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Serena T, Bailey W, Bendix S. Endovascular management of extensive iliocaval thrombosis secondary to synchronous uterine myoma compression and May-Thurner syndrome. J Vasc Surg Cases Innov Tech 2022; 8:179-182. [PMID: 35402754 PMCID: PMC8990033 DOI: 10.1016/j.jvscit.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/28/2022] [Indexed: 10/28/2022] Open
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Machin M, Salim S, Tan M, Onida S, Davies AH, Shalhoub J. Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome. Expert Rev Cardiovasc Ther 2021; 19:191-200. [PMID: 33455484 DOI: 10.1080/14779072.2021.1876563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: Post-thrombotic syndrome (PTS) is a common lifelong condition affecting up to 50% of those suffering from deep vein thrombosis (DVT). PTS compromises function and quality of life with subsequent venous ulceration in up to 29% of those affected.Areas covered: A literature review of surgical and non-surgical approaches in the prevention and treatment of PTS was undertaken. Notable areas include the use of percutaneous endovenous interventions and the use of graduated compression stockings (GCS) after acute proximal DVT.Expert opinion: In patients with acute iliofemoral DVT, we think it is important to have a frank conversation with the patient about catheter-directed thrombolysis, aiming to reduce the severity of PTS experienced. We advocate ultrasound-accelerated thrombolysis with adjunctive procedures, such as deep venous stenting for proximal iliofemoral DVT. For patients with isolated femoral DVT, we believe that anticoagulation and GCS should be recommended. In patients with established PTS, we recommend GCS for symptomatic relief. We recommend that patients engage in regular exercise where possible with the prospect of gaining symptomatic relief. For those with severe PTS that has a significant effect on quality of life, we discuss the patient's case at a multi-disciplinary team meeting to plan for endovenous intervention.
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Affiliation(s)
- M Machin
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - S Salim
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - M Tan
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - S Onida
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | - J Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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Trujillo Santos AJ. Treatment of deep vein thrombosis of the lower extremities. Rev Clin Esp 2020; 220:S0014-2565(20)30148-X. [PMID: 32782069 DOI: 10.1016/j.rce.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022]
Abstract
Deep vein thrombosis of the lower extremities is a common condition that should be treated appropriately given the possibility that it could lead to an ultimately fatal complication, as well as to a post-thrombotic syndrome that is in some cases disabling. The current treatment for this condition is differentiated into an acute phase, a long-term therapy and occasionally an extended therapy, which not only has defined objectives but also uses various drugs and even varying dosages for each drug. We describe the therapeutic anticoagulation options in each of these treatment phases and some of the treatments (thrombolysis, insertion of an inferior vena cava filter, surgery) that can play a role in certain conditions.
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Affiliation(s)
- A J Trujillo Santos
- Servicio de Medicina Interna, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España; Universidad Católica San Antonio de Murcia, Murcia, España.
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Surgical Thrombectomy and Simultaneous Stenting for Phlegmasia Cerulea Dolens Caused by Iliac Vein Occlusion. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.01.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Lower extremity deep venous thrombosis is a leading cause of morbidity and mortality. The mainstay of therapy is medical. However, anticoagulation does not remove the thrombus and restore venous patency. In select patients, early thrombus removal and anticoagulation can restore venous patency, preserve venous valve function, and may reduce the incidence of postthrombotic syndrome. Catheter-directed therapies are minimally invasive with low complication rates. However, in patients with a contraindication to thrombolytic agents who can receive anticoagulation, open thrombectomy should be considered if indications for thrombus removal are met and patients are good operative risks.
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Ockert S, von Allmen M, Heidemann M, Brusa J, Duwe J, Seelos R. Acute Venous Iliofemoral Thrombosis: Early Surgical Thrombectomy Is Effective and Durable. Ann Vasc Surg 2017; 46:314-321. [PMID: 28739469 DOI: 10.1016/j.avsg.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The first-line recommendation for the treatment of acute iliofemoral deep vein thrombosis (IFDVT) is catheter-directed thrombolysis or pharmacomechanical thrombolysis. Recent analysis of surgical thrombectomy has shown comparable results. However, this procedure is not commonly given as much importance as interventional techniques. We analyzed the patient outcome of surgical thrombectomy using modern endovascular techniques in both the short and long term. METHODS All consecutive patients who underwent surgical thrombectomy at our institution between April 2008 and April 2017 were included. Only patients with iliofemoral thrombosis, and only those with the first onset of symptoms <10 days, were analyzed. All patients received preoperative duplex ultrasound and contrast-enhanced computed tomography scans for thrombus extension and detection of pulmonary embolism. All operations were performed by vascular surgeons with open and endovascular skills in a C-arm-equipped operating room. During follow-up (FU), all patients received clinical examination for symptoms of postthrombotic syndrome (PTS), as well as duplex ultrasound. RESULTS Within a 9-year period, 21 patients underwent surgical thrombectomy for IFDVT (17 females/4 males). Primary technical success was 100%; 10 (47.6%) patients received additional primary stenting. 30-day mortality was 0%, 3 patients (14.3%) needed reoperation for early rethrombosis, while secondary 30-day patency was 100%. During FU (median, 6 years; range, 1-104 months), 1 patient received additional stenting for stenosis of the common iliac vein. Nineteen patients (90.5%) presented patent iliofemoral veins without signs of rethrombosis. Two patients (9.5%) died during FU of cancer without signs for recurrent IFDVT. All patients with patent veins were free of symptoms for PTS. CONCLUSIONS Surgical thrombectomy for acute IFDVT is a successful, safe, and durable procedure and provides alternative treatment options for acute IFDVT in selected cases.
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Affiliation(s)
- Stefan Ockert
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Matthias von Allmen
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Michaela Heidemann
- Department of Angiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Juliette Brusa
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jan Duwe
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Robert Seelos
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Hybrid operative thrombectomy is noninferior to percutaneous techniques for the treatment of acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2017; 5:177-184. [DOI: 10.1016/j.jvsv.2016.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/24/2016] [Indexed: 11/19/2022]
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Mumme A, Hummel T. Rekanalisierende Therapie der tiefen Bein-/Beckenvenenthrombose. GEFÄSSCHIRURGIE 2016. [DOI: 10.1007/s00772-016-0119-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The conservative treatment of deep leg and pelvic vein thrombosis leads to permanent damage of recanalised veins, which in cases of long distance clots as well as involvement of the pelvic level, increase the risk of developing a postthrombotic syndrome. Such subsequent damage of the deep veins can only be avoided if occluded veins are rapidly recanalised and the function of the valves is successfully reestablished. Recanalisation may consist of surgical, fibrolytic and interventional methods and aims to minimize any subsequent damage; however no potential benefit of recanalisation versus standard treatment has yet been proven by means of methodologically adequate comparative studies. Thus, the indications for recanalisation must remain strict and be founded on a thorough risk-benefit assessment.
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Affiliation(s)
- A Mumme
- Klinik für Gefäßchirurgie, Katholisches Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland,
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[Deep vein thrombosis - advances in diagnosis and treatment]. MMW Fortschr Med 2015; 156 Spec no 2:59-63; quiz 64. [PMID: 25552021 DOI: 10.1007/s15006-014-3298-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Trujillo Santos J. Cirugía de la trombosis venosa profunda iliofemoral: postura en contra. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2014.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mumme A, Hummel T. Die multimodale operative Therapie der tiefen Beinvenenthrombose. GEFÄSSCHIRURGIE 2013. [DOI: 10.1007/s00772-013-1211-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Venous thrombectomy in cases of acute deep vein thrombosis presenting as acute limb ischemia (Phlegmasia Cerulea Dolens): report of 2 cases and review of literature. Indian J Thorac Cardiovasc Surg 2013. [DOI: 10.1007/s12055-013-0252-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Butros SR, Liu R, Oliveira GR, Ganguli S, Kalva S. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol 2013; 86:20130284. [PMID: 23908347 DOI: 10.1259/bjr.20130284] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Extrinsic venous compression is caused by compression of the veins in tight anatomic spaces by adjacent structures, and is seen in a number of locations. Venous compression syndromes, including Paget-Schroetter syndrome, Nutcracker syndrome, May-Thurner syndrome and popliteal venous compression will be discussed. These syndromes are usually seen in young, otherwise healthy individuals, and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, CT, or MR conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method.
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Affiliation(s)
- S R Butros
- Department of Radiology, Division of Vascular Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
Venous thromboembolic disease is extremely common. Conventional treatment with anticoagulation alone aims to impede the progression of thrombus, and prevent recurrence and the development of pulmonary embolism. This is appropriate for most patients. However, in certain patient populations, this alone does not address the long-term complications of venous thromboembolic disease. Surgeons should be familiar with the surgical techniques that have been demonstrated to improve outcomes with low risk. Recent studies of catheter-directed thrombolysis have demonstrated its safety, efficacy, and possibly the superiority over standard treatment alone.
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Affiliation(s)
- Pasithorn A Suwanabol
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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