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Zeng X, Min X, Chen W, Zeng X, Ju Z, Dai K, Zhou W, Qiu J. Calf deep veins are safe and feasible accesses for the endovascular treatment of acute lower extremity deep vein thrombosis. Sci Rep 2024; 14:12916. [PMID: 38839895 PMCID: PMC11153529 DOI: 10.1038/s41598-024-63782-6] [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: 08/21/2023] [Accepted: 06/03/2024] [Indexed: 06/07/2024] Open
Abstract
This study was designed to assess the optimal access route for the endovascular treatment of acute lower extremity deep vein thrombosis. This was a retrospective analysis of patients with acute lower extremity deep venous thrombosis who underwent endovascular treatment from February 2009 to December 2020. Patients underwent non-direct calf deep vein puncture (NDCDVP) from February 2009 to December 2011 and direct calf deep vein puncture (DCDVP) from January 2012 to December 2020. Catheter directed thrombolysis (CDT) was used to treat all patients in the NDCDVP group, whereas patients in the DCDVP group were treated with CDT or the AngioJet rhyolitic thrombectomy system. In patients exhibiting iliac vein compression syndrome, the iliac vein was dilated and implanted with a stent. Technical success rates and perioperative complication rates were compared between these two treatment groups. The NDCDVP group included 83 patients (40 males, 43 females) with a mean age of 55 ± 16 years, while the DCDVP group included 487 patients (231 males. 256 females) with a mean age of 56 ± 15 years. No significant differences were observed between these groups with respect to any analyzed clinical characteristics. The technical success rates in the NDCDVP and DCDVP groups were 96.4 and 98.2%, respectively (P > 0.05). In the NDCDVP group, the small saphenous vein (SSV)or great saphenous vein (GSV)were the most common access routes (77.1%, 64/83), whereas the anterior tibial vein (ATV) was the most common access route in the DCDVP group (78.0%, 380/487), followed by the posterior tibial vein (PTV) and peroneal vein (PV)(15.6% and 6.4%, respectively). Relative to the NDCDVP group, more patients in the DCDVP group underwent the removal of deep vein clots below the knee (7.2% [6/83] vs. 24.2% [118/487], P < 0.001). Moreover, relative to the NDCDVP group, significantly lower complication rates were evident in the DCDVP group (local infection: 10.8% vs. 0.4%, P < 0.001; local hematoma: 15.7% vs. 1.0%, P < 0.001). The position change rate was also significantly lower in the DCDVP group relative to the NDCDVP group (0% [0/487] vs. 60.2% [50/83], P < 0.001). The calf deep veins (CDVs) represent a feasible and safe access route for the endovascular treatment of lower extremity deep vein thrombosis.
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Affiliation(s)
- Xiande Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xixi Min
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Wei Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiong Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhinan Ju
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Kanghui Dai
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Weimin Zhou
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jiehua Qiu
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
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He X, Zhang L, Qiu H, Jiang X, Zhang F, Peng J, Zhang H, Yu W, Gao X, Dong R, Zhao Z. Two New Methods of Supine Venographically Guided Popliteal Vein Puncture: A Retrospective Study. Eur J Vasc Endovasc Surg 2021; 62:622-628. [PMID: 34244092 DOI: 10.1016/j.ejvs.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: 07/10/2020] [Revised: 04/23/2021] [Accepted: 05/08/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Presently, the prone position is necessary for popliteal vein puncture access, but it makes the patients uncomfortable and does not allow traditional femoral or jugular access. To address these deficiencies, this study introduces two new methods, anterior and medial access carried out in the supine position. METHODS Venous interventions with punctures in the popliteal vein of 120 limbs in 97 patients were performed during the period from February 2017 to April 2019. After puncture, venographic guidance was achieved by dorsal vein injection of contrast medium. Interventional therapy was performed after puncture and insertion of the introducer sheath. RESULTS In all, 120 limbs were punctured in the popliteal vein, with technical success in 118 (98.3% in total) cases: 100%, 96.1%, and 100% successful punctures in, respectively, 32 anterior, 49 medial, and 37 posterior access cases. A comparison of the three groups revealed that the fluoroscopy time and duration of puncture were longer in the medial and anterior access groups than in the posterior access group. The rate of intra-operative and post-operative complications was 7.5% (9/120), with no statistically significant difference between the three access groups. Compared with the pre-operative median score of 2.5, the post-operative SVS (Society of Vascular Surgery) score of the popliteal vein was reduced to 1.5 in the anterior and 0.5 in the medial groups. CONCLUSION Medial and anterior puncture of the popliteal vein in the supine position can be used as a safe alternative in venous endovascular therapy. The two new methods can mitigate frailty or respiratory problems resulting from the prone position and facilitate traditional femoral and jugular access.
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Affiliation(s)
- Xinqi He
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Lei Zhang
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Huiqing Qiu
- Department of Geriatrics Department, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Xia Jiang
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Feng Zhang
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Junlu Peng
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Hongsong Zhang
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Weifang Yu
- Department of Endoscopy Centre, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Xian Gao
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Ruitao Dong
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China
| | - Zengren Zhao
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, the First Hospital of Hebei Medical University, Hebei, PR China.
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Liu G, Liu X, Wang R, Ye K, Yin M, Huang X, Lu M, Li W, Lu X, Jiang M. Catheter-Directed Thrombolysis of Acute Entire Limb Deep Vein Thrombosis From below the Knee Access. Catheter Cardiovasc Interv 2017; 91:310-317. [PMID: 28471007 DOI: 10.1002/ccd.27118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 03/22/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
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
| | - Xaiobing 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
| | - Ruihua Wang
- 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
| | - 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
| | - 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
| | - 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
| | - 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
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4
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Vedantham S, Padginton C. Percutaneous options for acute deep vein thrombosis. Semin Intervent Radiol 2011; 22:195-203. [PMID: 21326693 DOI: 10.1055/s-2005-921952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Anticoagulant therapy is associated with poor late limb outcomes in many patients with deep vein thrombosis (DVT). Because systemic thrombolysis and surgical thrombectomy have inherent limitations, image-guided percutaneous thrombus removal is currently favored. Pharmacologic thrombolysis is effective in removing thrombus, but long-term benefit has not been conclusively demonstrated and major bleeding rates appear to be higher than those observed with anticoagulation alone. Percutaneous mechanical thrombectomy is limited as a stand-alone DVT treatment method by inability to clear large thrombosed veins completely and by pulmonary embolism. Pharmacomechanical thrombolysis represents the most promising currently available method to treat DVT. Randomized trials with long-term follow-up are needed to determine the appropriate indications for these procedures. In the meantime, a highly individualized approach to selection of patients is recommended, taking into account the chronicity and anatomic extent of DVT, the presence of circulatory compromise, the patient's bleeding risk profile, life expectancy, and anticipated activity level.
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Affiliation(s)
- Suresh Vedantham
- Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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5
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Vedantham S, Grassi CJ, Ferral H, Patel NH, Thorpe PE, Antonacci VP, Janne d'Othée BM, Hofmann LV, Cardella JF, Kundu S, Lewis CA, Schwartzberg MS, Min RJ, Sacks D. Reporting Standards for Endovascular Treatment of Lower Extremity Deep Vein Thrombosis. J Vasc Interv Radiol 2009; 20:S391-408. [DOI: 10.1016/j.jvir.2009.04.034] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 11/12/2005] [Indexed: 11/25/2022] Open
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Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H, Hofmann LV, Janne d'Othée BM, Antonaci VP, Brountzos EN, Brown DB, Martin LG, Matsumoto AH, Meranze SG, Miller DL, Millward SF, Min RJ, Neithamer CD, Rajan DK, Rholl KS, Schwartzberg MS, Swan TL, Towbin RB, Wiechmann BN, Sacks D. Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. J Vasc Interv Radiol 2009; 20:S227-39. [DOI: 10.1016/j.jvir.2009.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Accepted: 11/12/2005] [Indexed: 10/20/2022] Open
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7
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Vedantham S, Grassi CJ, Ferral H, Patel NH, Thorpe PE, Antonacci VP, Janne d'Othée BM, Hofmann LV, Cardella JF, Kundu S, Lewis CA, Schwartzberg MS, Min RJ, Sacks D. Reporting Standards for Endovascular Treatment of Lower Extremity Deep Vein Thrombosis. J Vasc Interv Radiol 2006; 17:417-34. [PMID: 16567667 DOI: 10.1097/01.rvi.0000197359.26571.c2] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Suresh Vedantham
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
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8
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Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H, Hofmann LV, Janne d'Othée BM, Antonaci VP, Brountzos EN, Brown DB, Martin LG, Matsumoto AH, Meranze SG, Miller DL, Millward SF, Min RJ, Neithamer CD, Rajan DK, Rholl KS, Schwartzberg MS, Swan TL, Towbin RB, Wiechmann BN, Sacks D. Quality Improvement Guidelines for the Treatment of Lower Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. J Vasc Interv Radiol 2006; 17:435-47; quiz 448. [PMID: 16567668 DOI: 10.1097/01.rvi.0000197348.57762.15] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Suresh Vedantham
- Department of Radiology, Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
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9
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Mousa A, Henderson P, Dayal R, Bernheim J, Kent KC, Faries PL. Endoluminal recanalization in a patient with phlegmasia cerulea dolens using a multimodality approach. Vascular 2005; 13:313-7. [PMID: 16288709 DOI: 10.1258/rsmvasc.13.5.313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Phlegmasia cerulea dolens, a rare complication of deep venous thrombosis, has traditionally been difficult to treat. The patient described in this report posed additional therapeutic challenges based on a history of heparin-induced thrombocytopenia. She presented with severe leg pain and swelling, and a venogram showed occlusion of both her inferior vena cava and right iliac vein. The use of a multimodality approach, both chemical and mechanical, was successful in removing the venous occlusion, thereby preventing further complications, such as circulatory shock, postphlebitic syndrome, and venous gangrene.
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Affiliation(s)
- Albeir Mousa
- Department of Vascular Surgery, New York Presbyterian Hospital, Cornell University, Weill Medical School, New York, NY, USA
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10
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Sharafuddin MJ, Sun S, Hoballah JJ, Youness FM, Sharp WJ, Roh BS. Endovascular management of venous thrombotic and occlusive diseases of the lower extremities. J Vasc Interv Radiol 2003; 14:405-23. [PMID: 12682198 DOI: 10.1097/01.rvi.0000064849.87207.4f] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute complications of deep vein thrombosis (DVT) of the lower extremities include pulmonary embolism and venous ischemia. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Anticoagulation therapy is recognized as the mainstay of therapy in acute DVT. However, there are few data to suggest any major beneficial effect on PTS, which is thought to be mediated by valve damage and/or occlusive chronic thrombus and venous scarring. Endovascular catheter-directed thrombolysis techniques with pharmacologic thrombolytic agents, used alone or in combination with mechanical thrombectomy devices, have been proven highly effective in clearing acute DVT, which may allow the preservation of venous valve function and prevention of subsequent venous occlusive disease. Definitive management of underlying anatomic occlusive abnormalities can also be undertaken.
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Affiliation(s)
- Melhem J Sharafuddin
- Department of Radiology, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, Iowa 52242-1077, USA.
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11
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Chang R, Cannon RO, Chen CC, Doppman JL, Shawker TH, Mayo DJ, Wood B, Horne MK. Daily catheter-directed single dosing of t-PA in treatment of acute deep venous thrombosis of the lower extremity. J Vasc Interv Radiol 2001; 12:247-52. [PMID: 11265890 PMCID: PMC2374747 DOI: 10.1016/s1051-0443(07)61832-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The strong fibrin affinity of recombinant tissue plasminogen activator (rt-PA) theoretically obviates continuous infusion or replacement of t-PA after direct intrathrombic injection. This hypothesis led the authors to evaluate single daily catheter-directed injection of rt-PA as a thrombolytic treatment for acute deep vein thrombosis of the lower extremity. Once-daily injection of rt-PA was performed in large thrombosed veins (popliteal or larger) with use of pulse-spray catheters and in small thrombosed veins in patients' calves with use of 3-4-F coaxial catheters. Patients received only full systemic anticoagulation on his/her patient care unit. This dosing regimen has been tested in 10 patients (12 legs) with a maximum dose of 50 mg per leg per day. Extensive thrombolysis was achieved in nine patients and partial thrombolysis was achieved in one patient, at an average total dose of 106 mg of rt-PA per leg. Minor bleeding was seen in three patients and no transfusions were needed. Our technique and the rationale for this pilot study is the focus of this article.
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Affiliation(s)
- R Chang
- Department of Diagnostic Radiology, National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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12
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Patel NH, Stookey KR, Ketcham DB, Cragg AH. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol 2000; 11:1297-302. [PMID: 11099239 DOI: 10.1016/s1051-0443(07)61304-9] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The authors report their experience on the treatment of acute extensive iliofemoral deep venous thrombosis (DVT) due to May-Thurner syndrome using endovascular techniques. MATERIALS AND METHODS During a 1-year period, 10 symptomatic women (age range, 22-52 years; mean, 35.5 years) were referred for treatment. After ascending venography, an infusion catheter system was placed and urokinase was infused locally into the thrombus burden. After near complete clot dissolution (> or = 95%) or lytic stagnation, the residual left common iliac vein narrowing was treated by means of angioplasty and/or placement of Wallstent endoprosthesis. All patients continued to receive oral warfarin. Patients were followed-up by means of clinic visits, and stent patency was assessed by means of duplex Doppler sonography performed at 1, 3, 6, and 12 months, and then yearly thereafter. RESULTS The total dose of urokinase used and the duration of infusion were 5.87 +/- 2.57 million units (range, 3.18-10.7) and 51.95 +/- 21.57 hours (range, 26.5-89), respectively. After completion of thrombolytic therapy, the iliac vein narrowing was successfully treated by deployment of a Wallstent endoprosthesis in all 10 patients because of failure of angioplasty. No major bleeding complications occurred. Initial clinical success was 100%, with complete resolution of symptoms in all patients. One patient, who was hypercoagulable and was receiving chemotherapy for metastatic adenocarcinoma, had recurrent symptomatic acute DVT 1 month after therapy. She underwent successful repeated lysis. The remaining nine patients were asymptomatic, with a mean follow-up of 15.2 months (range, 6-36 months). One asymptomatic patient, at 36-month follow-up ultrasound, had iliac vein occlusion and well-developed venous collaterals. Serial ultrasonography in all 10 patients showed no evidence of valvular insufficiency in the femoral and popliteal veins. CONCLUSION Catheter-directed thrombolytic therapy for the treatment of acute extensive iliofemoral DVT due to May-Thurner syndrome is an effective method for restoring venous patency and provides relief of the acute symptoms. The underlying left common iliac vein lesion invariably needs to undergo stent placement.
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Affiliation(s)
- N H Patel
- Department of Radiology, Indiana University Medical Center, Indianapolis, USA.
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13
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Murray JD, Brennan FJ, Hall LD, Berry JM, Hatter DG, Hemp JR, Reeves TR, Velling TE, Bergan JJ. Left iliac vein occlusion: its clinical spectrum. Ann Vasc Surg 2000; 14:510-6. [PMID: 10990564 DOI: 10.1007/s100169910098] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The cases reported here demonstrate the variability of the clinical manifestations of left common iliac venous occlusive disease. In each instance, therapy must be adjusted to meet the symptomatic needs of the individual patient. The experience reported here should reinforce the fact that occlusions even 25 months or longer in duration may be reopened. Continuing patency can be enhanced by stent placement.
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Affiliation(s)
- J D Murray
- Department of Surgery, Naval Medical Center San Diego, CA, USA
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15
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Tamim W, Arous E. Thrombolytic therapy: the treatment of choice for iliac vein thrombosis in the presence of kidney transplant. Ann Vasc Surg 1999; 13:436-8. [PMID: 10398741 DOI: 10.1007/s100169900279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 49-year-old kidney transplant recipient was admitted with the diagnosis of acute iliofemoral deep venous thrombosis (DVT) extending into the external iliac vein in close proximity to the renal vein anastomosis. Thrombolytic therapy with urokinase was used and complete lysis of the thrombus was achieved within 36 hr. We feel that this method of therapy, rather than standard anticoagulation, represents the treatment of choice for acute DVT in the presence of a renal graft. Using this method we were able to salvage the kidney and avoid the complications of postphlebitic syndrome and pulmonary embolus.
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Affiliation(s)
- W Tamim
- University of Massachusetts Medical Center-Memorial Hospital, Worcester, MA 01604, USA
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16
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Centeno RF, Nguyen AH, Ketterer C, Stiller G, Chait A, Fallahnejad M. An Alternative Approach: Antegrade Catheter-directed Thrombolysis in a Case of Phlegmasia Cerulea Dolens. Am Surg 1999. [DOI: 10.1177/000313489906500309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Phlegmasia cerulea dolens is an uncommon sequela of severe deep venous thrombosis of the lower extremities. Characterized by massive edema, arterial and venous compromise, and threats to limb and life, this clinical entity is a clear indication for thrombolytic therapy. We report an innovative approach to conventional thrombolysis via a lesser saphenous vein cut-down. This simple technique is a safe, reliable alternative to present methods of achieving deep venous access. Hence, it should be considered as an addition to the treatment armamentarium for massive deep venous thrombosis of the lower extremity.
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Affiliation(s)
- R. F. Centeno
- Departments of Surgery, The Graduate Hospital, Philadelphia, Pennsylvania
| | - A. H. Nguyen
- Departments of Surgery, The Graduate Hospital, Philadelphia, Pennsylvania
| | - C. Ketterer
- Departments of Surgery, The Graduate Hospital, Philadelphia, Pennsylvania
| | - G. Stiller
- Departments of Surgery, The Graduate Hospital, Philadelphia, Pennsylvania
| | - A. Chait
- Departments of Radiology, The Graduate Hospital, Philadelphia, Pennsylvania
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17
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McCollom VE, Zwirko RM. Catheter-directed thrombolysis in acute, infected iliofemoral venous thrombosis. J Vasc Interv Radiol 1998; 9:941-4. [PMID: 9840038 DOI: 10.1016/s1051-0443(98)70427-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- V E McCollom
- University of Oklahoma Health Science Center, Department of Radiology, Oklahoma City 73104, USA
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