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Zhang H, Li XY, Li JS, Xia SB, Song C, Lu QS, Zhao W, Zhang L. Which one is the best in treating deep venous thrombosis -- percutaneous mechanical thrombectomy, catheter-directed thrombolysis or combination of them? J Cardiothorac Surg 2024; 19:423. [PMID: 38970107 PMCID: PMC11225378 DOI: 10.1186/s13019-024-02908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE To compare the treatment outcomes among percutaneous mechanical thrombectomy (PMT) with AngioJet, Catheter-directed thrombolysis (CDT), and a combination of both. METHODS One hundred forty nine patients with acute or sub-acute iliac-femoral vein thrombosis accepting CDT and/or PMT were divided into three groups respectively: PMT group, CDT group, PMT + CDT group (PMT followed by CDT). The severity of thrombosis was evaluated by venographic scoring system. Technical success was defined as restored patent deep venous blood flow after CDT and/or PMT. Clinical follow-up were assessed by ultrasound or venography imaging. The primary endpoints were recurrence of DVT, and severity level of post-thrombotic syndrome (PTS) during the follow-up. RESULTS Technical success and immediate clinical improvements were achieved on all patients. The proportion of sub-acute DVT and the venographic scoring in PMT + CDT group were significantly higher than that in CDT group and PMT group (proportion of sub-acute DVT: p = 0.032 and p = 0.005, respectively; venographic scoring: p < 0.001, respectively). The proportion of May-Thurner Syndrome was lower in PMT group than that in CDT and PMT + CDT group (p = 0.026 and p = 0.005, respectively). The proportion of DVT recurrence/stent thrombosis was significantly higher in CDT group than that in PMT + CDT group (p = 0.04). The severity of PTS was the highest in CDT group ( χ2 = 14.459, p = 0.006) compared to PMT group (p = 0.029) and PMT + CDT group (p = 0.006). CONCLUSION Patients with sub-acute DVT, high SVS scoring and combined May-Thurner Syndrome were recommended to take PMT + CDT treatment and might have lower rate of DVT recurrence/stent thrombosis and severe PTS. Our study provided evidence detailing of PMT + CDT therapy.
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Affiliation(s)
- Hao Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Xiao-Ye Li
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Jia-Si Li
- Department of Neurology, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Shi-Bo Xia
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Qing-Sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Wei Zhao
- Department of General Surgery, The Fifth People's Hospital of Chengdu, Chengdu, Sichuan Province, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China.
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Xiao N, Genet M, Karry RM, Hohlastos E, Karp J, Desai K. Single-procedure 8Fr rheolytic pharmacomechanical thrombectomy for treatment of acute iliofemoral deep venous thrombosis. CVIR Endovasc 2024; 7:34. [PMID: 38564094 PMCID: PMC10987403 DOI: 10.1186/s42155-024-00447-5] [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: 12/04/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE We hypothesize that single-procedure venous-specific rheolytic thrombectomy for treatment of acute iliofemoral deep venous thrombosis (DVT) will result in improved clinical symptoms as measured by the venous clinical severity score (VCSS), as well as durable venous patency, with decreased hemorrhagic risks and costs associated with conventional catheter-directed therapy and prolonged lytic exposure. MATERIALS AND METHODS Thirty-three consecutive patients with symptomatic, unilateral, iliofemoral DVT who were treated with single-procedure therapy using the 8Fr rheolytic thrombectomy catheter were retrospectively analyzed from 2012-2021. Abstracted data included technical success (> 95% clearance of acute thrombus), adverse events (AEs), and clinical and imaging outcomes at 1-month and 1-year. RESULTS Technical success was achieved in all 33 patients. Mean pre-procedure VCSS was 7.5 with mean edema and pain sub-scores of 2.6 and 1.8, respectively. Post-procedural total mean VCSS at one month was significantly improved (mean post-procedure VCSS = 0.3, mean reduction of 7.2, P < 0.01). Clinical improvement was sustained at 1-year (mean total VCSS = 0.2, P < 0.01). Primary patency was achieved in all patients at 1-month and 30 (91%) patients at 1-year. Among the 3 patients in which primary patency was not achieved at 1-year, primary-assisted patency was achieved in 2 patients. Secondary patency was achieved in the remaining patient at 1-year. No hemorrhagic AEs occurred in this study. CONCLUSION This study suggests that single-procedure venous-specific rheolytic thrombectomy for treatment of acute iliofemoral DVT is safe and effective, resulting in durable clinical and radiographic results at one year, while also limiting hemorrhagic risks, mitigating costs of admission, and expediting patient discharge.
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Affiliation(s)
- Nicholas Xiao
- Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Matthew Genet
- Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Rocio Marquez Karry
- Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Elias Hohlastos
- Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Jennifer Karp
- Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Kush Desai
- Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, IL, USA.
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Sukovatykh BS, Sereditsky AV, Sukovatykh MB. [Endovascular surgery for deep vein thrombosis]. Khirurgiia (Mosk) 2023:79-85. [PMID: 36748873 DOI: 10.17116/hirurgia202302179] [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: 02/08/2023]
Abstract
The authors reviewed national and world literature data on endovascular technologies for the treatment of deep vein thrombosis. Indications, technologies, complications and results of systemic and regional thrombolysis are described in detail. The authors consider percutaneous mechanical thrombectomy, pharmacomechanical thrombectomy, venous stenting and catheter thrombectomy. The role of combined endovascular approaches in delayed stages of disease is emphasized. The indications for implantation of cava filter are presented.
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Vedantham S, Desai KR, Weinberg I, Marston W, Winokur R, Patel S, Kolli KP, Azene E, Nelson K. Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis. J Vasc Interv Radiol 2023; 34:284-299.e7. [PMID: 36375763 DOI: 10.1016/j.jvir.2022.10.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To establish the updated position of the Society of Interventional Radiology (SIR) on the endovascular management of acute iliofemoral deep vein thrombosis (DVT). MATERIALS AND METHODS A multidisciplinary writing group with expertise in treating venous diseases was convened by SIR. A comprehensive literature search was conducted to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS A total of 84 studies, including randomized trials, systematic reviews and meta-analyses, prospective single-arm studies, and retrospective studies were identified and included in the review. The expert writing group developed 17 recommendations that pertain to the care of patients with acute iliofemoral DVT with the use of endovascular venous interventions. CONCLUSIONS SIR considers endovascular thrombus removal to be an acceptable treatment option in selected patients with acute iliofemoral DVT. Careful individualized risk assessment, high-quality general DVT care, and close monitoring during and after procedures should be provided.
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Affiliation(s)
- Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri.
| | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ido Weinberg
- Cardiology Division, Vascular Medicine Section, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - William Marston
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Ronald Winokur
- Department of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Kanti Pallav Kolli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ezana Azene
- Gundersen Health System, La Crosse, Wisconsin
| | - Kari Nelson
- Department of Radiology, Orange Coast Medical Center, Fountain Valley, California
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Emsley R, Haller C, Arts L. Catheter-directed thrombectomy with the JETi8 in the treatment of acute superior vena cava syndrome. J Vasc Surg Cases Innov Tech 2022; 8:545-548. [PMID: 36081742 PMCID: PMC9445904 DOI: 10.1016/j.jvscit.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Abstract
Superior vena cava syndrome can lead to significant morbidity and mortality, particularly in acute settings. We report a case of an acute Port-a-Cath-associated thrombosis of the superior vena cava. Percutaneous catheter-directed thrombectomy was performed using the JETi8 thrombectomy device with additional angioplasty and stenting, allowing rapid flow restoration and rapid clinical recovery. Postoperative anticoagulation was initiated and pursued lifelong. This report is unique in illustrating how JETi8 thrombectomy seems to be a safe and effective therapy, allowing rapid flow restoration, rapid clinical improvement, and persistent patency at 6 months.
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Affiliation(s)
| | | | - Laure Arts
- Correspondence: Laure Arts, MD, Av du Grand-Champsec 80, CH-1950 Sion, Switzerland
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6
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Gumus F, Arslanturk O. The effect of balloon-assisted pharmacomechanical catheter-directed thrombolysis on the patency and post-thrombotic syndrome in patients with acute iliofemoral deep vein thrombosis: Is it really necessary or not? Ann Vasc Surg 2022; 87:502-507. [PMID: 35760263 DOI: 10.1016/j.avsg.2022.05.033] [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: 03/26/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to describe the contribution and advantage of balloon-dilatation of iliac and femoral veins following pharmacomechanical catheter-directed thrombolysis (PCDT) on the development of post-thrombotic syndrome (PTS). METHODS From October 2018 and January 2022, 85 patients with acute total occlusion of the iliac and femoral veins were treated with PCDT. The cohort was divided into two groups depending on the utilization of concomitant balloon dilatation of iliac and femoral veins (Group 1, n=34, 40.0%) or not (Group 2, n=51, 60.0%) during the PCDT. All patients underwent duplex ultrasound scanning for evaluating the patency of iliac veins and recanalization rates at 3, 6, and 12 months postoperatively. the Villalta score was used to score the severity of PTS at 12 months postoperatively. RESULTS Patients who underwent balloon-assisted PCDT (group 1) exhibited significantly higher primary patency rates in CIV (recanalization 84.3 ± 14.6%, p = 0.003) , EIV (recanalization 82.8 ± 17.2, p = 0.003) and CFV (recanalization 88.1 ± 12.1%, p = 0.038) compared with the group 2 at the end of 12 months follow-up. Only 2 patients underwent venous stenting in follow-up due to severe venous claudication, however, 13 patients were required iliac vein stenting due to severe PTS proved with a high Villalta score at 12-month follow-up. The d-dimer level at 1-year follow-up had also significantly lower in Group 1 due to higher rates of patency and lower thrombosis burden. The most common bleeding events were hematuria (n =4) or oozing in the puncture site (n = 4). CONCLUSIONS This study showed that balloon-assisted PCDT reduces the risk of PTS, is more successful in common iliac vein recanalization, reduces the need for the venous stent, and even lowers the D-dimer levels of the patients compared to routine PCDT alone.
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Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Bartın State Hospital, Bartın, Turkey.
| | - Oguz Arslanturk
- Department of Cardiovascular Surgery, Karadeniz Eregli State Hospital, Turkey
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Liu Q, Liu F, Lü P, Wu HX, Ye P, You Y, Yao Z. Current Status and Prospect of Stent Placement for May-Thurner Syndrome. Curr Med Sci 2021; 41:1178-1186. [PMID: 34918176 DOI: 10.1007/s11596-021-2481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
Stent implantation has been proven to be safe and has become the first-line intervention for May-Thurner syndrome (MTS), with satisfactory mid-term patency rates and clinical outcomes. Recent research has demonstrated that catheter-directed thrombolysis is the preferred strategy when MTS is combined with deep vein thrombosis after self-expanding stent placement. However, the stent used for the venous system was developed based on the experience obtained in the treatment of arterial disease. Consequently, relatively common corresponding complications may come along later, which include stent displacement, deformation, and obstruction. Different measures such as adopting a stent with a larger diameter, improving stent flexibility, and increasing stent strength have been employed in order to prevent these complications. The ideal venous stent is presently being evaluated and will be introduced in detail in this review.
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Affiliation(s)
- Qin Liu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ping Lü
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Hong-Xiao Wu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Pin Ye
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yun You
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhong Yao
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario, M5S 2E8, Canada
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8
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Razavi C, Khalsa B, Openshaw L, Razavi MK. Single-Session Treatment of Patients with Symptomatic Iliocaval and Iliofemoral Deep Vein Thrombosis: Technical Results of a Prospective Pilot Study. J Vasc Interv Radiol 2021; 33:183-188. [PMID: 34700012 DOI: 10.1016/j.jvir.2021.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the short-term results of single-session treatment of iliocaval and iliofemoral DVT using a single thrombectomy device. MATERIALS AND METHODS This prospective pilot study analyzed patients with acute iliocaval or iliofemoral DVT treated in a single session using the JETi thrombectomy system. All analyses were performed on an intention-to-treat basis. The cohort consisted of 53 limbs in 47 patients (27 women), with a mean age of 57 years (range, 16-88 years). The primary safety and efficacy endpoints were freedom from major adverse events (MAEs) and reestablishment of unobstructed flow in a single session, respectively. RESULTS The mean duration of symptoms was 8.5 days ± SD 9.2, with 10 patients (11 limbs, 21.3%) presenting with a symptom duration of >14 days. Twelve (25.5%) patients had thrombosis of the inferior vena cava and the iliofemoral segments. During the index procedure, unobstructed flow was reestablished in 47 of 53 (88.6%) limbs in 41 of 47 (87.2%) patients (primary endpoint) with no MAEs through 30 days. Overall, unobstructed flow was restored in 50 of 53 (94.3%) limbs and in 44 of 47 (93.6%) patients. CONCLUSIONS Successful single-session treatment of patients with acute iliocaval and iliofemoral DVT is feasible with a high rate of efficacy and a low rate of adverse events. Such patients may be treated on an outpatient basis.
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Affiliation(s)
- Crystal Razavi
- University of Arizona School of Medicine, Tucson, Arizona
| | | | | | - Mahmood K Razavi
- Center for Clinical Trials, St. Joseph Heart & Vascular Center, Orange, California.
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9
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Evaluation of ultrasonic intravascular thrombectomy system on a rabbit model in the treatment of deep vein thrombosis. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.974368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Shao C, Yan J, Zhang N, Zhang L, Li Z, Yin L, Liu Z. Single-stage treatment with iliac vein stenting and stripping of great saphenous veins for patients with left iliac vein compression syndrome. Asian J Surg 2021; 45:257-264. [PMID: 34148753 DOI: 10.1016/j.asjsur.2021.05.011] [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] [Received: 01/17/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND We sought to evaluate the safety and feasibility of single-stage treatment with left iliac vein stenting and saphenous stripping in patients with left iliac vein compression (LIVC) and left great saphenous vein (GSV) incompetence. METHOD s: We conducted a prospective cohort study of 72 patients diagnosed with LIVC and left GSV incompetence between June 2012 to Oct 2018. We evaluated the periprocedural, 30-day, and 1-year outcomes of venous clinical severity score (VCSS), Chronic Venous Insufficiency Questionnaire 2 (CIVIQ2), the success rate of stent placement, duration of intervention, length of hospital stay, duplex recurrence, and clinically visible recurrence. RESULTS There were 43 patients in the two-staged group and 29 patients in the single-staged group. The clinical characteristics of the two groups were similar. There were no differences between the two groups in the technical success rate, perioperative mortality, and surgical morbidity. There was no significant difference in the duplex and clinically visible recurrence. The length of hospital stay was significantly lower in the single-staged group. The single-staged group was associated with a higher complication rate of ecchymosis. There was no death, pulmonary embolism, or contrast-induced nephropathy among the patients. The 1-year primary patency rate was similar. CONCLUSIONS Both treatment approaches were equally effective and had a high technical success rate. The single-staged group had a higher complication rate of ecchymosis due to heparin applying during the procedure.
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Affiliation(s)
- Changming Shao
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310009, China
| | - Jinlin Yan
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, Zhejiang Province, 315010, China
| | - Naiding Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310009, China
| | - Liang Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310009, China
| | - Zhenhua Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310009, China
| | - Li Yin
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310009, China.
| | - Zhenjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310009, China
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11
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Fletcher SE, Jasuja S, Lawler LP, Moriarty JM. Catheter-directed thrombolysis and mechanical intervention in deep venous thrombosis: what is the status after the ATTRACT trial? Postgrad Med 2021; 133:42-50. [PMID: 33863270 DOI: 10.1080/00325481.2021.1919435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Deep venous thrombosis (DVT) is a major cause of acute and chronic morbidity, mortality, and increased healthcare costs. Endovascular methods for thrombus removal and reestablishing venous patency are increasing in both scope and usage. The most commonly used method for endovascular thrombectomy is catheter-directed thrombolysis (CDT). Several studies have shown promise for CDT in alleviating acute symptomatology in acute lower extremity DVT as well as mitigating potential long-term consequences of DVT, such as post-thrombotic syndrome (PTS). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial is the largest and most comprehensive randomized-controlled trial to date evaluating CDT compared to anticoagulation alone for the treatment of acute symptomatic proximal lower extremity DVT. This review discusses the current status of CDT and adjunctive endovascular interventions for DVT, particularly in the context of the ATTRACT trial.
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Affiliation(s)
- Savannah E Fletcher
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Sonia Jasuja
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Leo P Lawler
- Division of Interventional Radiology, Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John M Moriarty
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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12
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Pernod G, Sanchez O. [What are the indications and options for vascular re-perfusion in the acute phase of DVT?]. Rev Mal Respir 2021; 38 Suppl 1:e59-e68. [PMID: 33744075 DOI: 10.1016/j.rmr.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Pernod
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; Service universitaire de médecine vasculaire, université Grenoble Alpes CNRS/TIMC-IMAG UMR 5525/Thèmas, CHU Grenoble, 38700 La Tronche, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; Inserm UMRS 1140, service de pneumologie et de soins intensifs, université Paris Descartes, Sorbonne Paris Cité, hôpital européen Georges-Pompidou, Assistance publique des Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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13
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Vijayvergiya R, Kaur N, Sahoo SK, Sharma A. Endovascular mechanical thrombectomy and stenting in a case of central vein thrombosis. BMJ Case Rep 2021; 14:14/2/e236508. [PMID: 33602756 PMCID: PMC7896565 DOI: 10.1136/bcr-2020-236508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Central vein stenosis and thrombosis are frequent in patients on haemodialysis for end-stage renal disease. Its management includes anticoagulation, systemic or catheter-directed thrombolysis, mechanical thrombectomy and percutaneous transluminal angioplasty (PTA). Use of mechanical thrombectomy in central vein thrombosis has been scarcely reported. We hereby report a case of right brachiocephalic vein thrombosis with underlying stenosis, which was successfully treated by mechanical thrombectomy followed by PTA and stenting. The patient had a favourable 10 months of follow-up.
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Affiliation(s)
- Rajesh Vijayvergiya
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navjyot Kaur
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sahoo
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Sharma
- Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Charitable JF, Yilmaz O, Rockman C, Jacobowitz GR. Case Series of Concomitant Klippel-Trenaunay Syndrome and May-Thurner Syndrome. Vasc Endovascular Surg 2021; 55:638-641. [PMID: 33596770 DOI: 10.1177/1538574421995011] [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: 01/19/2023]
Abstract
Klippel-Trenaunay syndrome is a rare vascular disorder which includes leg swelling, or lower extremity deep venous reflux/thrombosis as a presenting symptom. May-Thurner syndrome is also a rare pathology involving compression of the left common iliac vein, usually by the right common iliac artery. The incidence of concomitant occurrence of these entities is unknown and not well reported. This case series describes 3 patients who underwent evaluation of symptomatic left lower extremity venous disease. All 3 suffered symptomatic Klippel-Trenaunay initially, and were subsequently diagnosed with concomitant May-Thurner Syndrome. They were successfully treated with left common iliac vein stents with symptomatic improvement.
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Affiliation(s)
| | | | - Caron Rockman
- New York University Langone Medical Center, New York, NY, USA
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15
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Gwozdz AM, Black SA, Hunt BJ, Lim CS. Post-thrombotic Syndrome: Preventative and Risk Reduction Strategies Following Deep Vein Thrombosis. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Venous disease is common in the general population, with chronic venous disorders affecting 50–85% of the western population and consuming 2–3% of healthcare funding. It, therefore, represents a significant socioeconomic, physical and psychological burden. Acute deep vein thrombosis, although a well-recognised cause of death through pulmonary embolism, can more commonly lead to post-thrombotic syndrome (PTS). This article summarises the pathophysiology and risk factor profile of PTS, and highlights various strategies that may reduce the risk of PTS, and the endovenous management of iliofemoral deep vein thrombosis. The authors summarise the advances in PTS risk reduction strategies and present the latest evidence for discussion.
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Affiliation(s)
- Adam M Gwozdz
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, Guy’s and St Thomas’ NHS Trust, King’s College London, London, UK
| | - Stephen A Black
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, Guy’s and St Thomas’ NHS Trust, King’s College London, London, UK
| | - Beverley J Hunt
- Thrombosis and Haemostasis Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Chung S Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
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Tian S, Sinclair N, Shah S. A Case Report of Intravascular Hemolysis and Heme Pigment-Induced Nephropathy Following AngioJet Thrombectomy for Thrombosed DIPS Shunt. Can J Kidney Health Dis 2020; 7:2054358120979233. [PMID: 33403118 PMCID: PMC7739081 DOI: 10.1177/2054358120979233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/18/2020] [Indexed: 11/22/2022] Open
Abstract
RATIONALE The AngioJet system is a combined mechanical and pharmacological device used for thrombectomy. As a result of the mechanical disruption of clot, intravascular hemolysis is noted to occur. Rarely, intravascular hemolysis can be severe enough to cause heme pigment-induced acute kidney injury (AKI). PRESENTING CONCERNS OF THE PATIENT We describe a case of a 45-year-old man with Child-Pugh class B cirrhosis, Budd-Chiari syndrome, and antiphospholipid antibody syndrome who required thrombectomy following a thrombosed direct intrahepatic portosystemic shunt (DIPS). He developed evidence of worsening anemia, dark urine, direct antiglobulin test-negative intravascular hemolysis, and severe AKI within 24 hours of the procedure. DIAGNOSIS Based on his severe AKI in association with elevated hemolytic markers, and the temporal association with the AngioJet procedure, the patient was diagnosed with heme pigment-induced AKI secondary to intravascular hemolysis. INTERVENTIONS The patient remained anuric and became volume-overloaded after fluid resuscitation. He was started on dialysis 72 hours after the procedure. Five days after thrombectomy, hemolytic markers returned to normal. OUTCOME The patient received hemodialysis for approximately 3 weeks, followed by renal recovery and cessation of dialysis treatments. Five weeks after the AngioJet procedure, his renal function returned to normal. TEACHING POINTS We present a case of heme pigment-induced AKI following an AngioJet procedure that required initiation of dialysis. Although this rare complication has been reported in the literature, it typically occurs when the procedure is used for larger clot burden (ie, venous thromboembolism). To our knowledge, this is the first case of severe hemolysis with associated AKI following the use of the AngioJet for a thrombosed DIPS. Due to the patient's comorbid conditions, overlapping clinical features, and lack of appreciation of the hemolysis associated with the AngioJet system, the differential diagnosis of the patient's AKI was quite broad. Nephrologists should be aware of this complication when managing patients with AKI to direct therapy early and avoid unnecessary diagnostic and therapeutic interventions.
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Affiliation(s)
- Si Tian
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Nicolette Sinclair
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Sachin Shah
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
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17
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May-Thurner syndrome in pregnancy: a multi-institutional case series and review of the literature. Am J Obstet Gynecol MFM 2020; 2:100240. [PMID: 33345939 DOI: 10.1016/j.ajogmf.2020.100240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 11/20/2022]
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18
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Rodrigues LDS, Bertanha M, El Dib R, Moura R. Association between deep vein thrombosis and stent patency in symptomatic iliac vein compression syndrome: Systematic review and meta-analysis. J Vasc Surg Venous Lymphat Disord 2020; 9:275-284. [PMID: 32827731 DOI: 10.1016/j.jvsv.2020.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The study intended to evaluate stent primary patency rates for patients with iliac vein obstruction related with iliac vein compression syndrome according to clinic presentation. METHODS A systematic review and meta-analysis was conducted of studies that compared: unexposed patients with nonthrombotic iliac vein lesion (NIVL, group 1) vs exposed patients with iliac acute deep vein thrombosis (DVT, group 2); and NIVL (group 1) vs exposed patients with iliac vein obstruction and post-thrombotic syndrome (PTS, group 3). The following databases were searched: EMBASE, PubMed, Web of Science, Scopus, SciELO, and LILACS. Two reviewers independently selected the potential studies and extracted data. The pooled odds ratio (OR) and 95% confidence interval (95% CI) are shown for each outcome. RESULTS Five studies with a total of 1050 participants and 1169 lower limbs were included. Five hundred eighty-eight lower limbs presented NIVL (50.3%), 91 lower limbs presented acute DVT (7.7%), and 490 lower limbs presented PTS (42%). The endovascular technical success rate of stenting did not differ in any of the groups: 99.6% in NIVL, 94.5% in acute DVT, and 96.5% in PTS (P = .0632). The primary stent patency rates in the 6-month follow-up were 98.3% in NIVL vs 90.9% in PTS, with a statistical difference showing reduced stent patency rates in PTS (OR, 0.17; 95% CI, 0.06-0.48; P = .0008; I2 = 0%), and 100% in the NIVL group vs 91.6% in acute DVT, with no statistical difference (OR, 0.30; 95% CI, 0.06-2.32; P = .30; I2 = 0%). The primary stent patency rates in the 12-month follow-up were 94.6% in NIVL vs 84.1% in PTS, with a statistical difference showing decreases stent patency rates in the PTS group (OR, 0.29; 95% CI, 0.14-0.63; P = .0008; I2 = 0%), and 91.1% in NIVL vs 90.9% in acute DVT, with no statistical difference (OR, 1.03; 95% CI, 0.26-4.07; P = .96; I2 = 0%). CONCLUSIONS There is no statistical difference for the stent primary patency rates when the treatment is conducted in NIVL as compared with acute DVT lower limbs (at 6 and 12 months); therefore, other criteria must be considered for the indication of this treatment in NIVL patients. However, because there were better results of stent primary patency rates for NIVL vs PTS patients, this finding favors the treatment of acute DVT instead of PTS in lower limbs, once PTS renders smaller stent patency rates at 6 and 12 months.
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Affiliation(s)
- Lenize da Silva Rodrigues
- Department of Surgery and Orthopedics, São Paulo State University - UNESP, Botucatu Medical School, Botucatu, SP, Brazil.
| | - Matheus Bertanha
- Department of Surgery and Orthopedics, São Paulo State University - UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Regina El Dib
- Institute of Science and Technology, University Estadual Paulista, São Paulo, São José dos Campo, SP, Brazil; McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University, Hamilton, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Regina Moura
- Department of Surgery and Orthopedics, São Paulo State University - UNESP, Botucatu Medical School, Botucatu, SP, Brazil
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19
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A Swine Model of Filter-Assisted Caval Thrombosis for Endovascular Thrombectomy Using AngioJet. J Cardiovasc Transl Res 2020; 14:365-370. [PMID: 32661981 DOI: 10.1007/s12265-020-10059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
To assess the feasibility of creating swine model of filter-assisted caval thrombosis and to evaluate the efficacy in removing clot in this model using rheolytic thrombectomy. The model was created by implanting a filter into the inferior vena cava followed by injection of autologous thrombus. Rheolytic thrombectomy was performed for all models to remove the clot. The success rate of model creation and the efficacy of clot removal were analyzed. The success rate of model creation was 100% (15/15). Following rheolytic thrombectomy, 3 of 5 pigs attained complete clot removal in a 7-day-old model, while no pigs attained complete clot removal in 14- and 21-day-old models. Creating a filter-related caval thrombosis model in swine is technically feasible and can be used to mimic a clinical episode of caval thrombosis from acute phase to chronic occlusion. Rheolytic thrombectomy can be used to remove filter-related thrombosis that aged less than 14 days. Graphical Abstract Swine Model of Filter-Assisted Caval Thrombotic Occlusion.
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20
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Badawy E, Seif MA, Elmoheen A. May-Thurner Syndrome: A Neglected Cause of Unilateral Leg Swelling. OPEN ACCESS EMERGENCY MEDICINE 2020; 12:121-125. [PMID: 32431556 PMCID: PMC7202772 DOI: 10.2147/oaem.s246018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/19/2020] [Indexed: 12/17/2022] Open
Abstract
May-Thurner syndrome (MTS) is a clinical condition characterized by the compression of the left iliac vein by the right iliac artery. This condition predisposes the patient to deep venous thrombosis (DVT). We present the case of a 30-year-old female who arrived at the emergency department of our facility with progressive left leg swelling for four weeks, with low-risk probability for DVT. Examination revealed left leg swelling with pitting edema extending up to the knee. Her calf muscle was tender to palpation. Dorsalis pedis, anterior tibial, and posterior tibial pulsations were fairly palpable due to the edema; however, the rest of her pulsations were appropriately felt. Therefore, the provisional diagnosis of possible DVT was made, and further investigations were requested. We present this case intending to highlight the clinical presentation of May-Thurner syndrome, its diagnosis, and treatment.
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Affiliation(s)
- Ehab Badawy
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed A Seif
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Amr Elmoheen
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
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21
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Mesa A, Milazzo E, Rivera O, Hernández T, Umanzor G. Chronic Inferior Vena Cava Filter Thrombosis: Endovascular Treatment and One-Year Follow-Up with Intravascular Ultrasonography. Tex Heart Inst J 2020; 47:140-143. [PMID: 32603466 DOI: 10.14503/thij-18-6704] [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: 11/23/2022]
Abstract
Inferior vena cava (IVC) filter thrombosis can be fatal when it is not detected and treated. Its management can be challenging, because little evidence supports specific treatments. We present the case of a 72-year-old man with a history of deep vein thrombosis in whom IVC filter thrombosis developed 7 years after filter placement. Recanalization with oral anticoagulation had failed. Using intravascular ultrasonography, we performed pharmacomechanical thrombolysis, deploying 2 stents simultaneously through the IVC filter and then 2 more into the iliac veins, with excellent results. One year later, the patient's veins and IVC filter were patent, his symptoms were greatly improved, and only nonobstructive neointimal hyperplasia was seen. This case highlights the usefulness of balloon venoplasty and double-barrel stent placement in restoring blood flow through an occluded IVC, and the value of intravascular ultrasonography during and after such procedures.
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Affiliation(s)
- Andrés Mesa
- Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas 77030
| | - Eliana Milazzo
- Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas 77030
| | - Oscar Rivera
- Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas 77030
| | - Tabata Hernández
- Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas 77030
| | - Gilberto Umanzor
- Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas 77030
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22
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Salahuddin T, Armstrong EJ. Intervention for Iliofemoral Deep Vein Thrombosis and May-Thurner Syndrome. Interv Cardiol Clin 2020; 9:243-254. [PMID: 32147124 DOI: 10.1016/j.iccl.2019.11.003] [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] [Indexed: 12/22/2022]
Abstract
May-Thurner syndrome, also known as iliac vein compression syndrome, may cause symptoms of venous hypertension and is a predisposing factor for the development of iliofemoral deep vein thrombosis (DVT). Iliofemoral DVT is associated with high rates of development of postthrombotic syndrome, a potentially debilitating condition associated with development of symptoms related to venous outflow obstruction and resulting in reduced quality of life. In this Clinics article, we review procedural intervention with catheter-directed thrombolysis and stenting for iliofemoral DVT and iliac vein compression.
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Affiliation(s)
- Taufiq Salahuddin
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA
| | - Ehrin J Armstrong
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA; Interventional Cardiology, Vascular Laboratory, Rocky Mountain Regional VA, Division of Cardiology, University of Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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23
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Technical success and short-term outcomes after treatment of lower extremity deep vein thrombosis with the ClotTriever system: A preliminary experience. J Vasc Surg Venous Lymphat Disord 2020; 8:174-181. [DOI: 10.1016/j.jvsv.2019.10.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
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24
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Harbin MM, Lutsey PL. May-Thurner syndrome: History of understanding and need for defining population prevalence. J Thromb Haemost 2020; 18:534-542. [PMID: 31821707 DOI: 10.1111/jth.14707] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/13/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022]
Abstract
Patients with May-Thurner syndrome (MTS) are at elevated risk of developing an extensive left iliofemoral deep vein thrombosis (DVT; localized blood clot) due to an anatomical variant where the right common iliac artery compresses the left common iliac vein against the lumbar spine. While MTS was initially presumed to be rare when it was first anatomically defined in 1957, case reports of this syndrome have recently become more frequent, perhaps due to improved imaging techniques allowing for enhanced visualization of the iliac veins. Still, the population burden of this condition is unknown, and there is speculation it may be higher than generally perceived. In the present review, we (a) review history of how MTS became recognized, (b) describe practical challenges of studying MTS in population-based settings due to the specialized imaging required for diagnosis, (c) discuss why the contribution of MTS to DVT may be underestimated, (d) describe uncertainty regarding the degree of venous compression which leads to DVT, and (e) outline future research needs. Our goal is to raise awareness of MTS and spark additional research into the epidemiology of this condition, which may be an underappreciated causative venous thromboembolism risk factor.
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Affiliation(s)
- Michelle M Harbin
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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25
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Cournoyer-Rodrigue J, Bui TB, Gilbert P, Soulez G, Perreault P, Bouchard L, Oliva VL, Giroux MF, Therasse E. Percutaneous Thrombectomy with the JETi8 Peripheral Thrombectomy System for the Treatment of Deep Vein Thrombosis. J Vasc Interv Radiol 2020; 31:444-453.e2. [PMID: 31982312 DOI: 10.1016/j.jvir.2019.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study evaluated the safety and efficacy of the JETi8 peripheral thrombectomy system in treating acute deep vein thrombosis (DVT). MATERIALS AND METHODS A retrospective study was conducted in 18 consecutive patients (mean age, 41 years old [range, 15-74 years old]; 5 men and 13 women). There were 21 instances of DVTs (9 iliofemoral, 10 axillosubclavian, and 2 portal), which were treated using the JETi8 thrombectomy device between November 2016 and July 2018. Thrombus was laced with recombinant tissue plasminogen activator (r-TPA) (9.3 mg, on average; range, 2-12 mg) in 17 procedures (81%) prior to thrombectomy. Technical success was defined as restoration of antegrade flow using the JETi8 with or without additional treatment of an underlying obstructive lesion. Procedural success was defined as technical success with or without the addition of overnight catheter-directed thrombolysis (CDT) RESULTS: Mean procedure time was 83 minutes (range, 30-160 minutes), and mean thrombus reduction with the JETi8 alone was 92% (range, 60%-100%). Stent placement was required in 6 procedures (29%). Technical success using the JETi8 system alone was 76% (16 of 21 procedures), whereas 5 procedures (24%) required subsequent overnight CDT in the intensive care unit. Procedural success rate was 100% (20 of 20 procedures). Mean aspirated volume was 531 mL (range, 250-1,230 mL). The only adverse event was a subsegmental pulmonary embolism. Seven patients (33%) were discharged the same day. Recurrent thrombosis was observed in 5 patients (24%), of whom 3 were successfully treated with the JETi8 system. CONCLUSIONS The JETi8 system may be a safe and effective option for thrombectomy of acute DVT.
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Affiliation(s)
- Jean Cournoyer-Rodrigue
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - The-Bao Bui
- Department of Radiology, Centre Hospitalier de l'Université de Sherbrooke, Hôpital Fleurimont (CHUS), Sherbrooke, Québec, Canada
| | - Patrick Gilbert
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Centre de recherche, CHUM, Pavillon R, 900 rue Saint-Denis, Montréal, Québec, Canada, H2X 0A9
| | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Vincent L Oliva
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Centre de recherche, CHUM, Pavillon R, 900 rue Saint-Denis, Montréal, Québec, Canada, H2X 0A9.
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26
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Jiang C, Zhao Y, Wang X, Liu H, Tan TW, Li F. Midterm outcome of pharmacomechanical catheter-directed thrombolysis combined with stenting for treatment of iliac vein compression syndrome with acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2020; 8:24-30. [DOI: 10.1016/j.jvsv.2019.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/10/2019] [Indexed: 01/10/2023]
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Abstract
Iliac vein compression syndrome (May-Thurner syndrome - MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.
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Affiliation(s)
- Katalin Mako
- University of Medicine and Pharmacy, Targu Mures, Romania
| | - Attila Puskas
- Angio-Center-Vascular Medicine Romania, Targu Mures, Romania
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28
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Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. [Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV)]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:e1-e47. [PMID: 30770089 DOI: 10.1016/j.jdmv.2018.12.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38043 Grenoble, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, Hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, Hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-Les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, Hôpital Nord, CHU St-Étienne, 42, avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue de la Maison Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, 38043 Grenoble, France.
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29
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Quéré I, Elias A, Maufus M, Elias M, Sevestre MA, Galanaud JP, Bosson JL, Bura-Rivière A, Jurus C, Lacroix P, Zuily S, Diard A, Wahl D, Bertoletti L, Brisot D, Frappe P, Gillet JL, Ouvry P, Pernod G. Unresolved questions on venous thromboembolic disease. Consensus statement of the French Society for Vascular Medicine (SFMV). JOURNAL DE MEDECINE VASCULAIRE 2019; 44:28-70. [PMID: 30770082 DOI: 10.1016/j.jdmv.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Affiliation(s)
- I Quéré
- Service de médecine vasculaire, CHU Montpellier, 80, avenue Augustun-Fliche, 34090 Montpellier, France
| | - A Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M Maufus
- Service de médecine vasculaire, CH Pierre Oudot, 38300 Bourgoin-Jallieu, France
| | - M Elias
- Service de médecine vasculaire, CH Sainte Musse, 83100 Toulon, France
| | - M-A Sevestre
- Service de médecine vasculaire, CHU Amiens Picardie, avenue Laennec, 80054 Amiens cedex 1, France
| | - J-P Galanaud
- Département de médecine, Sunnybrook Health Sciences Centre, université de Toronto, Toronto, Canada
| | - J-L Bosson
- Département de biostatistiques, CHU Grenoble-Alpes, 38700 La Tronche, France
| | - A Bura-Rivière
- Service de médecine vasculaire, CHU Rangueil, 31059 Toulouse cedex 9, France
| | - C Jurus
- Service de médecine vasculaire, clinique du Tonkin, 69100 Villeurbanne, France
| | - P Lacroix
- Service de médecine vasculaire, hôpital Dupuytren, CHU Limoges, 87042 Limoges cedex, France
| | - S Zuily
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - A Diard
- Médecine vasculaire, 25, route de Créon, 33550 Langoiran, France
| | - D Wahl
- Service de médecine vasculaire, hôpital Brabois, CHU Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
| | - L Bertoletti
- Service de médecine vasculaire et thérapeutique, hôpital Nord, CHU St.-Étienne, 42, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - D Brisot
- Médecine vasculaire, 34830 Clapiers, France
| | - P Frappe
- Département de médecine générale, université Jean-Monnet, 42000 St.-Étienne, France
| | - J-L Gillet
- Médecine vasculaire, 1328, avenue Maison-Blanche, 38300 Bourgoin-Jallieu, France
| | - P Ouvry
- Médecine vasculaire, 1328, avenue Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - G Pernod
- Service de médecine vasculaire, CHU Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38043 Grenoble, France.
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Comerota AJ. Pharmacologic and Pharmacomechanical Thrombolysis for Acute Deep Vein Thrombosis: Focus on ATTRACT CME. Methodist Debakey Cardiovasc J 2019; 14:219-227. [PMID: 30410653 DOI: 10.14797/mdcj-14-3-219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Systemically delivered pharmacologic thrombolysis for acute deep vein thrombosis long ago gave way to catheter delivery of plasminogen activators within the clot. This simple concept resulted in markedly improved efficacy and safety. In an effort to accelerate thrombus dissolution or extraction, mechanical methods were developed, but the initial techniques left substantial residual thrombus that required subsequent catheter-directed thrombolysis (CDT). It was soon observed that combined pharmacomechanical thrombolysis was more effective than either one alone. Randomized trials of catheter-based strategies for thrombus removal have documented objective benefit, including improved patency, preserved valve function, and reduced post-thrombotic syndrome. The largest randomized study is the ATTRACT trial published at the end of 2017. Although mild post-thrombotic syndrome (PTS) was no different between the pharmacomechanical catheter-directed thrombolysis (PCDT) and control groups, acute pain and swelling and moderate-to-severe PTS were reduced with PCDT. Additional analyses from this robust data set are forthcoming.
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Govindarajulu U, Bedi S, Kluger A, Resnic F. Survival analysis of hierarchical learning curves in assessment of cardiac device and procedural safety. Stat Med 2018; 37:4185-4199. [PMID: 30062850 DOI: 10.1002/sim.7906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/14/2018] [Indexed: 11/07/2022]
Abstract
Many Americans rely on cardiac surgical procedures and devices such as pacemakers and thrombolytic catheters to treat or manage their cardiovascular diseases. However, the failure of these cardiac devices and procedures could have grave consequences. One reason cardiac devices tended to fail was due to physician error; there is a learning effect for the physician or operator to come up to speed in skillfully implanting devices and conducting procedures. In order to better understand these learning effects, we had previously modeled the resulting learning curve effects in simulations a hierarchical setting with physicians clustered within institutions using our unique methodology (see the work of Govindarajulu et al 2017). Previously, we had employed these in hierarchical linear modeling and also in generalized estimating equations. In this setting, we have demonstrated how to apply similar methodology but revised in a survival analytic framework or time-to-event analyses. Through simulations and real dataset applications, we found that, out of the three shapes modeled to fit the learning curve, the logarithmic shape tended to have the best fit, similar to previous work (see the work of Govindarajulu et al 2017). However, as seen before, modeling the learning rate can be dataset specific and one shape may be better than another. We learned that modeling the learning rate could also be applied in the survival analysis setting through this new methodology. The goal of this paper is to model cardiac device and procedure learning curve effects in a time-to-event setting so that this knowledge may allow for the improvement of both short and long-term patient survival.
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Affiliation(s)
- Usha Govindarajulu
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Sandeep Bedi
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Aaron Kluger
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Frederic Resnic
- Department of Cardiology, Lahey Clinic, Burlington, Massachusetts
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Liu G, Zhao Z, Cui C, Ye K, Yin M, Liu X, Qin J, Huang X, Lu M, Jiang M, Li W, Lu X. Endovascular management of extensive lower extremity acute deep vein thrombosis with AngioJet rheolytic thrombectomy plus catheter-directed thrombolysis from contralateral femoral access. Phlebology 2018; 34:257-265. [PMID: 30049252 DOI: 10.1177/0268355518790407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of the present study was to report the clinical outcomes of endovascular treatment for extensive lower limb deep vein thrombosis with AngioJet rheolytic thrombectomy (ART) plus catheter-directed thrombolysis (CDT) using a contralateral femoral approach. METHODS A retrospective analysis of consecutive ART+CDT treatments in 38 deep vein thrombosis patients (LET I-III, from September 2014 to March 2016) was performed. RESULTS The technical success rate was 100%. Complete lysis was achieved in 82% of LET III segments (calf veins), 87% of LET II segments (popliteal-femoral veins), and 90% of LET III segments (iliac veins). The best results were obtained in patients treated within seven days of symptom onset. During follow-up, well-preserved, competent femoral valves were observed in 86% of the patients, and recanalization of LET III, LET II, and LET I segments was achieved in 100%, 94%, and 91% of the patients, respectively. The post-thrombotic syndrome rate was 17% during a mean 20-month follow-up.
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Affiliation(s)
- Guang Liu
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhen Zhao
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chaoyi Cui
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Kaichuang Ye
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Minyi Yin
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xaiobing Liu
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jinbao Qin
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xintian Huang
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Min Lu
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Mier Jiang
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Weimin Li
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xinwu Lu
- 1 Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,2 The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Thromboembolic Risk of Endovascular Intervention for Lower Extremity Deep Venous Thrombosis. Ann Vasc Surg 2018; 49:247-254. [DOI: 10.1016/j.avsg.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 10/15/2017] [Accepted: 10/20/2017] [Indexed: 01/26/2023]
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Elbasty A, Metcalf J. Safety and Efficacy of Catheter Direct Thrombolysis in Management of Acute Iliofemoral Deep Vein Thrombosis: A Systematic Review. Vasc Specialist Int 2017; 33:121-134. [PMID: 29354622 PMCID: PMC5754069 DOI: 10.5758/vsi.2017.33.4.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose Catheter direct thrombolysis (CDT) has been shown to be an effective treatment for deep venous thrombosis. The objective of the review is to improve safety and efficacy of the CDT by using ward based protocol, better able to predict complications and treatment outcome through monitoring of haemostatic parameters and clinical observation during thrombolysis procedure. Materials and Methods MEDLINE, EMBASE, CENTRAL and Web of Science were searched for all articles on deep venous thrombosis, thrombolysis and correlations of clinical events (bleeding, successful thrombolysis) during thrombolysis with hemostatic parameters to March 2016. The risk of bias in included studies was assessed by Cochrane Collaboration’s tool and Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions. Results Twenty-four studies were included in the review and we found that improving safety and efficacy of CDT by using ward based protocol depending on eight factors; strict patient selection criteria, types of fibrinolytic drugs, mode of fibrinolytic drug injection, biochemical markers monitoring (fibrinogen, D-dimer, activated partial thromboplastin time, plasminogen activator inhibitor-1), timing of intervention, usage of intermittent pneumatic calf, ward monitoring and thrombolysis imaging assessment (intravascular ultrasound). These factors may help to improve safety and efficacy by reducing total thrombolytic drug dosage and at the same time ensure successful lysis. There is a marked lack of randomized controlled trials discussing the safety and efficacy of catheter direct thrombolysis. Conclusion CDT can be performed safely and efficiently in clinical ward, providing that careful nursing, biochemical monitoring, proper selection and mode of infusion of fibrinolytic drugs, usage of Intermittent pneumatic calf and adequate thrombolysis imaging assessment are ensured.
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Affiliation(s)
- Ahmed Elbasty
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - James Metcalf
- Department of Vascular Surgery, Royal Bournemouth General Hospital, Bournemouth, UK
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Knuttinen MG, Naidu S, Oklu R, Kriegshauser S, Eversman W, Rotellini L, Thorpe PE. May-Thurner: diagnosis and endovascular management. Cardiovasc Diagn Ther 2017; 7:S159-S164. [PMID: 29399519 DOI: 10.21037/cdt.2017.10.14] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Common left iliac vein compression, otherwise known as May-Thurner (MT), is an anatomical risk factor for lower extremity deep vein thrombosis (DVT). MT refers to chronic compression of the left iliac vein against the lumbar spine by the overlying right common iliac artery. The compression may be asymptomatic. The syndrome is a clinical spectrum of physical findings and history plus the lesion. It is characterized by the varying degrees of venous hypertension. This can be non-thrombotic, combined with acute DVT or post-thrombotic. Traditionally, acute DVT was treated with standard anticoagulation and sometimes, thrombectomy. However these measures do not address the underlying culprit lesion of mechanical compression. Furthermore, if managed only with anticoagulation, patients with residual thrombus are at risk for developing recurrent DVT or post-thrombotic syndrome (PTS). Both retrospective and prospective studies have shown that endovascular management should be the preferred approach to dissolve proximal thrombus and to also treat the underlying compression with endovascular stent placement.
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Affiliation(s)
- M-Grace Knuttinen
- Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Sailendra Naidu
- Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | | | - William Eversman
- Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Lisa Rotellini
- Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
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Liu G, Qin J, Cui C, Ye K, Shi H, Liu X, Yin M, Huang X, Lu M, Jiang M, Li W, Lu X. Comparison of Direct Iliofemoral Stenting Following AngioJet Rheolytic Thrombectomy vs Staged Stenting After AngioJet Rheolytic Thrombectomy Plus Catheter-Directed Thrombolysis in Patients With Acute Deep Vein Thrombosis. J Endovasc Ther 2017; 25:133-139. [PMID: 28618846 DOI: 10.1177/1526602817714570] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare the treatment outcomes in patients with acute proximal deep vein thrombosis (DVT) and iliofemoral stenosis who underwent either direct stenting after AngioJet rheolytic thrombectomy or staged stenting after AngioJet thrombectomy plus catheter-directed thrombolysis with urokinase. Methods: From June 2014 to February 2016, 91 DVT patients underwent 2 treatments for duplex-verified iliofemoral stenosis: direct stenting (n = 46; mean age 54.8 years; 32 men) or staged stenting (n = 45; mean age 56.5 years; 27 men). The degree of patency after thrombectomy or thrombolysis was evaluated using the Venous Registry Index (VRI), while the risk of postthrombotic syndrome (PTS) was evaluated according to the Villalta scale. Patients were followed with periodic duplex ultrasound scans up to 1 year. Results: The technical success rates were 100% in both groups; there was no 30-day mortality. Immediate (24-hour) clinical improvement was achieved in 42 (91%) of 46 direct group patients vs 33 (73%) of 45 staged group patients (p<0.001). A significant reduction (p<0.001) in the length of hospital stay was noted in the direct group (4.59±0.91) compared with that in the staged group (5.8±1.6). The stents used in the direct group were longer but with similar diameter compared with the staged group. The thrombolysis rates were 81.50%±5.76% in the direct group and 85.67%±3.84% in the staged group (p<0.001). The VRIs declined (improved) significantly in both groups (11.68±1.92 to 3.21±1.44 in the direct group and 12.17±2.29 to 2.36±1.19 in the staged group, both p<0.001). The Villalta scores were significantly better in the staged group (p<0.001). Recurrent DVT occurred in 2 patients in the direct group. The primary patency rates at 1 year were 93.5% in the direct group and 97.8% in the staged group (p=0.323). Conclusion: Both direct and staged stenting are effective treatment modalities for patients with acute proximal DVT. Compared with staged stenting, direct stenting provides similar treatment success and a significant reduction in the length of hospital stay; however, it has lower thrombolysis efficacy, and the risk of PTS at 1 year is greater with direct stenting.
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Affiliation(s)
- Guang Liu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Guang Liu, Jinbao Qin, and Chaoyi Cui contributed equally to this work and have shared first authorship
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Guang Liu, Jinbao Qin, and Chaoyi Cui contributed equally to this work and have shared first authorship
| | - Chaoyi Cui
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Guang Liu, Jinbao Qin, and Chaoyi Cui contributed equally to this work and have shared first authorship
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Huihua Shi
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xintian Huang
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Min Lu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Mier Jiang
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Alkhater M, Jockenhöfer F, Stoffels I, Dissemond J. May-Thurner syndrome: an often overlooked cause for refractory venous leg ulcers. Int Wound J 2017; 14:578-582. [PMID: 28251803 DOI: 10.1111/iwj.12724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/25/2017] [Indexed: 11/28/2022] Open
Abstract
We report a 53-year-old female patient presenting with a refractory venous leg ulcer and unremarkable findings in the doppler Ultrasound venous mapping of the leg veins. Further comprehensive diagnostics demonstrated an underlying May-Thurner syndrome. After resolution of the primary mechanical obstruction, rapid wound healing in the following 3 weeks was documented. Iliac vein compression syndrome, commonly known as May-Thurner syndrome, is a distinguishable anatomical variant that results from an external compression over the left iliac vein exerted by the overriding adjacent right common iliac artery. It is mostly seen among young, healthy female patients and can easily be under-diagnosed. Lower extremities duplex ultrasonography remains the gold standard in diagnosing venous insufficiency, but it should not solely depend on it. Instead, clinicians should consider other possibilities, assessing the patency within the truncal veins, which in turn might contribute to the venous insufficiency along the lower limbs. An active early diagnostic approach can prevent significant overall morbidity and help patients to ease back into their daily-life activities. Therefore, it is recommended that all patients with suspected venous insufficiency and normal lower limbs duplex findings should undergo further evaluation of the truncal venous system pattern. May-Thurner syndrome, along with other causes of iliac veins compression, should be considered in the differential diagnosis in unclear persistent cases of unilateral venous symptoms.
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Affiliation(s)
- Maryam Alkhater
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Finja Jockenhöfer
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Essen, Germany
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Zayed MA, De Silva GS, Ramaswamy RS, Sanchez LA. Management of Cavoatrial Deep Venous Thrombosis: Incorporating New Strategies. Semin Intervent Radiol 2017; 34:25-34. [PMID: 28265127 DOI: 10.1055/s-0036-1597761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cavoatrial deep venous thrombosis (DVT) is diagnosed with increasing prevalence. It can be managed medically with anticoagulation or with directed interventions aimed to efficiently reduce the thrombus burden within the target venous segment. The type of management chosen depends greatly on the etiology and chronicity of the thrombosis, existing patient comorbidities, and the patient's tolerance to anticoagulants and thrombolytic agents. In addition to traditional percutaneous catheter-based pharmacomechanical thrombolysis, other catheter-based suction thrombectomy techniques have emerged in recent years. Each therapeutic modality requires operator expertise and a coordinated care paradigm to facilitate successful outcomes. Open surgical thrombectomy is alternatively reserved for specific patient conditions, including intolerance of anticoagulation, failed catheter-based interventions, or acute emergencies.
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Affiliation(s)
- Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
| | - Gayan S De Silva
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Raja S Ramaswamy
- Interventional Radiology Section, Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Luis A Sanchez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Abstract
OBJECTIVE The purpose of this article is to describe the indications for and approach to catheter-based treatment of acute venous thromboembolism (VTE). CONCLUSION Catheter-based treatment of VTE is a viable adjunct to anticoagulant therapy and is being rapidly adopted around the United States. Early data suggest that these therapies reduce postthrombotic sequelae and improve quality of life, but bleeding events are still frequent, particularly at low-volume centers. Protocols need to be standardized to improve patient care.
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Abstract
Deep vein thrombosis, and the resultant development of post-thrombotic syndrome, is a significant health issue. Recent evidence demonstrates that the severity of post-thrombotic syndrome symptoms is directly related to the level of venous thrombosis and following treatment these subsequent symptoms are inversely related to the degree of thrombus removal. If we can improve, and preferably standardise the terminology associated with pre-treatment assessment of thrombus load and post-treatment success of thrombus removal techniques, we should then be able to choose more tailor-made techniques to greater benefit our patients. A number of scoring systems have been devised for the assessment of venous thrombus burden, with a majority impractical for everyday usage. In order to provide a more practical solution, the lower extremity thrombosis classification has been developed, using information on anatomical location for venous thrombus combined with a clinical indicator as to the likely sequelae. Anatomical success following venous thrombolysis can be defined by assessing restoration of anterograde flow in the treated vein or the percentage degree of thrombolysis, using venography. The second option is the method most frequently utilised, with the Venous Registry grading system applied. Data from recent trials have given us conflicting and confusing data mainly because we are not using standardised terminology. We urgently need to agree on a standard method of description of thrombus removal before stent placement which also incorporates the likely clinical impact of the area involved in the thrombosis.
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Affiliation(s)
- Patrick Navin
- Department of Radiology, Galway University Hospital, Galway, Ireland
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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.
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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
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Chaer RA, Dayal R, Lin SC, Trocciola S, Morrissey NJ, McKinsey J, Kent KC, Faries PL. Multimodal Therapy for Acute and Chronic Venous Thrombotic and Occlusive Disease. Vasc Endovascular Surg 2016; 39:375-80. [PMID: 16193209 DOI: 10.1177/153857440503900501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Critical deep venous thrombosis and occlusion constitutes a small percentage of patients with venous disease. However, these patients exhibit severe symptomatology including pain and extensive edema that may progress to limb-or life-threatening complications such as phlegmasia cerulea dolens and superior vena cava syndrome. This paper reviews the different multimodal percutaneous interventions currently available for the treatment of complex critical venous thrombotic and occlusive disease.
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Affiliation(s)
- Rabih A Chaer
- Department of Surgery, Division of Vascular Surgery, The New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY 10021, USA
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Painless acrocyanosis: Paget-Schroetter syndrome secondary to thoracic outlet obstruction from muscle hypertrophy. Am J Emerg Med 2016; 34:1323.e1-3. [DOI: 10.1016/j.ajem.2015.11.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/18/2015] [Indexed: 11/17/2022] Open
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El Sayed HF, Kougias P, Zhou W, Lin PH. Utility of Retrievable Vena Cava Filters and Mechanical Thrombectomy in the Endovascular Management of Acute Deep Venous Thrombosis. Vascular 2016; 14:305-12. [PMID: 17038301 DOI: 10.2310/6670.2006.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endovascular interventions of symptomatic deep venous thrombosis (DVT) using various therapeutic modalities, such as thrombolysis, mechanical thrombectomy, and inferior vena cava (IVC) filter placement, have received increased focus owing in part to advances in catheter-based interventional technologies. Although systemic anticoagulation remains the primary treatment modality in DVT, catheter-based interventions can provide rapid removal of large thrombus burden and possibly preserve venous valvular function in patients with symptomatic DVT. This article reviews current endovascular treatment strategies for acute DVT. Specifically, the utility of mechanical thrombectomy along with various temporary IVC filters in the setting of DVT is examined. Lastly, an illustrative case of acute DVT that was treated with endovascular intervention with IVC filter placement is presented.
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Affiliation(s)
- Hosam F El Sayed
- Division of Vascualr and Endovascular Therapy, Micheal E. DeBakey Department of Surgery, Baylor College of Medicine, Micheal E. DeBakey VA Medical Center, Houston, TX 77030, USA
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Kayılıoğlu SI, Köksoy C, Alaçayır İ. Diagnostic value of the femoral vein flow pattern for the detection of an iliocaval venous obstruction. J Vasc Surg Venous Lymphat Disord 2016; 4:2-8. [DOI: 10.1016/j.jvsv.2015.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
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Vedantham S, Piazza G, Sista AK, Goldenberg NA. Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism. J Thromb Thrombolysis 2016; 41:68-80. [PMID: 26780739 PMCID: PMC4715849 DOI: 10.1007/s11239-015-1318-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patients with venous thromboembolism (VTE) are prone to the development of both short-term and long-term complications that can substantially affect their functional capacity and quality of life. Patients with deep vein thrombosis (DVT) often develop recurrent VTE or the post-thrombotic syndrome, whereas patients with pulmonary embolism (PE) can develop long-term symptoms and functional limitations along a broad spectrum extending to full-blown chronic thromboembolic pulmonary hypertension. Clinicians who care for patients showing severe clinical manifestations of DVT and PE are often faced with challenging decisions concerning whether and how to escalate to more aggressive treatments such as those involving the use of thrombolytic drugs. The purpose of this chapter is to provide guidance on how best to individualize care to these patients.
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Affiliation(s)
- Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, St. Louis, MO, 63110, USA.
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Goto M, Miura SI, Yamamoto T, Fukuda Y, Kuwano T, Kimura I, Sanui A, Miyamoto S, Saku K. Anticoagulant Therapy in a Pregnant Woman with May-Thurner Syndrome. Intern Med 2016; 55:59-62. [PMID: 26726087 DOI: 10.2169/internalmedicine.55.5215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 39-year-old woman with a 9-week abdominal pregnancy noted pain in her lower abdomen and left leg. Since successive thrombi were observed extending from the left common iliac vein to the popliteal vein along with a thrombus in the left pulmonary artery, we diagnosed her with pulmonary thromboembolism with deep venous thrombosis (DVT). May-Thurner syndrome may have contributed to DVT in the left leg when the left iliac vein was compressed by the right iliac artery. She underwent anticoagulant therapy with heparin, followed by the subcutaneous injection of heparin at home after discharge. We herein report the case of a pregnant woman with May-Thurner syndrome who safely gave birth.
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Affiliation(s)
- Masaki Goto
- Department of Cardiology, Fukuoka University School of Medicine, Japan
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Jia Z, Tu J, Zhao J, Ren B, Tian F, Wang K, Li S, Jiang G. Aspiration thrombectomy using a large-size catheter for acute lower extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2015; 4:167-71. [PMID: 26993862 DOI: 10.1016/j.jvsv.2015.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study retrospectively evaluated the safety and efficacy of aspiration thrombectomy using a large-size catheter for acute lower extremity deep vein thrombosis (DVT). METHODS All patients who underwent aspiration thrombectomy using 9F or 10F catheters for acute lower extremity DVT were included and analyzed. Aspiration thrombectomy was performed in all patients. Additional intravenous thrombolysis was performed in patients with residual thrombus, and stent placement was performed in patients with iliac vein compression syndrome. RESULTS From October 2010 to September 2013, the study enrolled 68 patients (37 women, 31 men) with a mean age of 61.7 ± 7.8 years (range, 24-86 years). All patients presented with lower extremity swelling and pain, and the duration of symptoms ranged from 1 to 14 days. The DVTs involved popliteal-iliofemoral veins in 29 patients, iliofemoral veins in 31, and iliac veins in 8. Endovascular procedures were performed in all patients with a technical success rate of 100%. Aspiration alone was effective in 47 patients, and additional thrombolysis was required in the remaining 21. An additional stent was required in 32 patients. Significant improvement in presenting symptoms was achieved in all patients after the procedures, with a clinical success rate of 100%. There were no procedure-related or thrombolysis-related complications. The Villalta scores were <5 in 60 patients and from 5 to 9 in four patients. Primary and secondary patency rates were 89.1% (57 of 64) and 96.9% (62 of 64) at 1 year of follow-up. CONCLUSIONS Aspiration thrombectomy using a large-size catheter is safe and effective for acute lower extremity DVT.
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Affiliation(s)
- Zhongzhi Jia
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China
| | - Jianfei Tu
- Department of Radiology and Interventional Radiology, Li Shui Central Hospital, Lishui, China
| | - Jinwei Zhao
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China
| | - Baosheng Ren
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China
| | - Feng Tian
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China
| | - Kai Wang
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China
| | - Shaoqin Li
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China
| | - Guomin Jiang
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China.
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