurgie, Luisenstr. 58-58, 10117, Berlin, Deutschland
| | - M Hakimi
- Klinik für Gefässchirurgie, Luzerner Kantonsspital, Spitalstr., 6000, Luzern 16, Schweiz
| |
Collapse
|
3
|
Guven H. Strain-gauge venous occlusion plethysmography: An objective and non-invasive approach to the evaluation of venous hemodynamics in patients with acute deep-vein thrombosis undergoing post-pharmacomechanical thrombolysis. Vascular 2023:17085381231174951. [PMID: 37167292 DOI: 10.1177/17085381231174951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Strain-gauge venous occlusion plethysmography (SGVOP) is a means of acquiring hemodynamic data non-invasively, unlike other methods used routinely for the diagnosis and follow-up of venous diseases. The present study compares the plethysmographic data with early- and mid-term routine data of patients with acute deep-vein thrombosis (DVT) who underwent pharmacomechanical thrombolysis. PATIENTS AND METHOD Included in this retrospective study were 118 patients with acute DVT, who underwent pharmacomechanical thrombolysis between February 2018 and July 2019. Pre- and post-procedure follow-up data including CIVIQ-20 (quality of life), VCSS (Venous Clinical Severity Score), D-Dimer, Doppler USG results, venous capacity (VC), and venous outflow (VO) obtained by SGVOP were recorded and compared. RESULTS In all 118 (100%) patients who underwent the procedure, early- and mid-term patency was seen to have been provided on Doppler USG follow-up, and various degrees of venous insufficiency were identified. A statistically significant improvement was observed in VCSS, CIVIQ-20, D-Dimer, VO, and VC measurements, although when the discrepancies between CIVIQ-20 and plethysmographic measurements were examined individually during the 6-month follow-up, nine (13.1%) patients were identified with comorbidities. CONCLUSIONS Pharmacomechanical thrombolysis is an effective treatment approach for patients with acute DVT. Providing non-invasive objective data supporting the diagnosis and follow-up of venous diseases, the SGVOP approach offers significant benefits and should be considered more frequently as a viable therapy.
Collapse
Affiliation(s)
- Hakan Guven
- Cardiovascular Surgery Department, Bursa Heart and Arrhythmia Hospital, Bursa, Turkey
| |
Collapse
|
4
|
Pandelaki J, Hadibrata H, Sini I, Kalwani R, Sidipratomo P, Ramandika H, Adrisyel D, Sandra F, Jason J. Massive DVT from the proximal IVC to the pedal vein: Our approach using aspiration mechanical thrombectomy and open surgery thrombectomy. Radiol Case Rep 2023; 18:1830-1837. [PMID: 36923386 PMCID: PMC10008835 DOI: 10.1016/j.radcr.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/07/2023] Open
Abstract
Deep venous thrombosis might present in an acute condition requiring early thrombus removal. Several endovascular and surgical approaches are available with a short treatment time and minimal complications compared to pharmacotherapies. However, due to a lack of evidence, these are not the first treatment choice for deep vein thrombosis. Our case report showed a successful multimodality treatment for an acute-on-chronic massive deep vein thrombosis from the inferior vena cava to the pedal vein. A 47-year-old with chief complaints of cold, significant swelling, and severe pain in her left leg was diagnosed with deep vein thrombosis through Doppler ultrasound and contrast-enhanced computed tomography. The patient received aspiration mechanical thrombectomy with the "kissing catheter" technique, adjunctive stent, percutaneous transluminal angioplasty, and open surgical thrombectomy by Fogarty catheter without recurrence and complication.
Collapse
Affiliation(s)
- Jacub Pandelaki
- Department of Radiology, Dr Cipto Mangunkusumo National General Hospital-Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, Kenari, Senen, Central Jakarta, Jakarta, Indonesia.,Bunda General Hospital, Jakarta, Indonesia
| | | | - Ivan Sini
- Bunda General Hospital, Jakarta, Indonesia
| | | | - Prijo Sidipratomo
- Department of Radiology, Dr Cipto Mangunkusumo National General Hospital-Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, Kenari, Senen, Central Jakarta, Jakarta, Indonesia
| | - Heltara Ramandika
- Department of Radiology, Dr Cipto Mangunkusumo National General Hospital-Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, Kenari, Senen, Central Jakarta, Jakarta, Indonesia
| | - Dieby Adrisyel
- Department of Radiology, Dr Cipto Mangunkusumo National General Hospital-Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, Kenari, Senen, Central Jakarta, Jakarta, Indonesia
| | - Febian Sandra
- Department of Radiology, Dr Cipto Mangunkusumo National General Hospital-Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, Kenari, Senen, Central Jakarta, Jakarta, Indonesia
| | - Jason Jason
- Clerkship Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
5
|
Muacevic A, Adler JR, Das K, Nayyar R. Thrombectomy of a Complex Deep Vein Thrombosis: A Case Report. Cureus 2023; 15:e33413. [PMID: 36751222 PMCID: PMC9897676 DOI: 10.7759/cureus.33413] [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: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
A deep vein thrombosis (DVT) is a multifactorial condition characterized by a thrombus or blood clot developing in the deep veins of the upper or lower extremities. The presentation of DVT is characterized by unilateral peripheral edema and signs of inflammation in the affected extremity. The treatment of DVT is complex and case-dependent; however, most individuals are managed with oral anticoagulation therapy, while complex cases can be treated with advanced interventions. This report discusses a singular case of an atypical or complex DVT in a middle-aged woman with prior venous thromboembolic events undergoing a thrombectomy using an Inari FlowTriever system.
Collapse
|
6
|
Bismuth J, Rotolo PD, Mathews SJ. Venous Thrombectomy: Are We Driving Procedures or Outcomes? J Endovasc Ther 2022:15266028221144590. [PMID: 36565274 DOI: 10.1177/15266028221144590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Jean Bismuth
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Katy Heart and Vascular Institute, LLC, Katy, TX, USA
| | - Paul D Rotolo
- Department of Interventional Radiology, Health First, Melbourne, FL, USA
| | - S Jay Mathews
- Bradenton Cardiology Center, Manatee Memorial Hospital, Bradenton, FL, USA
| |
Collapse
|
7
|
Chang CT, Chang CD. Successful treatment of phlegmasia cerulea dolens with percutaneous thrombectomy and catheter-directed thrombolysis: A case report. Medicine (Baltimore) 2022; 101:e31483. [PMID: 36451393 PMCID: PMC9704923 DOI: 10.1097/md.0000000000031483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Phlegmasia cerulea dolens (PCD) is an uncommon condition of acute deep vein thrombosis, characterized by marked swelling of the affected limb with pain and cyanosis. High mortality and morbidity rates have been reported. Early diagnosis, quick and effective treatment are crucial for preventing potential limb loss or even death. PATIENT CONCERNS A 39-year-old woman presented to our emergency department with painful swelling and cyanotic discoloration of the left lower limb for 2 days. DIAGNOSES Computed tomography revealed thrombosis in the left common iliac vein and inferior vena cava. Angiography demonstrated extensive venous occlusion from the lower inferior vena cava to the left popliteal vein. The diagnosis of PCD was made. INTERVENTIONS Systemic anticoagulation with intravenous unfractionated heparin was initiated immediately. Mechanical thrombectomy with Angiojet and angioplasty were performed, and catheter-directed thrombolysis (CDT) was administered subsequently. OUTCOMES Follow-up angiography revealed regression of the thrombosis and the opacification of the deep vein was restored. The patient was discharged from the hospital uneventfully. CONCLUSIONS PCD is a rare but potentially limb and life-threatening condition that requires immediate recognition. Treatment should be in a timely manner. Anticoagulation alone may be inadequate and more aggressive management such as CDT and thrombectomy should be considered.
Collapse
Affiliation(s)
- Ching-Tang Chang
- Department of Emergency, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City, Taiwan
| | - Ching-Di Chang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- *Correspondence: Ching-Di Chang, Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan (e-mail: )
| |
Collapse
|
8
|
Trinidad B, Berman SS, Labropoulos N, Pacanowski J, Yanquez F, Chen W, Leon LR. Acute Limb Arterial Ischemia Following Iliac Vein Stenting in the Setting of a Frozen Pelvis. Vasc Endovascular Surg 2022; 56:797-801. [PMID: 35921088 DOI: 10.1177/15385744221084148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report on a young patient with previous radiation to her pelvis who presented with acute limb ischemia following iliac vein stenting believed to be secondary to extrinsic iliac artery compression in the setting of a frozen pelvis. She underwent revascularization and a trans-femoral amputation, ultimately needing a femoral to femoral artery crossover bypass in order to achieve amputation stump healing. This case describes a potential arterial complication of venous stenting in a previously irradiated field.
Collapse
Affiliation(s)
- Bradley Trinidad
- Department of Surgery, Division of Vascular Surgery, 22165University of Arizona Medical Center, Tucson, AZ, USA
| | - Scott S Berman
- Department of Surgery, Division of Vascular Surgery, 22165University of Arizona Medical Center, Tucson, AZ, USA.,Vascular and Endovascular Surgery Staff, Pima Heart Physicians, Tucson, AZ, USA
| | - Nicos Labropoulos
- Department of Vascular and Endovascular Surgery at Stony Brook, Stony Brook University hospital, Long Island, NY, USA
| | - John Pacanowski
- Department of Surgery, Division of Vascular Surgery, 22165University of Arizona Medical Center, Tucson, AZ, USA.,Vascular and Endovascular Surgery Staff, Pima Heart Physicians, Tucson, AZ, USA
| | | | - Winsor Chen
- Department of Surgery, Division of Vascular Surgery, 22165University of Arizona Medical Center, Tucson, AZ, USA
| | - Luis R Leon
- Department of Surgery, Division of Vascular Surgery, 22165University of Arizona Medical Center, Tucson, AZ, USA.,Vascular and Endovascular Surgery Staff, Pima Heart Physicians, Tucson, AZ, USA
| |
Collapse
|
9
|
Extensive deep venous thrombosis in a young male with absent infrarenal inferior vena cava. J Vasc Surg Cases Innov Tech 2022; 8:146-150. [PMID: 35330898 PMCID: PMC8938606 DOI: 10.1016/j.jvscit.2022.01.001] [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: 10/18/2021] [Accepted: 01/06/2022] [Indexed: 11/21/2022] Open
Abstract
A previously well, independent 20-year-old man presented with a 4-day history of progressive left lower limb pain with associated phlegmasia cerulea dolens. Duplex venous ultrasound examination and computed tomography venogram revealed extensive deep vein thrombus from the left popliteal vein to abnormal venous vasculature proximally. Notably, no infrarenal inferior vena cava was detected, with distal venous return channeled through lumbar and visceral collateral channels into the azygous system. Treatment included systemic anticoagulation, catheter-directed thrombolysis, and prolonged therapeutic anticoagulation. In the absence of other risk factors, anatomical abnormalities should be considered in young, well patients presenting with lower limb venous thrombosis.
Collapse
|
10
|
Sagris M, Tzoumas A, Kokkinidis DG, Tzavellas G, Korosoglou G, Lichtenberg M. Invasive and Pharmacological Treatment of Deep Vein Thrombosis: a Scoping Review. Curr Pharm Des 2022; 28:778-786. [PMID: 35440298 DOI: 10.2174/1381612828666220418084339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Abstract
The annual occurrence of venous thromboembolism (VTE) is 300,000-600,000 cases in the United States and 700,000 in Europe. VTE includes deep venous thrombosis (DVT) of upper or lower extremities, superior and inferior vena cava thrombosis, and pulmonary embolism (PE) as well. The primary treatment of DVT includes oral anticoagulation to prevent the progression of the thrombus and decrease the risk of pulmonary embolism. Depending on the symptoms, more invasive treatments can be applied to target the iliofemoral thrombus and its removal. However, less emphasis is given to acute symptomatology, early recovery of function, quality of life improvement, and the individualized likelihood of developing post-thrombotic syndrome. While invasive therapy has been used to enhance the acute management of iliofemoral DVT, our knowledge about the overall outcomes associated with the invasive treatment of VTE is still limited. In this review, we illustrate the available data on pharmacological and endovascular management of iliofemoral VTE, including therapies such as catheter-directed thrombolysis (CDT), mechanical thrombectomy (PMT), and pharmacomechanical catheter-directed thrombolysis (PCDT).
Collapse
Affiliation(s)
- Marios Sagris
- Department of Medicine, General Hospital of Nikaia, Piraeus, Athens, Greece
| | - Andreas Tzoumas
- Department of Medicine, University of Cincinnati Health, Cincinnati, OH
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine/Yale New Haven Hospital, New Haven, CT
| | - Georgios Tzavellas
- Department of Vascular and Endovascular Surgery, Indiana University Health Ball Memorial Hospital
| | | | | |
Collapse
|
11
|
Montes MC, Carbonell JP, Gómez-Mesa JE. Endovascular and medical therapy of May-Thurner syndrome: Case series and scoping literature review. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:80-89. [PMID: 33752850 DOI: 10.1016/j.jdmv.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION May-Thurner syndrome has been recognized as a cause of chronic venous insufficiency and a trigger for venous thromboembolism. There is no consensus about the definition, diagnosis, and therapeutic approach. We are aiming to describe its characteristics and a scoping literature review. METHODS A retrospective review of patients with May-Thurner syndrome from March 2010 to May 2018 and scoping literature review were made. RESULTS Seven patients were identified. All patients were female with a median age of 36 (20-60) years. The median time from the first symptom to diagnosis was 3.41 (0.01-9) years. The primary clinical presentation was post-thrombotic syndrome (4 patients). Six patients had at least one risk factor for deep venous thrombosis. All patients underwent angioplasty with stent; patients with acute deep venous thrombosis, furthermore mechanic thrombectomy with or without catheter-directed thrombolysis were done. There were three complications (one patient, lymphedema, and two venous stent thrombosis). Scoping review results were descriptively summarized. CONCLUSION May-Thurner syndrome has a varied spectrum of clinical presentation, and clinical awareness is paramount for diagnosis. Its principal complication is the post-thrombotic syndrome, which is associated with high morbidity. There is no consensus on the antithrombotic treatment approach.
Collapse
Affiliation(s)
- M C Montes
- Internal Medicine Department, Cardiology Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J P Carbonell
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J E Gómez-Mesa
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia.
| |
Collapse
|
12
|
Machin M, Salim S, Tan M, Onida S, Davies AH, Shalhoub J. Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome. Expert Rev Cardiovasc Ther 2021; 19:191-200. [PMID: 33455484 DOI: 10.1080/14779072.2021.1876563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: Post-thrombotic syndrome (PTS) is a common lifelong condition affecting up to 50% of those suffering from deep vein thrombosis (DVT). PTS compromises function and quality of life with subsequent venous ulceration in up to 29% of those affected.Areas covered: A literature review of surgical and non-surgical approaches in the prevention and treatment of PTS was undertaken. Notable areas include the use of percutaneous endovenous interventions and the use of graduated compression stockings (GCS) after acute proximal DVT.Expert opinion: In patients with acute iliofemoral DVT, we think it is important to have a frank conversation with the patient about catheter-directed thrombolysis, aiming to reduce the severity of PTS experienced. We advocate ultrasound-accelerated thrombolysis with adjunctive procedures, such as deep venous stenting for proximal iliofemoral DVT. For patients with isolated femoral DVT, we believe that anticoagulation and GCS should be recommended. In patients with established PTS, we recommend GCS for symptomatic relief. We recommend that patients engage in regular exercise where possible with the prospect of gaining symptomatic relief. For those with severe PTS that has a significant effect on quality of life, we discuss the patient's case at a multi-disciplinary team meeting to plan for endovenous intervention.
Collapse
Affiliation(s)
- M Machin
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - S Salim
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - M Tan
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - S Onida
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | - J Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| |
Collapse
|
13
|
Salem KM, Saadeddin Z, Go C, Malak OA, Eslami MH, Hager E, Al-Khoury G, Chaer RA, Avgerinos ED. Risk factors for acute kidney injury after pharmacomechanical thrombolysis for acute deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2020; 9:868-873. [PMID: 33186753 DOI: 10.1016/j.jvsv.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pharmacomechanical thrombolysis (PMT) is an established treatment for selected patients with acute deep vein thrombosis (DVT). Despite significant clinical success, hemolysis can lead to acute kidney injury (AKI) with unknown longer term implications. Our aim was to characterize the rate of AKI after PMT and identify those patients at the greatest risk. METHODS A retrospective medical record review of patients with acute DVT who had undergone PMT in our institution from 2007 to 2018 was performed. The baseline demographics, comorbidities, preoperative clinical characteristics, procedural details, postoperative hospital course, and follow-up data were reviewed. The primary outcome was postoperative AKI (≥1.5 times preoperative creatinine), and longer term renal impairment. Logistic regression modeling was used to identify associated factors. RESULTS A total of 137 patients (mean age, 47 ± 16.6 years; 49.6% male) who had undergone PMT for treatment of acute DVT were identified (85.4% AngioJet system; Boston Scientific Corp, Marlborough, Mass). Of the 137 patients, 30 (21.9%) had developed AKI in the periprocedural period, 1 of whom had required hemodialysis in the perioperative period. The patients who had developed AKI had had significantly greater rates of preoperative coronary artery disease (23.1% vs 4.7%; P = .002), diabetes mellitus (19.2% vs 6.6%; P = .045), dyslipidemia (42.3% vs 17.9%; P = .008), and hypertension (53.6% vs 29.3%; P = .018). No significant difference was found in preoperative creatinine (0.99 vs 0.92 mg/dL; P = .65) or glomerular filtration rate (GFR; 96.9 vs 91.8 mL/min; P = .52) between the two groups. Multivariate analysis demonstrated bilateral DVT (odds ratio [OR], 4.35; 95% confidence interval [CI], 1.47-12.86; P = .008), single-session PMT (OR, 3.05; 95% CI, 1.02-9.11; P = .046), and female sex (OR, 2.85; 95% CI, 1.01-8.04; P = .048) were significant predictors of AKI. Of the 30 patients, 10 had had normal renal function at discharge and 15 and 25 patients had had normal renal function at the first and subsequent clinical follow-up visits, respectively. The remaining five patients (3.6%) had progressed to moderate (GFR, <60 mL/min) or severe (GFR, <30 mL/min) renal insufficiency, with one requiring long-term hemodialysis. CONCLUSIONS The use of PMT for treatment of acute DVT conferred a risk of AKI that will progress to chronic renal failure in a small fraction of affected patients. Patients with bilateral extensive DVTs have a greater risk of AKI; thus, longer priming with a thrombolytic drip before PMT should be preferred for this population.
Collapse
Affiliation(s)
- Karim M Salem
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa.
| | - Zein Saadeddin
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa
| | - Catherine Go
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa
| | - Othman A Malak
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa
| | - Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa
| | - Eric Hager
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa
| | - Georges Al-Khoury
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa
| |
Collapse
|
14
|
Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, Hutten BA, Jaff MR, Manja V, Schulman S, Thurston C, Vedantham S, Verhamme P, Witt DM, D Florez I, Izcovich A, Nieuwlaat R, Ross S, J Schünemann H, Wiercioch W, Zhang Y, Zhang Y. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4:4693-4738. [PMID: 33007077 PMCID: PMC7556153 DOI: 10.1182/bloodadvances.2020001830] [Citation(s) in RCA: 559] [Impact Index Per Article: 139.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually. OBJECTIVE These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE. METHODS ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events. CONCLUSIONS Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE.
Collapse
Affiliation(s)
- Thomas L Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham NC
| | | | - Walter Ageno
- Department of Medicine and Surgery, University of Insurbria, Varese, Italy
| | - Rebecca Beyth
- Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Nathan P Clark
- Clinical Pharmacy Anticoagulation Service, Kaiser Permanente, Aurora, CO
| | - Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Barbara A Hutten
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Veena Manja
- University of California Davis, Sacramento, CA
- Veterans Affairs Northern California Health Care System, Mather, CA
| | - Sam Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Suresh Vedantham
- Division of Diagnostic Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Peter Verhamme
- KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Daniel M Witt
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ariel Izcovich
- Internal Medicine Department, German Hospital, Buenos Aires, Argentina; and
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Stephanie Ross
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuqing Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
15
|
Nickler M, Haubitz S, Méndez A, Gissler M, Stierli P, Kieback A. Phlegmasia cerulea dolens - an uncommon but alarming manifestation of deep vein thrombosis. VASA 2020; 49:422-426. [PMID: 32646321 DOI: 10.1024/0301-1526/a000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In phlegmasia cerulea dolens (PCD), immediate diagnosis and prompt treatment is crucial for limb salvage. Aggressive treatment options including venous intervention, thrombolysis and/or surgical thrombectomy should be considered. Due to the lack of data, the most appropriate intervention depends upon etiology of PCD, clinical presentation and patient's bleeding risk.
Collapse
Affiliation(s)
- Manuela Nickler
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical University Department, Division of Infectiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Adriana Méndez
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Martin Gissler
- Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Peter Stierli
- Surgical Department, Division of Vascular Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Arne Kieback
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
16
|
Mühlberger D, Wenkel M, Papapostolou G, Mumme A, Stücker M, Reich-Schupke S, Hummel T. Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years. PLoS One 2020; 15:e0235003. [PMID: 32555683 PMCID: PMC7302664 DOI: 10.1371/journal.pone.0235003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Deep vein thrombosis (DVT) is a frequent burden and a post-thrombotic syndrome (PTS) can be a serious long-term consequence. Iliofemoral DVT should be associated with severe forms of PTS. Therefore an early thrombus removal has been recommended in specific conditions. The aim of this study was to find out both, the long-term results after surgical thrombectomy of iliofemoral DVT in respect of the development of PTS as well as the venous hemodynamics after surgery concerning venous reflux and venous obstruction. Methods Sixty-seven patients who underwent surgical thrombectomy between the years 2000 and 2014 were included in this study; iliofemoral DVT was present in 52 of these patients. 35 patients could be reinvestigated after a mean follow-up of 8.5 years. CEAP (Clinical-Etiological-Anatomical-Pathophysiological) and Villalta scores were recorded in order to describe and assess PTS. Follow-up examinations included a detailed duplex mapping. Venous hemodynamics were measured by digital photoplethysmography and venous occlusion plethysmography. Results The primary patency rate of the iliofemoral segment was 88% after 8.5 years. 48% of all patients showed reflux in deep vein segments. Mild or moderate PTS occurred in 57% of all patients. Notably, there was no patient with an active ulcer or severe PTS. The mean venous outflow volume of all patients in the treated legs was 66.1 ml/100ml/min and significantly less than in the controlled contralateral non-treated legs (p<0.05). The mean venous refilling time was 16.3 seconds, while the mean value of the non-treated contralateral legs was 25.6 seconds and therefore significantly higher (p<0.05). Conclusion Even though venous hemodynamics are significantly inferior in the treated legs, this study demonstrates excellent patency rates and good clinical outcome after surgical thrombectomy of iliofemoral veins.
Collapse
Affiliation(s)
- Dominic Mühlberger
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
- * E-mail:
| | - Martin Wenkel
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Georg Papapostolou
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Achim Mumme
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Markus Stücker
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
- Department of Dermatology, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stefanie Reich-Schupke
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
- Department of Dermatology, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Thomas Hummel
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| |
Collapse
|
17
|
Xu YD, Zhong BY, Yang C, Cai XS, Hu B, Wang XY, Fan BR, Jin YH, Ni CF, Duan PF. Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis. Phlebology 2020; 35:589-596. [PMID: 32316832 DOI: 10.1177/0268355520919201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate and compare the treatment efficacy and safety between catheter-directed thrombolysis monotherapy and catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy for patients with subacute iliofemoral deep vein thrombosis. METHODS We conducted a retrospective analysis of a total of 74 subacute iliofemoral deep vein thrombosis patients who underwent catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy. Patients treated with catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy (percutaneous mechanical thrombectomy group, n = 30) or catheter-directed thrombolysis monotherapy (catheter-directed thrombolysis group, n = 44) were included. The primary endpoints were the clinical efficacy rate of thrombolysis, primary patency, and the incidence of post-thrombotic syndrome (at 12 months diagnosed according to the original Villalta score criteria. Secondary endpoints were the total urokinase dose, the thrombolysis time, the detumescence rate and complications. RESULTS The percentage of successful thrombolysis for percutaneous mechanical thrombectomy group was higher than that for catheter-directed thrombolysis group (P = 0.045). At the 12-month follow-up, there was no difference in the primary patency (P > 0.05) or the incidence of post-thrombotic syndrome (P = 0.36). Percutaneous mechanical thrombectomy group had significant advantages in reducing urokinase doses and thrombolysis times compared with catheter-directed thrombolysis group for patients with thrombus clearance levels II and III (P < 0.05). CONCLUSION Catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy performs better in removing vein thrombi, reducing urokinase doses, and shortening thrombolysis times.
Collapse
Affiliation(s)
- Yi-Ding Xu
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bin-Yan Zhong
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chao Yang
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu-Sheng Cai
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Hu
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao-Yun Wang
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bao-Rui Fan
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yong-Hai Jin
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cai-Fang Ni
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng-Fei Duan
- Department of Vascular and Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
18
|
Söderman M, Grimm P. Phlegmasia cerulea dolens in a patient treated with carboplatin. BMJ Case Rep 2020; 13:13/4/e233760. [PMID: 32295798 DOI: 10.1136/bcr-2019-233760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Phlegmasia cerulea dolens (PCD) is a rare, fulminant, potentially lethal and often debilitating presentation of deep venous thrombosis (DVT). Mortality and amputations rates are high. We present a rare case of bilateral PCD in the lower extremities. A 67-year-old woman presented with newly diagnosed squamous cell cancer of unknown primary origin with lymph node metastases to the neck. The patient started curatively intended treatment, consisting of removal of one lymph node on the neck, radiotherapy with concomitant carboplatin and nimorazol. The patient developed bilateral DVT in the legs. Despite treatment with low-molecular-weight heparins, the patient developed thrombosis in the inferior vena cava and lungs. Due to developing painful discolouration and necrosis on the legs, the patient underwent acute and extensive surgery. PCD is a severe and potentially lethal form of DVT. There are several known risk factors for developing DVT, including active cancer and the use of chemotherapy.
Collapse
Affiliation(s)
- Martin Söderman
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark .,Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Peter Grimm
- Department of Oncology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
19
|
Akram F, Sadashiv RG. May-Thurner syndrome: an overlooked cause of venous thromboembolism. Med J Aust 2020; 212:402-403.e1. [PMID: 32162703 DOI: 10.5694/mja2.50548] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Farooq Akram
- Changi General Hospital, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
| | - Roshni G Sadashiv
- Changi General Hospital, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
| |
Collapse
|
20
|
Single-Stage Treatment of AngioJet Rheolytic Thrombectomy and Stenting for Iliac Vein Compression Syndrome with Secondary Acute Iliofemoral Deep Vein Thrombosis. Ann Vasc Surg 2019; 61:384-393. [DOI: 10.1016/j.avsg.2019.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/09/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
|
21
|
Preventive Effects of Different Drugs on Asymptomatic Lower Extremities Deep Venous Thrombosis After Artificial Joint Replacement: A Mixed Treatment Comparison. Am J Ther 2019; 26:e45-e53. [PMID: 26938762 DOI: 10.1097/mjt.0000000000000438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This network meta-analysis aims to compare the preventive effects of 8 drugs (edoxaban, dabigatran, apixaban, rivaroxaban, warfarin, bemiparin, ximelagatran, and enoxaparin) on asymptomatic deep venous thrombosis (DVT) of lower extremities after artificial joint replacement. PubMed, Cochrane Library, and Embase were searched from their inception through October 2015 for randomized controlled trials comparing 8 drugs for the prevention of asymptomatic DVT of lower extremities after artificial joint replacement. Network meta-analysis combined the direct and indirect evidence to evaluate odd ratios (ORs) and surface under the cumulative ranking curves values. A total of 15 randomized controlled trials satisfying the inclusion criteria were enrolled. Edoxaban, apixaban, and rivaroxaban had poorer preventive effects on asymptomatic DVT of lower extremities after undergoing artificial joint replacement when compared with warfarin [OR = 0.16, 95% confidence interval (CI), 0.04-0.60; OR = 0.22, 95% CI, 0.07-0.64; OR = 0.16, 95% CI, 0.05-0.49, respectively]. When compared with enoxaparin, the preventive effects of edoxaban and rivaroxaban were poorer (OR = 0.37, 95% CI, 0.15-0.85; OR = 0.37, 95% CI, 0.21-0.59, respectively). The preventive effects of edoxaban and rivaroxaban were poorer than dabigatran (OR = 0.38, 95% CI, 0.14-0.99; OR = 0.38, 95% CI, 0.18-0.73, respectively). The surface under the cumulative ranking curves values showed that warfarin had better preventive effects on asymptomatic DVT of lower extremities after undergoing artificial joint replacement. Among the 8 drugs (edoxaban, dabigatran, apixaban, rivaroxaban, warfarin, bemiparin, ximelagatran, and enoxaparin), warfarin had better preventive effects on asymptomatic DVT of lower extremities after undergoing artificial joint replacement.
Collapse
|
22
|
Eckenrode G, Baltich Nelson B, Belarmino A, Chen SA, Goel S, Meltzer AJ. Meta-analysis and systematic review of interventional therapy versus anticoagulation for isolated femoropopliteal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2019; 7:272-276. [PMID: 30660583 DOI: 10.1016/j.jvsv.2018.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Percutaneous endovenous intervention (PEVI) is gaining acceptance for select patients with symptomatic proximal lower extremity deep venous thrombosis (DVT), but the benefits are uncertain in patients with isolated femoropopliteal DVTs. We performed a systematic review and meta-analysis of the literature to assess the safety and effectiveness of PEVI vs systemic anticoagulation for patients with isolated femoropopliteal DVT. METHODS We systematically searched PubMed, Embase, and the Cochrane Library from inception to March 2018. All studies comparing clinical outcomes between PEVI and systemic anticoagulation were included. The main end points were post-thrombotic syndrome and bleeding complications. Secondary outcomes included femoropopliteal patency rate, venous obstruction, and recurrent DVT. RESULTS No studies directly comparing PEVI with systemic anticoagulation in isolated femoropopliteal DVTs were identified by the systematic review. A traditional literature review identified one randomized controlled trial comparing the two, which found no difference in rates of post-thrombotic syndrome in PEVI vs systemic anticoagulation (risk ratio, 0.96; 95% confidence interval, 0.82-1.11; P = .56). We additionally identified five retrospective case series containing patients with isolated femoropopliteal DVTs, of which two reported on patency rates (46%-100% at 2 years). CONCLUSIONS More data are required to definitively state that PEVI should be the preferred intervention for patients with isolated femoropopliteal DVTs, although the initial evidence is promising.
Collapse
Affiliation(s)
| | - Becky Baltich Nelson
- Information Technologies and Services - Library, Weill Cornell Medical College, New York, NY
| | - Andre Belarmino
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | | | - Shokhi Goel
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Andrew J Meltzer
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, Ariz
| |
Collapse
|
23
|
Kungurtsev VV, Saraniuk RI, Kungurtsev EV, Chernov AA, Zvereva LS, Ianus VM. [Thrombectomy for acute iliofemoral thrombosis in prevention of pulmonary embolism]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:181-187. [PMID: 31855216 DOI: 10.33529/angio2019422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acute thrombosis in the system of the inferior vena cava is one of the most common vascular diseases and is of serious danger as a potential source of one of the most severe complications. In order to assess efficacy of open thrombectomy for embologenic iliofemoral venous thromboses we carried out comparison of the results of open thrombectomy and implantation of cava filters in a total of 119 patients presenting with iliofemoral thrombosis. PATIENTS AND METHODS Open thrombectomy was performed in a total of 59 patients. Of these, 12 patients with segmental thromboses underwent radical thrombectomy and 47 patients with disseminated forms of thrombosis were subjected to partial thrombectomy with plication of the femoral vein. In 5 patients, the operation was supplemented with applying an arteriovenous fistula. Efficacy of operations was assessed with the help of ultrasonographic duplex angioscanning and regression of clinical manifestations. In the remote period, the degree of manifestations of post-thrombotic disease was assessed by means of the Villalta scale. RESULTS After radical thrombectomy, patency of the iliofemoral segment was preserved in all patients during the whole follow-up period. In the group of patients with partial thrombectomy, 5 (9.5%) patients developed rethrombosis above the placation site at terms from 8 to 12 months. Four-year patency of the iliofemoral segment in this group of patients amounted to 81.5%. In patients with implanted cava filters, neither femoral vein nor iliac segment were patent completely. During the first year, thrombosis of cava filter developed in 9 cases; after 2 years, occlusion of the cava filter was diagnosed in 7 patients. In clinical assessment of the remote results with the use of the Villalta scale in patients after open thrombectomy the symptoms of post-traumatic disease were absent or weakly pronounced. After implantation of the cava filter all patients demonstrated the clinical course of post-traumatic disease, corresponding to 10-15 points. CONCLUSION Open thrombectomy for iliofemoral embologenic thromboses performed at specialized departments is a radical method of preventing thromboembolic complications and promotes restoration or improvement of venous blood flow in the extremity.
Collapse
Affiliation(s)
- V V Kungurtsev
- Multimodality Medical Centre of the Bank of Russia, Moscow, Russia
| | - R I Saraniuk
- Multimodality Medical Centre of the Bank of Russia, Moscow, Russia
| | - E V Kungurtsev
- Multimodality Medical Centre of the Bank of Russia, Moscow, Russia
| | - A A Chernov
- Multimodality Medical Centre of the Bank of Russia, Moscow, Russia
| | - L S Zvereva
- Multimodality Medical Centre of the Bank of Russia, Moscow, Russia
| | - V M Ianus
- Multimodality Medical Centre of the Bank of Russia, Moscow, Russia
| |
Collapse
|
24
|
|
25
|
Abstract
The surgical treatment of deep venous thrombosis (DVT) has significantly evolved and is focused on different strategies of early thrombus removal in the acute phase and deep venous recanalization or bypass in the chronic phase. Along with the use of anticoagulation agents, endovascular techniques based on catheter-directed thrombolysis and pharmacomechanical thrombectomy have been increasingly used in patients with acute extensive DVT. Patient selection is crucial to provide optimal outcomes and minimize complications.
Collapse
Affiliation(s)
- Cassius Iyad Ochoa Chaar
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar street, Boardman 204, New Haven, CT 06510, USA.
| | - Afsha Aurshina
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar street, Boardman 204, New Haven, CT 06510, USA
| |
Collapse
|
26
|
Surgical Thrombectomy and Simultaneous Stenting for Phlegmasia Cerulea Dolens Caused by Iliac Vein Occlusion. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.01.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
27
|
Li W, Chuanlin Z, Shaoyu M, Yeh CH, Liqun C, Zeju Z. Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis. Rev Lat Am Enfermagem 2018; 26:e2990. [PMID: 29947719 PMCID: PMC6047892 DOI: 10.1590/1518-8345.2309.2990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023] Open
Abstract
Objectives: To evaluate case series studies that quantitatively assess the effects of
catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and
anticoagulation in patients with acute lower extremity deep vein thrombosis
(DVT). Methods: Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and
Scopus, were searched through January 2017. The inclusion criteria were
applied to select patients with acute lower extremity DVT treated with CDT
or with anticoagulation. In the case series studies, the pooled estimates of
efficacy outcomes for patency rate, complete lysis, rethrombosis and
post-thrombotic syndrome (PTS) were calculated across the studies. In
studies comparing CDT with anticoagulation, summary odds ratios (ORs) were
calculated. Results: Twenty-five articles (six comparing CDT with anticoagulation and 19 case
series) including 2254 patients met the eligibility criteria. In the case
series studies, the pooled results were a patency rate of 0.87 (95% CI:
0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95%
CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the
efficacy outcomes of CDT and anticoagulation showed that CDT was associated
with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and a higher
patency rate (OR 4.76, 95%CI 2.14-10.56, p<0.0001). Conclusion: Acute lower extremity DVT patients receiving CDT were found to have a lower
incidence of PTS and a higher incidence of patency rate. In our
meta-analysis, CDT is shown to be an effective treatment for acute lower
extremity DVT patients.
Collapse
Affiliation(s)
- Wang Li
- MSc, RN, School of Nursing, Chongqing Medical University, Chongqing, Chongqing, China
| | - Zhang Chuanlin
- MSc, RN, The First Affiliated Hospital, Chongqing Medical University, Chongqing, Chongqing, China
| | - Mu Shaoyu
- Professor, School of Nursing, Chongqing Medical University, Chongqing, Chongqing, China
| | - Chao Hsing Yeh
- PhD, Professor, School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Chen Liqun
- MSc, RN, School of Nursing, Chongqing Medical University, Chongqing, Chongqing, China
| | - Zhang Zeju
- MSc, RN, School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, Chongqing, China
| |
Collapse
|
28
|
Prevention and treatment of the post-thrombotic syndrome. Thromb Res 2018; 164:116-124. [DOI: 10.1016/j.thromres.2017.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/19/2017] [Accepted: 07/10/2017] [Indexed: 11/21/2022]
|
29
|
García-Fernández-Bravo I, Demelo-Rodríguez P, Ordieres-Ortega L, Álvarez-Luque A, Del Toro-Cervera J. Cancer associated phlegmasia cerulea dolens successfully treated with apixaban. Blood Res 2018; 53:90-92. [PMID: 29662871 PMCID: PMC5899006 DOI: 10.5045/br.2018.53.1.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/14/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Pablo Demelo-Rodríguez
- Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Lucia Ordieres-Ortega
- Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Arturo Álvarez-Luque
- Department of Vascular Interventional Radiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Jorge Del Toro-Cervera
- Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| |
Collapse
|
30
|
Abstract
Lower extremity deep venous thrombosis is a leading cause of morbidity and mortality. The mainstay of therapy is medical. However, anticoagulation does not remove the thrombus and restore venous patency. In select patients, early thrombus removal and anticoagulation can restore venous patency, preserve venous valve function, and may reduce the incidence of postthrombotic syndrome. Catheter-directed therapies are minimally invasive with low complication rates. However, in patients with a contraindication to thrombolytic agents who can receive anticoagulation, open thrombectomy should be considered if indications for thrombus removal are met and patients are good operative risks.
Collapse
|
31
|
Wang CN, Deng HR. Percutaneous Endovenous Intervention Plus Anticoagulation versus Anticoagulation Alone for Treating Patients with Proximal Deep Vein Thrombosis: A Meta-analysis and Systematic Review. Ann Vasc Surg 2018; 49:39-48. [PMID: 29454036 DOI: 10.1016/j.avsg.2017.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/27/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Combination treatment with percutaneous endovenous intervention (PEVI) and anticoagulation has been proposed for treating lower-extremity proximal deep vein thrombosis (DVT). We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of PEVI plus anticoagulation versus anticoagulation alone in patients with lower-extremity proximal DVT. METHODS We systematically searched PubMed, Embase, and the Cochrane Library from inception to May 2016. All RCTs comparing clinical outcomes between additional PEVI and anticoagulation alone were included. The main end points were postthrombotic syndrome (PTS) and major bleeding complications. Secondary outcomes included the iliofemoral patency rate, venous obstruction, and recurrent DVT. We assessed pooled data using a random-effects model. RESULTS Four RCTs were included. PEVI plus standard anticoagulation compared with anticoagulation alone was associated with a lower rate of PTS (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.18-0.63), significantly higher iliofemoral patency rate at 6 months and 12 months (OR 8.49, 95% CI 1.32-54.60), a lower rate of venous obstruction (OR 0.42, 95% CI 0.20-0.924), and a lower rate of recurrent DVT (OR 0.42, 95% CI 0.20-0.92). However, more major bleeding episodes occurred in the group with catheter-directed thrombolysis (Peto OR 5.86, 95% CI 1.76-19.48). CONCLUSIONS PEVI plus anticoagulation reduced the occurrence of PTS, recurrent DVT, and venous obstruction. Another advantage is an increased patency rate at 6 and 12 months. The disadvantage is an increased occurrence of major bleeding events.
Collapse
Affiliation(s)
- Chao-Nan Wang
- Department of Vascular Surgery, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Hong-Ru Deng
- Department of Vascular Surgery, Fuxing Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
32
|
Czaplicki C, Albadawi H, Partovi S, Gandhi RT, Quencer K, Deipolyi AR, Oklu R. Can thrombus age guide thrombolytic therapy? Cardiovasc Diagn Ther 2017; 7:S186-S196. [PMID: 29399522 DOI: 10.21037/cdt.2017.11.05] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Venous thrombosis (VT) is a common yet complex clinical condition that has shown minimal alteration in clinical management for decades. It is well known that thrombus evolves structurally over time, with complex changes resulting from the interplay between coagulation factors, cytokines, leukocytes and a myriad of other factors. Our current treatment options are most effective in the acute thrombus, which is composed predominantly of a loose mesh of fibrin and red blood cells (RBCs), making current anticoagulation therapies and thrombolytics quite effective in treatment. Later stages of thrombus are more cellular containing leukocytes, and develop a fibrotic collagenous framework that is more resistant to our current treatments. Understanding the biology of an evolving thrombus will allow us to tailor our treatment and optimize outcomes, as well as focus on novel therapies for the treatment of chronic thrombus. Given the morbidity and mortality of both post thrombotic syndrome (PTS) in patients with deep VT, as well as chronic thromboembolic pulmonary hypertension (CTEPH) in patients with pulmonary embolism (PE), new and innovative therapies must continue to be explored to help prevent these potentially devastating conditions.
Collapse
Affiliation(s)
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Sasan Partovi
- University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ripal T Gandhi
- Miami Cardiac and Vascular Institute, University of South Florida College of Medicine, Kendall, FL, USA
| | - Keith Quencer
- Department of Radiology, University of California San Diego Medical Center, San Diego, CA, USA
| | - Amy R Deipolyi
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
33
|
Wagenhäuser MU, Sadat H, Dueppers P, Meyer-Janiszewski YK, Spin JM, Schelzig H, Duran M. Open surgery for iliofemoral deep vein thrombosis with temporary arteriovenous fistula remains valuable. Phlebology 2017; 33:600-609. [PMID: 29065779 DOI: 10.1177/0268355517736437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective We assessed outcomes of open surgical venous thrombectomy with temporary arteriovenous fistula, and the procedure's effect on health-related quality of life. Method We retrospectively analyzed 48 (26 at long-term) patient medical records. Mortality rates, patency, and risk of post-thrombotic syndrome were analyzed using Kaplan-Meier estimation. The association between risk factors/coagulation disorders and patency/post-thrombotic syndrome along with patient health-related quality of life at long-term was analyzed employing various statistical methods. Results Patient one-year survival rate was 93 ± 4% and primary one-year patency rate was 89 ± 5% (secondary one-year patency rate 97 ± 3%). Freedom from post-thrombotic syndrome after eight years was 80 ± 12% (post-thrombotic syndrome rate 20 ± 12%). Health-related quality of life was impaired vs. normative data in the physical and social subscales, and in the mental component score ( p < .05). Conclusions Open surgical venous thrombectomy appears safe compared with literature-reported outcomes in similar patients using alternative approaches. Iliofemoral deep vein thrombosis impairs physical, social, and mental health-related quality of life.
Collapse
Affiliation(s)
- Markus U Wagenhäuser
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany.,2 Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hellai Sadat
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Philip Dueppers
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Yvonne K Meyer-Janiszewski
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Joshua M Spin
- 2 Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hubert Schelzig
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Mansur Duran
- 1 Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
34
|
Ioannou P, Tsagkaraki E, Andrianaki AM, Papadakis JA. Unnecessary hospitalizations for DVT in the era of NOACs. Eur J Intern Med 2017; 44:e40-e41. [PMID: 28739351 DOI: 10.1016/j.ejim.2017.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Emmanouela Tsagkaraki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Aggeliki M Andrianaki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| |
Collapse
|
35
|
Perforator Vein Access for Venous Pharmacomechanical Thrombolysis. Ann Vasc Surg 2017; 45:269.e11-269.e14. [PMID: 28739461 DOI: 10.1016/j.avsg.2017.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 11/21/2022]
Abstract
A 28-year-old Hispanic female with a history of deep vein thrombosis (DVT) presented to the emergency room with left lower extremity swelling and pain. On duplex venous examination, an extensive left lower extremity DVT extending to her left common iliac vein was identified. A perforator vein measuring 2.6 mm located in the midcalf area was used to access and perform mechanical and chemical thrombolysis. Complete resolution of symptoms was observed.
Collapse
|
36
|
Ockert S, von Allmen M, Heidemann M, Brusa J, Duwe J, Seelos R. Acute Venous Iliofemoral Thrombosis: Early Surgical Thrombectomy Is Effective and Durable. Ann Vasc Surg 2017; 46:314-321. [PMID: 28739469 DOI: 10.1016/j.avsg.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The first-line recommendation for the treatment of acute iliofemoral deep vein thrombosis (IFDVT) is catheter-directed thrombolysis or pharmacomechanical thrombolysis. Recent analysis of surgical thrombectomy has shown comparable results. However, this procedure is not commonly given as much importance as interventional techniques. We analyzed the patient outcome of surgical thrombectomy using modern endovascular techniques in both the short and long term. METHODS All consecutive patients who underwent surgical thrombectomy at our institution between April 2008 and April 2017 were included. Only patients with iliofemoral thrombosis, and only those with the first onset of symptoms <10 days, were analyzed. All patients received preoperative duplex ultrasound and contrast-enhanced computed tomography scans for thrombus extension and detection of pulmonary embolism. All operations were performed by vascular surgeons with open and endovascular skills in a C-arm-equipped operating room. During follow-up (FU), all patients received clinical examination for symptoms of postthrombotic syndrome (PTS), as well as duplex ultrasound. RESULTS Within a 9-year period, 21 patients underwent surgical thrombectomy for IFDVT (17 females/4 males). Primary technical success was 100%; 10 (47.6%) patients received additional primary stenting. 30-day mortality was 0%, 3 patients (14.3%) needed reoperation for early rethrombosis, while secondary 30-day patency was 100%. During FU (median, 6 years; range, 1-104 months), 1 patient received additional stenting for stenosis of the common iliac vein. Nineteen patients (90.5%) presented patent iliofemoral veins without signs of rethrombosis. Two patients (9.5%) died during FU of cancer without signs for recurrent IFDVT. All patients with patent veins were free of symptoms for PTS. CONCLUSIONS Surgical thrombectomy for acute IFDVT is a successful, safe, and durable procedure and provides alternative treatment options for acute IFDVT in selected cases.
Collapse
Affiliation(s)
- Stefan Ockert
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Matthias von Allmen
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Michaela Heidemann
- Department of Angiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Juliette Brusa
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jan Duwe
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Robert Seelos
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| |
Collapse
|
37
|
Smirnov P, Hynynen K. Design of a HIFU array for the treatment of deep venous thrombosis: a simulation study. Phys Med Biol 2017; 62:6108-6125. [PMID: 28486218 DOI: 10.1088/1361-6560/aa71fb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deep venous thrombosis of the iliofemoral veins is a common and morbid disease, with the recommended interventional treatment carrying a high risk of hemorrhaging and complications. High intensity focused ultrasound delivered with a single element transducer has been shown to successfully precipitate thrombolysis non-invasively in vitro and in vivo. However, in all previous studies damage to the veins or surrounding tissue has been observed. Using a simulation model of the human thigh, this study investigated whether a phased array device could overcome the large focal region limitations faced by single transducer treatment devices. Effects of the size, shape and frequency of the array on its focal region were considered. It was found that a [Formula: see text] spaced array of 7680 elements operating at 500 kHz could consistently focus to a region fully contained within the femoral vein. Furthermore, it is possible to reduce the number of elements required by building arrays operating at lower frequencies. The results suggest that phased transducer arrays hold potential for developing a safe, non-invasive treatment of thrombolysis.
Collapse
Affiliation(s)
- Petr Smirnov
- Sunnybrook Research Institute, Physical Sciences Platform, Toronto, Canada. Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | | |
Collapse
|
38
|
Yuksel A, Tuydes O. Midterm Outcomes of Pharmacomechanical Thrombectomy in the Treatment of Lower Extremity Deep Vein Thrombosis With a Rotational Thrombectomy Device. Vasc Endovascular Surg 2017; 51:301-306. [DOI: 10.1177/1538574417708726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study was to assess the safety and efficacy with midterm outcomes of pharmacomechanical thrombectomy (PMT) performed by using a relatively new thrombectomy device in the treatment of lower extremity deep vein thrombosis (DVT). Methods: Between February 2014 and February 2016, a total of 46 patients with lower extremity DVT were treated with PMT by using Cleaner rotational thrombectomy system. Preprocedural, intraprocedural, postprocedural, and follow-up records of patients were collected and retrospectively analyzed. Results: Mean age of patients was 50.5 (14.8) years, and 58.7% of them were female. Technical success rate of procedure was 91.3%. Mean procedure time was 81.8 (40.3) minutes. Early clinical improvement was observed in all patients with successful treatment. No serious adverse event related to procedure and mortality was observed. Mean follow-up time was 16.0 (7.9) months. Reocclusion was observed in 7 (17.5%) patients during the follow-up period. Venous patency rates of patients at 1-, 3-, 6-, and 12-month follow-up visits were 95%, 92.5%, 89.7%, and 79.5%, respectively. Mild, moderate, and severe postthrombotic syndrome were observed in 8 (20%) patients, 4 (10%) patients, and 1 (2.5%) patient, respectively. Postthrombotic syndrome–free survival rate was 67.5%. Conclusion: Cleaner rotational thrombectomy system appears to be safe and effective in the treatment of lower extremity DVT. Further larger randomized studies are needed to determine the long-term outcomes of this treatment modality.
Collapse
Affiliation(s)
- Ahmet Yuksel
- Department of Cardiovascular Surgery, Bursa State Hospital, Bursa, Turkey
| | - Oktay Tuydes
- Department of Cardiovascular Surgery, Bingol State Hospital, Bingol, Turkey
| |
Collapse
|
39
|
Editor's Choice – Factors Associated with Long-Term Outcome in 191 Patients with Ilio-Femoral DVT Treated With Catheter-Directed Thrombolysis. Eur J Vasc Endovasc Surg 2017; 53:419-424. [DOI: 10.1016/j.ejvs.2016.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
|
40
|
Rabinovich A, Kahn SR. The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost 2017; 15:230-241. [PMID: 27860129 DOI: 10.1111/jth.13569] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Indexed: 01/18/2023]
Abstract
Postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients. PTS manifests as a spectrum of symptoms and signs of chronic venous insufficiency that can impose significant morbidity and have a negative impact on quality of life. Chronic venous hypertension caused by a combination of residual venous obstruction and valvular reflux is believed to play a major role in the pathophysiology of PTS. The Villalta scale is the most widely applied clinical scale used to diagnose and define PTS. Proximal DVT and recurrent ipsilateral DVT are the two principal established risk factors for PTS, and efforts in recent years have been focused on identifying a combination of clinical and biomarker predictors that will define high-risk patients and possibly new therapeutic targets. The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. Recent years have brought progress in our understanding of the role of endovascular techniques in the prevention and treatment of PTS and the subgroups of patients that may benefit from these modalities. Pharmacomechanical catheter-directed thrombolysis is the most promising interventional modality for prevention of PTS. This review summarizes the current state of evidence on PTS of the lower limbs, and highlights areas where uncertainty still exists that require further research.
Collapse
Affiliation(s)
- A Rabinovich
- Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - S R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Division of Internal Medicine and Department of Medicine, McGill University, Montreal, Canada
| |
Collapse
|
41
|
Avgerinos ED, El-Shazly O, Jeyabalan G, Al-Khoury G, Hager E, Singh MJ, Makaroun MS, Chaer RA. Impact of inferior vena cava thrombus extension on thrombolysis for acute iliofemoral thrombosis. J Vasc Surg Venous Lymphat Disord 2016; 4:385-91. [PMID: 27638990 DOI: 10.1016/j.jvsv.2016.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inferior vena cava (IVC) thrombosis may occur in patients with iliofemoral deep venous thrombosis (DVT), and its impact on thrombolysis outcomes is poorly defined. This study compared outcomes of patients undergoing thrombolysis for acute iliofemoral DVT with and without IVC involvement. METHODS Patients who underwent thrombolysis for iliofemoral DVT between May 2007 and March 2014 were identified from a prospectively maintained database and divided into two groups: those with IVC involvement and those without. End points were technical and clinical success (≥50% lysis or freedom from 30-day DVT recurrence), long-term DVT recurrence, and post-thrombotic syndrome (PTS; Villalta score ≥5). Multivariate regression models were used to determine predictors of anatomic and clinical failures. RESULTS There were 102 patients (127 limbs) treated with various combinations of catheter-directed or pharmacomechanical thrombolysis. In 46 patients, thrombus extended into the IVC (54.3% extended up to the renal veins; 87% had ≥50% luminal reduction; 50% occurred in association with an indwelling thrombosed IVC filter). The caval group had fewer women and more previous DVTs but otherwise was similar to the noncaval group. Pharmacomechanical thrombolysis was used more frequently in the caval thrombus group (97.8% vs 82.1%; P = .011), and iliac vein stenting was used more often in the noncaval group (41.3% vs 62.5%; P = .033). Clinical success was similar between the two groups (88.7% for caval vs 89.3% for noncaval; P = .921). All failures in the caval group occurred in patients with an indwelling thrombosed IVC filter. Primary patency at 2 years for the caval and noncaval groups was 76.7% and 78.0%, respectively (P = .787). Valve reflux and PTS at 2 years were higher in the noncaval group (50.8% and 34.3% vs 23.3% and 11.5% in the caval group; P = .013 and P = .035). On multivariate analysis, incomplete lysis was predictive of recurrence (hazard ratio [HR], 22.7; P < .001) and PTS (HR, 5.59; P = .010), whereas caval involvement (HR, 0.22; P = .005) was protective from PTS. CONCLUSIONS IVC thrombosis does not have an impact on the technical success of thrombolysis in patients with iliofemoral DVT; the presence of a thrombosed IVC filter, though, may make failure more likely. Caval thrombosis may not affect primary patency but is associated with a lower incidence of PTS after successful lysis.
Collapse
Affiliation(s)
- Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Omar El-Shazly
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Geetha Jeyabalan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - George Al-Khoury
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Eric Hager
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael J Singh
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel S Makaroun
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| |
Collapse
|
42
|
Min SK, Kim YH, Joh JH, Kang JM, Park UJ, Kim HK, Chang JH, Park SJ, Kim JY, Bae JI, Choi SY, Kim CW, Park SI, Yim NY, Jeon YS, Yoon HK, Park KH. Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines. Vasc Specialist Int 2016; 32:77-104. [PMID: 27699156 PMCID: PMC5045251 DOI: 10.5758/vsi.2016.32.3.77] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 01/28/2023] Open
Abstract
Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.
Collapse
Affiliation(s)
- Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Hwan Kim
- Department of Radiology, Keimyung University College of Medicine, Daegu,
Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Jin Mo Kang
- Department of Surgery, Gachon University College of Medicine, Incheon,
Korea
| | - Ui Jun Park
- Department of Surgery, Keimyung University College of Medicine, Daegu,
Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu,
Korea
| | - Jeong-Hwan Chang
- Department of Surgery, Chosun University College of Medicine, Gwangju,
Korea
| | - Sang Jun Park
- Department of Surgery, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jang Yong Kim
- Department of Surgery, Catholic University College of Medicine,
Korea
| | - Jae Ik Bae
- Mint Intervention Clinic, Seongnam,
Korea
| | - Sun Young Choi
- Department of Radiology, Ewha Womans University College of Medicine, Seoul,
Korea
| | - Chang Won Kim
- Department of Radiology, Pusan National University School of Medicine, Yangsan,
Korea
| | - Sung Il Park
- Department of Radiology, Yonsei University College of Medicine, Seoul,
Korea
| | - Nam Yeol Yim
- Department of Radiology, Chonnam National University College of Medicine, Gwangju,
Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University College of Medicine, Incheon,
Korea
| | - Hyun-Ki Yoon
- Department of Radiology, University of Ulsan College of Medicine, Seoul,
Korea
| | - Ki Hyuk Park
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu,
Korea
| |
Collapse
|
43
|
Jiang K, Li XQ, Sang HF, Qian AM, Rong JJ, Li CL. Mid-term outcome of endovascular treatment for acute lower extremity deep venous thrombosis. Phlebology 2016; 32:200-206. [PMID: 27022012 DOI: 10.1177/0268355516640370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purposes of the study To evaluate the benefit of stenting the iliac vein in patients with residual iliac vein stenosis treated with catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis. Procedures In this randomized prospective study, patients with a first-time acute lower extremity deep venous thrombosis that had persisted <14 days were treated with catheter-directed thrombolysis. After catheter-directed thrombolysis, patients with >50% residual iliac vein stenosis were randomly divided into two groups: catheter-directed thrombolysis + Stent Group and catheter-directed thrombolysis Alone Group. Patients received urokinase thrombolysis and low-molecular-weight heparin/oral warfarin during the hospitalization period and were administrated oral warfarin after discharge. Cumulative deep vein patency, the Clinical Etiology Anatomic Pathophysiologic classification system, the Venous Clinical Severity Score and the Chronic Venous Insufficiency Questionnaire score were evaluated. Findings The cumulative deep vein patency rate was 74.07% in the catheter-directed thrombolysis + Stent Group and 46.59% in the catheter-directed thrombolysis Alone Group. The mean postoperative Clinical Etiology Anatomic Pathophysiologic classification and Venous Clinical Severity Score was significantly lower in the catheter-directed thrombolysis + Stent Group than in the catheter-directed thrombolysis Alone Group. The mean postoperative Chronic Venous Insufficiency Questionnaire score was significantly higher in the catheter-directed thrombolysis + Stent Group than the catheter-directed thrombolysis Alone Group. Conclusions Placement of an iliac vein stent in patients with residual iliac vein stenosis after catheter-directed thrombolysis for acute lower extremity deep venous thrombosis increases iliac vein patency and improves clinical symptoms and health-related quality of life at mid-term follow-up compared to patients treated with catheter-directed thrombolysis alone.
Collapse
Affiliation(s)
- Kun Jiang
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Xiao-Qiang Li
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Hong-Fei Sang
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Ai-Min Qian
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Jian-Jie Rong
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Cheng-Long Li
- The Second Affiliated Hospital of Soochow University, Suzhou City, China
| |
Collapse
|
44
|
|
45
|
Affiliation(s)
- Alfred I Lee
- From the Department of Medicine, Section of Hematology (A.I.L.), and the Department of Surgery, Section of Vascular Surgery (C.I.O.C.), Yale University School of Medicine, New Haven, CT
| | - Cassius I Ochoa Chaar
- From the Department of Medicine, Section of Hematology (A.I.L.), and the Department of Surgery, Section of Vascular Surgery (C.I.O.C.), Yale University School of Medicine, New Haven, CT
| |
Collapse
|
46
|
Rodríguez LE, Aponte-Rivera F, Figueroa-Vicente R, Bolanos-Avila GE, Martínez-Trabal JL. Symptomatic iliofemoral deep venous thrombosis treated with hybrid operative thrombectomy. J Vasc Surg Venous Lymphat Disord 2016; 3:438-441. [PMID: 26992622 DOI: 10.1016/j.jvsv.2015.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/09/2015] [Indexed: 11/27/2022]
Abstract
During the past 15 years, strategies that promote immediate and complete thrombus removal have gained popularity for the treatment of acute-onset iliofemoral deep venous thrombosis. In this case report, we describe a novel operative approach to venous thrombus removal known as hybrid operative thrombectomy. The technique employs a direct inguinal approach with concomitant retrograde advancement of a balloon catheter by femoral venotomy. Moreover, it provides effective thrombus removal through a single incision, with or without stent placement, and has the advantage of a completion venogram.
Collapse
Affiliation(s)
- Limael E Rodríguez
- Vascular Surgery Division, Department of Surgery, St. Luke's Memorial Hospital, Ponce School of Medicine and Health Sciences, "Ponce School of Medicine and Health Sciences", Ponce, Puerto Rico.
| | - Francisco Aponte-Rivera
- Vascular Surgery Division, Department of Surgery, St. Luke's Memorial Hospital, Ponce School of Medicine and Health Sciences, "Ponce School of Medicine and Health Sciences", Ponce, Puerto Rico
| | - Ricardo Figueroa-Vicente
- Vascular Surgery Division, Department of Surgery, St. Luke's Memorial Hospital, Ponce School of Medicine and Health Sciences, "Ponce School of Medicine and Health Sciences", Ponce, Puerto Rico
| | - Guillermo E Bolanos-Avila
- Vascular Surgery Division, Department of Surgery, St. Luke's Memorial Hospital, Ponce School of Medicine and Health Sciences, "Ponce School of Medicine and Health Sciences", Ponce, Puerto Rico
| | - Jorge L Martínez-Trabal
- Vascular Surgery Division, Department of Surgery, St. Luke's Memorial Hospital, Ponce School of Medicine and Health Sciences, "Ponce School of Medicine and Health Sciences", Ponce, Puerto Rico
| |
Collapse
|
47
|
Alkhouli M, Morad M, Narins CR, Raza F, Bashir R. Inferior Vena Cava Thrombosis. JACC Cardiovasc Interv 2016; 9:629-43. [PMID: 26952909 DOI: 10.1016/j.jcin.2015.12.268] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/22/2015] [Accepted: 12/17/2015] [Indexed: 01/20/2023]
Abstract
Thrombosis of the inferior vena cava (IVC) is an under-recognized entity that is associated with significant short- and long-term morbidity and mortality. In absence of a congenital anomaly, the most common cause of IVC thrombosis is the presence of an unretrieved IVC filter. Due to the substantial increase in the number of IVC filters placed in the United States and the very low filter retrieval rates, clinicians are faced with a very large population of patients at risk for developing IVC thrombosis. Nevertheless, there is a paucity of data and societal guidelines with regards to the diagnosis and management of IVC thrombosis. This paper aims to enhance the awareness of this uncommon, but morbid, condition by providing a concise, yet comprehensive, review of the etiology, diagnostic approaches, and treatment strategies in patients with IVC thrombosis.
Collapse
Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York.
| | - Mohammad Morad
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Craig R Narins
- Division of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York; Department of Surgery, Section of Vascular Surgery, University of Rochester Medical Center, Rochester, New York
| | - Farhan Raza
- Division of Cardiovascular Disease, Temple University Hospital, Philadelphia, Pennsylvania
| | - Riyaz Bashir
- Division of Cardiovascular Disease, Temple University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
48
|
Sharifi M, Freeman W, Bay C, Sharifi M, Schwartz F. Low incidence of post-thrombotic syndrome in patients treated with new oral anticoagulants and percutaneous endovenous intervention for lower extremity deep venous thrombosis. Vasc Med 2016; 20:112-6. [PMID: 25832599 DOI: 10.1177/1358863x14553882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-thrombotic syndrome (PTS) is a common complication of deep venous thrombosis (DVT) of the iliofemoral venous system leading to significant morbidity and high health care costs. It has been recently shown that percutaneous endovenous intervention (PEVI) can effectively reduce the incidence of PTS. The role of new oral anticoagulants (NOACs) in combination with PEVI in the reduction of PTS has not been previously studied. This report sought to evaluate the role of PEVI plus NOACs in the reduction of PTS in acute symptomatic femoropopliteal and iliac DVT. We studied 127 patients with acute lower extremity DVT who had undergone PEVI plus administration of NOACs. All had received a minimum of 3 months of anticoagulation with a NOAC following PEVI. The mean follow-up was 22±5 months. The patients were evaluated for development of PTS, bleeding, recurrent venous thromboembolism (VTE), duration of hospitalization and mortality. There was no in-hospital bleeding. The mean duration of hospitalization was 46±9 hours. DVT occurred in two patients who had been later switched to warfarin. There were four non-VTE-related deaths. PTS developed in five patients (3%), two of whom were those who had been switched to warfarin. Their mean Villalta score was 6.2±0.9. We conclude that the combination of PEVI plus NOAC and low dose aspirin is associated with a very low rate of PTS with the severity being only mild. This approach leads to very low rates of bleeding and recurrent VTE and promotes early discharge.
Collapse
Affiliation(s)
- Mohsen Sharifi
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA A.T. Still University, Mesa, AZ, USA
| | | | - Curt Bay
- A.T. Still University, Mesa, AZ, USA
| | - Mirali Sharifi
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
| | | |
Collapse
|
49
|
Mumme A, Hummel T. Rekanalisierende Therapie der tiefen Bein-/Beckenvenenthrombose. GEFÄSSCHIRURGIE 2016. [DOI: 10.1007/s00772-016-0119-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
50
|
De Maeseneer MGR, Bochanen N, van Rooijen G, Neglén P. Analysis of 1,338 Patients with Acute Lower Limb Deep Venous Thrombosis (DVT) Supports the Inadequacy of the Term "Proximal DVT". Eur J Vasc Endovasc Surg 2016; 51:415-20. [PMID: 26777542 DOI: 10.1016/j.ejvs.2015.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE/BACKGROUND For decades acute lower limb deep venous thrombosis (DVT) has been subdivided into distal DVT (isolated to the calf veins) and proximal DVT (extending above calf vein level). The aim of this study was to analyse the anatomical site and extent of thrombus in a large cohort of patients with acute DVT. METHODS A retrospective analysis of all patients aged >18 years, presenting with unilateral DVT according to duplex ultrasound investigation was performed at the University Hospital of Antwerp, Belgium (1994-2012). The anatomical site and extent of thrombus was registered and subdivided into five segments: calf veins (segment 1), popliteal vein (segment 2), femoral vein (segment 3), common femoral vein (segment 4), and iliac veins, with or without inferior vena cava (segment 5). RESULTS The median age of the 1,338 patients (50% male) included was 62 years (range 18-98 years). Left sided DVT was predominant (57%). DVT was limited to one segment in 443 patients, of whom 370 had DVT isolated to the calf veins (28% of total cohort). In 968 patients with what was previously called "proximal DVT", the median number of affected segments was three (range 1-5 segments). In this group iliofemoral DVT (at least involving segment four and/or five) was present in 506 patients (38% of total cohort), whereas the remaining patients had femoropopliteal DVT (at least in segment two and/or three but not in four or five). Iliofemoral DVT without thrombus in segments one and two was present in 160 patients (12% of total cohort). CONCLUSION This study illustrates the large diversity of thrombus distribution in patients previously described as having "proximal DVT". Therefore, this term should be abandoned and replaced with iliofemoral and femoropopliteal DVT. Patients with iliofemoral DVT (38%) could be considered for early clot removal; 12% of all patients with DVT would be ideal candidates for such intervention.
Collapse
Affiliation(s)
- M G R De Maeseneer
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - N Bochanen
- Internal Medicine, University Hospital of Antwerp, Antwerp, Belgium
| | - G van Rooijen
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - P Neglén
- SP Vascular Center, Limassol, Cyprus
| |
Collapse
|