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Bækgaard N, Black SA. Endovenous treatment strategies for iliofemoral deep venous thrombosis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:3-4. [PMID: 38300167 DOI: 10.23736/s0021-9509.24.12971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Niels Bækgaard
- Vascular Department, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark -
- Rigshospitalet, Copenhagen, Denmark -
| | - Stephen A Black
- Section of Vascular Surgery, Kings College London, Guy's & St Thomas' Hospital, London, UK
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Teng B, Li F, Wang X, Tian H, Zhao Y, Zeng Q. Central Venous Catheter as a Novel Approach to Postoperative Thrombolysis in Patients with Acute Iliofemoral Deep Venous Thrombosis. Clin Exp Hypertens 2023; 45:2224940. [PMID: 37326510 DOI: 10.1080/10641963.2023.2224940] [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: 02/21/2023] [Revised: 05/19/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS Percutaneous mechanical thrombectomy (PMT) along with postoperative thrombolysis (POT) has been the standard treatment for acute iliofemoral deep venous thrombosis (IFDVT). However, commonly used catheter directed thrombolysis (CDT) approaches for POT carry certain disadvantages, including the need for a sheath, inferior comfortability, and catheter-related complications. Therefore, we propose a new simplified method of POT using a central venous catheter (CVC). METHODS The retrospective study analyzed patients with IFDVT who underwent POT using CVC from January 2020 to August 2021. The treatment modalities included filter placement, thrombus removal, iliac vein obstruction release, postoperative CVC thrombolysis, filter retrieval, and adequate full course anticoagulation. RESULTS A total of 39 patients were included in this retrospective study. All patients underwent PMT surgery with a procedure success rate of 100%. In the post-PMT CVC thrombolysis, the puncture sites were located in the below-knee vein, including 58.97% in the peroneal vein. The mean duration of CVC-directed thrombolysis was 3.69 ± 1.08 days, and the total urokinase dose was 2.27 ± 0.71 MIU. A total of 37 patients (94.87%) had successful thrombolysis with a length of hospital stay of 5.82 ± 2.21 days. During CVC-directed thrombolysis, only four minor bleeding complications occurred, two of which were indwelling catheter-related. During the 12-month follow-up period, the patency rate and post-thrombotic syndrome incidences were 97.44% and 2.56%, respectively. CONCLUSION Thrombolysis through a CVC is a feasible, safe, and effective POT method, and could be an alternative to the conventional CDT approach for patients with IFDVT.
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Affiliation(s)
- Biyun Teng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuehu Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Tian
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiu Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Foegh P, Strandberg C, Joergensen S, Myschetzky PS, Klitfod L, Just S, Hansen S, Baekgaard N. Long-term integrity of 53 iliac vein stents after catheter-directed thrombolysis. Acta Radiol 2023; 64:881-886. [PMID: 35404166 DOI: 10.1177/02841851221090118] [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: 11/17/2022]
Abstract
BACKGROUND Long-term surveillance data on venous stent integrity is sparse. There is limited knowledge on whether duplex ultrasound (DUS) can detect potential stent deformities such as kinking, straightening, and fracture, which may impact long-term patency of the stented veins. PURPOSE To assess venous stent integrity after at least five years of follow-up and to establish the efficacy of DUS as surveillance in patients with venous stent. MATERIAL AND METHODS A total of 45 patients with acute iliac-femoral deep vein thrombosis (DVT) treated with catheter directed thrombolysis (CDT) and stenting >5 years before follow-up. Stents were evaluated with 3D volume low dose non-contrast computed tomography (CT) and DUS for kinking, straightening, stent fracture, and patency. Results from CT scans and DUS were compared to assess the overall agreement between the methods. RESULTS Median follow-up was 13.2 years (mean = 11.2 years; range = 5.2-15.8 years). 3D CT reconstructions showed normal stent configuration in 47 stents (89%). All intact stents were identified by DUS. In the remaining six stents, 3D CT reconstructions showed compression, tapering, kinking, and minor fracture. DUS recognized all stent complications except the minor fracture. Overall agreement between CT and DUS was 98% (kappa = 0.90). Two cases of stent occlusion were found. CONCLUSION The long-term physical resilience of iliac vein stents evaluated with 3D CT in patients treated with CDT for iliofemoral DVT was high. Stent deformities were mostly compression, whereas fracture was rarely seen. DUS seems to be sufficient to evaluate venous stent integrity.
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Affiliation(s)
- Pia Foegh
- Department of Vascular Surgery, 53147Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Charlotte Strandberg
- Department of Diagnostic Radiology, 53146Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Sanne Joergensen
- Department of Diagnostic Radiology, 53146Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Peter S Myschetzky
- Department of Diagnostic Radiology, 53146Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Lotte Klitfod
- Department of Vascular Surgery, 53147Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Sven Just
- Department of Diagnostic Radiology, 53146Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Susanne Hansen
- Center for Clinical Research and Prevention, 572755Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Niels Baekgaard
- Department of Vascular Surgery, 53147Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
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Mühlberger D, Falkenstein T, Mumme A, Stücker M, Reich-Schupke S, Hummel T. Stellenwert der operativen multimodalen venösen Thrombektomie bei der Behandlung der akuten iliofemoralen Thrombose. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1424-8388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungFür das Gros aller Patienten mit tiefer Beinvenenthrombose ist ein konservatives Vorgehen mit Antikoagulation und Kompression die Therapie der Wahl. In ausgewählten Fällen kann jedoch auch ein rekanalisierendes Therapieverfahren zum Einsatz kommen. Dies gilt speziell für besonders ausgedehnte Thrombosen mit Beteiligung der Vena cava oder der Beckenetage. Die multimodale operative Thrombektomie kann ein drohendes postthrombotisches Syndrom abwenden. Die Vorteile der operativen Therapie liegen vor allem in der hohen Effektivität und einer breiten Anwendbarkeit, auch bei Kontraindikation zur Fibrinolysetherapie.
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Affiliation(s)
- Dominic Mühlberger
- Klinik für Gefäßchirurgie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
| | - Thomas Falkenstein
- Klinik für Gefäßchirurgie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
| | - Achim Mumme
- Klinik für Gefäßchirurgie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
| | - Markus Stücker
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
- Klinik für Dermatologie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
| | | | - Thomas Hummel
- Klinik für Gefäßchirurgie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
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Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, Ten Cate-Hoek AJ, Elalamy I, Enzmann FK, Geroulakos G, Gottsäter A, Hunt BJ, Mansilha A, Nicolaides AN, Sandset PM, Stansby G, Esvs Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Chakfé N, Hinchliffe R, Kolh P, Koncar I, Lindholt JS, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, De Maeseneer MG, Comerota AJ, Gloviczki P, Kruip MJHA, Monreal M, Prandoni P, Vega de Ceniga M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg 2020; 61:9-82. [PMID: 33334670 DOI: 10.1016/j.ejvs.2020.09.023] [Citation(s) in RCA: 304] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Cheng Z, Jia W, Tian X, Jiang P, Zhang Y, Li J, Tian C, Liu J. Cotinine inhibits TLR4/NF-κB signaling pathway and improves deep vein thrombosis in rats. Biosci Rep 2020; 40:BSR20201293. [PMID: 32441737 PMCID: PMC7273908 DOI: 10.1042/bsr20201293] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The present study was designed to explore the regulatory mechanisms and influences of cotinine on deep vein thrombosis (DVT) in rats via the toll-like receptor 4/nuclear factor κ binding (TLR-4/NF-κB) pathway. METHODS In this experimental study, 30 SD rats were randomly assigned to control group, sham operation group, model group, cotinine (10 μg/kg) group, and model + cotinine (10 μg/kg) group. The thromboxane B2 (TXB2), 6-keto-PGF1α, plasminogen activator inhibitor (PAI), tissue plasminogen activator (t-PA), TLR4, NF-κB, and p65 mRNA and protein expression and tissue changes were analyzed by ELISA, Hematoxylin-Eosin (HE) staining, RT-PCR, and Western blot. RESULTS There was no significant difference between the control and sham operation groups (P>0.05). The model and cotinine groups showed significantly higher mRNA and protein levels of TXB2, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), PAI, TLR-4, and NF-κB, and significantly lower levels of 6-keto-PGF1α and t-PA than the control and sham operation groups (P<0.05), and the model + cotinine group showed significantly higher mRNA and protein levels of TXB2, IL-6 and TNF-α, PAI, TLR-4, and NF-κB and significantly lower levels of 6-keto-PGF1α and t-PA than the model group (P<0.05). CONCLUSION Cotinine can aggravate thrombus and inflammation in rats with DVT, and the mechanism may be associated with the activation of the TLR-4/NF-κB inflammatory signaling pathway.
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Affiliation(s)
- Zhiyuan Cheng
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing City, China
| | - Wei Jia
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing City, China
| | - Xuan Tian
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing City, China
| | - Peng Jiang
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing City, China
| | - Yunxin Zhang
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing City, China
| | - Jinyong Li
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing City, China
| | - Chenyang Tian
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing City, China
| | - Jianlong Liu
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing City, China
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Farsad K, Kapoor BS, Fidelman N, Cain TR, Caplin DM, Eldrup-Jorgensen J, Gupta A, Higgins M, Hohenwalter EJ, Lee MH, McBride JJ, Minocha J, Rochon PJ, Sutphin PD, Lorenz JM. ACR Appropriateness Criteria® Radiologic Management of Iliofemoral Venous Thrombosis. J Am Coll Radiol 2020; 17:S255-S264. [PMID: 32370969 DOI: 10.1016/j.jacr.2020.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
Iliofemoral venous thrombosis carries a high risk for pulmonary embolism, recurrent deep vein thrombosis, and post-thrombotic syndrome complicating 30% to 71% of those affected. The clinical scenarios in which iliofemoral venous thrombosis is managed may be diverse, presenting a challenge to identify optimum therapy tailored to each situation. Goals for management include preventing morbidity from venous occlusive disease, and morbidity and mortality from pulmonary embolism. Anticoagulation remains the standard of care for iliofemoral venous thrombosis, although a role for more aggressive therapies with catheter-based interventions or surgery exists in select circumstances. Results from recent prospective trials have improved patient selection guidelines for more aggressive therapies, and have also demonstrated a lack of efficacy for certain conservative therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Portland, Oregon.
| | | | - Nicholas Fidelman
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Thomas R Cain
- Desert Regional Medical Center, Palm Springs, California
| | - Drew M Caplin
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | | | | | - Margaret H Lee
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Jeet Minocha
- University of California San Diego, San Diego, California
| | - Paul J Rochon
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
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Diniz J, Coelho A, Mansilha A. Endovascular treatment of iliofemoral deep venous thrombosis: is there enough evidence to support it? A systematic review with meta-analysis. INT ANGIOL 2020; 39:93-104. [DOI: 10.23736/s0392-9590.19.04298-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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The ATTRACT Trial Becomes More Attractive. Eur J Vasc Endovasc Surg 2019; 57:755-756. [PMID: 30982730 DOI: 10.1016/j.ejvs.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/23/2022]
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10
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Wang W, Sun R, Chen Y, Liu C. Meta-analysis and systematic review of percutaneous mechanical thrombectomy for lower extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2018; 6:788-800. [DOI: 10.1016/j.jvsv.2018.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/05/2018] [Indexed: 01/01/2023]
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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]
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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.
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