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Kadowaki K, Tomita H, Wada T, Miki Y, Fujiwara A, Nakamura K, Mori T. Percutaneous transcatheter right atrial stent placement for recurrent cor triatriatum dexter following initial surgical excision of right intra-atrial membrane in a dog. J Vet Cardiol 2024; 55:9-14. [PMID: 39043082 DOI: 10.1016/j.jvc.2024.06.003] [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: 11/07/2023] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024]
Abstract
A four-year-old spayed female Shiba Inu dog weighing 6.1 kg presented with ascites. Cor triatriatum dexter (CTD) without any other concurrent cardiovascular anomalies was diagnosed using echocardiography. The ostium of the abnormal membrane dividing the right atrium into two abnormal chambers was surgically excised under cardiopulmonary bypass. All clinical abnormalities were resolved after surgery. However, seven months later, ascites and CTD recurred. A balloon-expandable stent was placed at the site of recurrence, which improved caudal venous return to the right ventricle. After the second procedure, ascites were resolved, and the dog remained asymptomatic for 18 months without complications. There are previous reports of successful surgical resection of the CTD and of stenting in recurrent CTD following balloon dilation in dogs. However, to the authors' knowledge, no previous reports have described recurrent CTD in dogs after surgical resection of the CTD. In this case, as with recurrent CTD following balloon dilation, stent placement at the site of the CTD can be a viable treatment option when the abnormal membrane recurs.
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Affiliation(s)
- K Kadowaki
- Japan Animal Cardiovascular Care Team, 1-21-15-701, Higashinakajima, Higashiyodogawa-ku, Osaka-shi, Osaka, 533-0033, Japan; Kinki Animal Medical Training Institute & Veterinary Clinic, 3-15-27, Hishie, Higashiosaka-shi, Osaka, 578-0948, Japan.
| | - H Tomita
- Pediatric Heart Disease & Adult Congenital Heart Disease Centre, Showa University, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan
| | - T Wada
- Japan Animal Cardiovascular Care Team, 1-21-15-701, Higashinakajima, Higashiyodogawa-ku, Osaka-shi, Osaka, 533-0033, Japan; Kinki Animal Medical Training Institute & Veterinary Clinic, 3-15-27, Hishie, Higashiosaka-shi, Osaka, 578-0948, Japan
| | - Y Miki
- Japan Animal Cardiovascular Care Team, 1-21-15-701, Higashinakajima, Higashiyodogawa-ku, Osaka-shi, Osaka, 533-0033, Japan; Ikezawa Doubutsu Byouin, 417, Hirano, Kakogawa-cho, Kakogawa-shi, Hyougo, 675-0063, Japan
| | - A Fujiwara
- Japan Animal Cardiovascular Care Team, 1-21-15-701, Higashinakajima, Higashiyodogawa-ku, Osaka-shi, Osaka, 533-0033, Japan; Kinki Animal Medical Training Institute & Veterinary Clinic, 3-15-27, Hishie, Higashiosaka-shi, Osaka, 578-0948, Japan
| | - K Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-ku, Sapporo, 060-0818, Japan
| | - T Mori
- Japan Animal Cardiovascular Care Team, 1-21-15-701, Higashinakajima, Higashiyodogawa-ku, Osaka-shi, Osaka, 533-0033, Japan; Kinki Animal Medical Training Institute & Veterinary Clinic, 3-15-27, Hishie, Higashiosaka-shi, Osaka, 578-0948, Japan; Department of Cardiovascular Surgery, Juntendo University School of Medicine, 3-1-3, Hongou, Bunkyou-ku, Tokyo, 113-8431, Japan
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Bai H, Kibrik P, Shaydakov ME, Singh M, Ting W. Indications, technical aspects, and outcomes of stent placement in chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord 2024:101904. [PMID: 38759753 DOI: 10.1016/j.jvsv.2024.101904] [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: 06/27/2023] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Iliofemoral venous stent placement (IVS) has evolved to a well-established endovascular treatment modality for chronic iliofemoral venous obstruction (CIVO). Dedicated venous stents gained approval from the US Food and Drug Administration in 2019 and solidified IVS as a defined intervention with clear indications, contraindications, risks, benefits, and procedural management principles. This review focuses on the indications, technical aspects and outcomes of stenting for CIVO. Other aspects pertaining to IVS are covered in other articles that are a part of this series. METHODS This study conducted a literature search limited to English articles. Three search strategies were used, and references were managed in Covidence software. Four investigators screened and evaluated articles independently, excluding meta-analyses, clinical trial protocols, and nonrelevant studies. Eligible studies, focused on clinical outcomes and stent patencies, underwent thorough review. RESULTS The literature search yielded 1704 studies, with 147 meeting eligibility criteria after screening and evaluation. Exclusions were based on duplicates, irrelevant content, and noniliac vein stent placement. CONCLUSIONS Successful IVS for CIVO relies on meticulous patient selection, consistent use of intravascular ultrasound examination during procedures and attention to the technical details of IVS.
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Affiliation(s)
- Halbert Bai
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pavel Kibrik
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maxim E Shaydakov
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburg, PA
| | - Mandeep Singh
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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Trujillo-Santos J, Demelo-Rodríguez P, Bravo de Laguna-Taboada A, Zubicoa-Ezpeleta S, Rodríguez-Morata A, Lojo-Rocamonde I, Riera-Mestre A. Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis. Semin Thromb Hemost 2024. [PMID: 38733984 DOI: 10.1055/s-0044-1786755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Deep vein thrombosis (DVT) poses a complex challenge and often leads to postthrombotic syndrome (PTS), a debilitating complication. The emergence of venous stents offers a potential preventive avenue against this complication. This study aimed to provide consensus recommendations on the use of venous stent for DVT. MATERIALS AND METHODS From June to July 2023, 20 internal medicine, angiology and vascular surgery, and vascular and interventional radiology experts were involved in the Delphi process. Thirty-one recommendations, categorized into three thematic areas, were rigorously evaluated: indications for stent use, stent selection and placement, and monitoring and prevention of complications. Agreement was evaluated using a Likert scale, with consensus defined as agreement by two-thirds of the participants. RESULTS Consensus was reached for 23 (74.2%) of 31 recommendations. The agreement was centered on considerations, such as stent placement in specific acute DVT scenarios, emphasizing pivotal stent characteristics. However, there were divergences in the recommended stent length to prevent migration and stent characteristics based on iliocaval bifurcation morphology. Notably, there was no consensus on whether patients with DVT caused by a major transient risk factor need more than 3 months of anticoagulation therapy or whether aspirin should be added to anticoagulant treatment after venous stenting. CONCLUSIONS These consensus recommendations offer practical insights into optimizing venous stent use to prevent PTS in DVT patients. Addressing the critical aspects of stent selection, placement, and postprocedural care, these recommendations contribute to clinical decision-making. The identified divergences underscore the importance of consensus and thus indicate the need for further investigation.
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Affiliation(s)
- Javier Trujillo-Santos
- Internal Medicine Department, Venous Thromboembolism Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
- Universidad Católica San Antonio, Región de Murcia, Spain
- Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
- Department of Internal Medicine, Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Sanitary Research Institute Gregorio Marañón, Madrid, Spain
| | - Alexis Bravo de Laguna-Taboada
- Interventional Radiology Service, Hospital Insular de Gran Canaria, Las Palmas, Spain
- Sociedad Española de Radiología Vascular e Intervencionista
| | - Santiago Zubicoa-Ezpeleta
- Sociedad Española de Radiología Vascular e Intervencionista
- Unidad de Radiología Intervencionista, Hospital Ruber Internacional, Madrid
| | - Alejandro Rodríguez-Morata
- Servicio de Angiología y Cirugía Vascular, Hospital Quirónsalud Málaga, Málaga, Spain
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, Spain
| | - Ignacio Lojo-Rocamonde
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, Spain
- Servicio de Angiología y Cirugía Vascular, Hospital Quirónsalud A Coruña, A Coruña, Spain
| | - Antoni Riera-Mestre
- Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
- Internal Medicine Department, Venous Thromboembolism Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona, Spain)
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat (Barcelona), Spain
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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Lei J, Pu H, Zhang L, Zeng C, Peng Z, Wu Z, Jiang Y, Wang R, Lu X. Drug-coated balloon therapy for in-stent restenosis in patients with iliofemoral deep vein thrombosis: A single-arm observational study. Catheter Cardiovasc Interv 2024; 103:752-757. [PMID: 38385905 DOI: 10.1002/ccd.30975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/13/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Iliofemoral deep vein thrombosis (IFDVT) causes severe symptoms and affect the quality of life to a great extent. Endovascular thrombectomy and stent implantation have been a feasible strategie to alleviate the signs and symptoms of IFDVT. However, venous in-stent restenosis (ISR) has become an emerging non-negligible problem. METHODS To evaluate the histological characteristics of venous ISR, neointima of arterial and venous ISR patients were collected and examed. To explore the effect of drug-coated balloon (DCB) on venous ISR lesions, we conducted a single-center retrospective case series study involving IFDVT patients with ISR after venous stenting who were treated with paclitaxel-coated balloon dilatation. RESULTS We found a collagen-rich matrix but not elastin, as well as fewer cells and less neovascularization in venous intimal hyperplasia compared with neointima in arteries. Thirteen IFDVT patients were involved in the study, with average preoperative stenosis degree of 87.69% ± 13.48%. After intervention, the stenosis degree was significantly reduced to 14.6% ± 14.36% immediately (p < 0.0001) and to 16.54% ± 15.73% during follow-up (p < 0.0001). During follow-up, the VEINES-QOL scores (p < 0.0001), VEINES-Sym scores (p < 0.0001), and Villalta scores (p = 0.04) of patients was improved significantly compared with those before intervention. No major adverse events were observed. CONCLUSIONS The use of DCB may have a positive effect in the treatment of venous ISR by targeting intimal hyperplasia. Moreover, the application of DCB dilatation in IFDVT stenting patients with ISR is deemed safe and effective.
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Affiliation(s)
- Jiahao Lei
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Linjie Zhang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chenlin Zeng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhaoxi Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yihong Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, 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
- Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai JiaoTong 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
- Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
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Guo B, Chen C, Li Y, Lv Q, Li X, Guo D, Shi Z, Fu W, Zhang WW. Principles of Optimal Antithrombotic Therapy for Iliac VEnous Stenting (POATIVES): A national expert-based Delphi consensus study. J Vasc Surg Venous Lymphat Disord 2024; 12:101739. [PMID: 38242205 DOI: 10.1016/j.jvsv.2023.101739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Management of antithrombotic therapy in patients undergoing venous stents has not yet reached consensus, and there are not any recommendations from published guidelines. We undertook a Delphi consensus from Chinese experts to develop recommendations regarding the preferred antithrombotic therapy in patients following venous stenting. METHODS The phase 1 questionnaire was comprised of three clinical scenarios of venous stenting for non-thrombotic iliac vein lesions (NIVL), acute deep vein thrombosis (DVT), and post-thrombotic syndrome (PTS) and was sent to venous practitioners across China. In phase 2, the results of phase 1 were distributed to a panel of experts for evaluation along with a questionnaire encompassing a series of statements produced during phase 1. A modified Delphi method was used to reach consensus on recommendations through two rounds of surveys. RESULTS The phase 1 questionnaire was completed by 283 respondents. In phase 2, an expert panel consisting of 28 vascular surgeons and interventional radiologists was assembled and voted 17 statements relating to antithrombotic management after venous stenting for NIVL (4 statements), DVT (6 statements), and PTS (7 statements). The majority of the statements about the antithrombotic agent selection received a high consensus strength. CONCLUSIONS Based on the national Delphi consensus of Chinese experts regarding antithrombotic therapy following iliac venous stenting in three common scenarios, most of the statements could be used to guide antithrombotic management following venous stenting. Further studies are required to clarify controversial issues including the dose and duration of anticoagulants, the role of antiplatelet agents, especially in patients with NIVL.
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Affiliation(s)
- Baolei Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Can Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanli Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Wayne W Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, WA
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Benzakine J, Rial C, Mohamedi N, Messas E, Mauge L, Sapoval M, Gendron N, Khider L. Perioperative management of venous recanalization in a patient with inherited antithrombin deficiency: case report. Res Pract Thromb Haemost 2024; 8:102384. [PMID: 38617049 PMCID: PMC11015152 DOI: 10.1016/j.rpth.2024.102384] [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] [Received: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 04/16/2024] Open
Abstract
Background Inherited antithrombin (AT) deficiency (ATD) is a severe thrombophilia causing venous thromboembolism, which can be complicated by postthrombotic syndrome (PTS). Venous recanalization, used to treat PTS, often requires a temporary withdrawal of anticoagulant therapy. In ATD patients, there is a risk of insufficient perioperative anticoagulation due to altered heparin response. Key Clinical Question There is no consensus on how to manage perioperative anticoagulation in ATD patients. Clinical Approach Warfarin-unfractionated heparin transition could be a more reliable strategy than low-molecular-weight heparin transition because unfractionated heparin anti-Xa activity not only reflects heparin-bound AT but also AT's activity, which correlates strongly with therapeutic anticoagulation. Biological monitoring could thus decrease the number of plasma-derived AT supplementation. Conclusion This study describes a successful perioperative management of anticoagulation for venous recanalization that could be suggested to type 1 ATD patients with PTS.
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Affiliation(s)
- Julie Benzakine
- Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Carla Rial
- Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Nassim Mohamedi
- Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, Centre-University Paris Cité, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, Centre-University Paris Cité, Paris, France
| | - Laetitia Mauge
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
- Paris Cardiovascular Research Centre, INSERM, Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Marc Sapoval
- Paris Cardiovascular Research Centre, INSERM, Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- Paris Cardiovascular Research Centre, INSERM, Interventional Radiology, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Lina Khider
- Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France
- Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, Centre-University Paris Cité, Paris, France
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Bækgaard N, van Rijn MJE. The background and role of catheter-directed thrombolysis evolving procedures for acute iliofemoral deep venous thrombosis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:12-22. [PMID: 38261268 DOI: 10.23736/s0021-9509.23.12860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Minimal invasive treatment such as early endovenous thrombus removal for iliofemoral deep venous thrombosis (DVT) emerged in the end of last century. The principle is catheter-directed thrombolysis (CDT) using either plasminogen activating agents alone, as ultrasound-assisted CDT, or in combination with mechanical devices as pharmaco-mechanical CDT. The interest for this treatment modality is the high rate of post-thrombotic syndrome (PTS) with anticoagulation (AC) alone, especially after iliofemoral DVT. Recently published randomized controlled trials (RCTs) comparing early thrombus removal with AC alone, as well as non-randomized studies, have demonstrated favorable rates, or at least a decrease of moderate and severe PTS, in favor of these procedures. This article will summarize the background and evolution of the procedures in the last three decades and discuss fundamental criteria for inclusion and exclusion, focusing on the procedures regarding thrombus age and location, technical issues, complications and results including different outcome measures for PTS, for which iliac DVT involvement is a massive risk factor to be prevented.
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Affiliation(s)
- Niels Bækgaard
- Vascular Department, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Copenhagen, Denmark -
| | - Marie Josee E van Rijn
- Department of Vascular and Endovascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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Pu H, Song J, He Z, Wang F, Hu J, Huang S, Yin M, Li W, Liu X, Lu X, Liu G. Assessing outcomes after thrombectomy with or without iliac vein stenting for young provoked DVT patients with iliac vein stenosis. Thromb J 2023; 21:96. [PMID: 37715246 PMCID: PMC10503137 DOI: 10.1186/s12959-023-00537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND This study aimed to assess the outcomes of thrombectomy with/without iliac vein stenting for young and transiently provoked DVT patients with iliac vein stenosis. METHODS This is a retrospective analysis of a prospectively collected multicenter database. Acute, transiently provoked DVT patients between 18 and 45 years old with iliac vein stenosis were included. All patients underwent thrombectomy. Outcomes including the Villalta score, the VEINES-QOL score, and adverse events were evaluated. RESULTS The data of 522 patients were collected of whom 75 were included, 58 underwent thrombectomy alone (nonstenting group) and 17 underwent thrombectomy and stenting (stenting group). Within 6 months, the Villalta score of patients in stenting group is lower than that of patients in nonstenting group (6 mo: 0.73 ± 0.77 vs. 1.41 ± 0.56, p = .0004), and the VEINES-QOL score of stenting group is higher than that of nonstenting group (6 mo: 89.00 ± 2.94 vs. 87.47 ± 3.72, p = .2141). At the following follow-ups, the Villalta score (12 mo: 0.56 ± 0.49 vs. 0.60 ± 0.58, p = .8266) and VEINES-QOL score (12 mo: 88.36 ± 2.29 vs. 88.31 ± 3.36, p = .9604) between the two groups are similar. CONCLUSION The stenting group had better efficacy within 6 months after intervention, while there was no significant difference in the symptom, signs, and quality of life between two groups after 6 months within a 2-year follow-up. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (Registration Number: ChiCTR2200056073).
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Affiliation(s)
- Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Rd, Shanghai, 200011 P. R. China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Jumin Song
- Department of Vascular Surgery, Fengcheng Hospital, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Zhijun He
- Department of General Surgery, Shanghai University of Medicine & Health Sciences affiliated Zhoupu Hospital, Shanghai, P. R. China
| | - Fuyin Wang
- Department of Orthopedics, Putuo Hospital of Zhejiang, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhoushan, P. R. China
| | - Jiateng Hu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Rd, Shanghai, 200011 P. R. China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Sheng Huang
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Rd, Shanghai, 200011 P. R. China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Vascular Surgery, Fengcheng Hospital, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Rd, Shanghai, 200011 P. R. China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Vascular Surgery, Fengcheng Hospital, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Rd, Shanghai, 200011 P. R. China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Vascular Surgery, Fengcheng Hospital, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Rd, Shanghai, 200011 P. R. China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Vascular Surgery, Fengcheng Hospital, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Rd, Shanghai, 200011 P. R. China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Vascular Surgery, Fengcheng Hospital, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Guang Liu
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Rd, Shanghai, 200011 P. R. China
- The Vascular Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Vascular Surgery, Fengcheng Hospital, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
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Twine CP, Kakkos SK, Aboyans V, Baumgartner I, Behrendt CA, Bellmunt-Montoya S, Jilma B, Nordanstig J, Saratzis A, Reekers JA, Zlatanovic P, Antoniou GA, de Borst GJ, Bastos Gonçalves F, Chakfé N, Coscas R, Dias NV, Hinchliffe RJ, Kolh P, Lindholt JS, Mees BME, Resch TA, Trimarchi S, Tulamo R, Vermassen FEG, Wanhainen A, Koncar I, Fitridge R, Matsagkas M, Valgimigli M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases. Eur J Vasc Endovasc Surg 2023; 65:627-689. [PMID: 37019274 DOI: 10.1016/j.ejvs.2023.03.042] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
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Espitia O, Douane F, Hersant J, Abbadie F, Sobocinski J, Heautot JF, Miossec A, Lapébie FX, Hartung O. Predictive Factors of Stent Patency in Iliofemoral Venous Diseases in a Multicentre Cohort Study. Eur J Vasc Endovasc Surg 2023; 65:564-572. [PMID: 36642400 DOI: 10.1016/j.ejvs.2023.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/13/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study assessed primary stent patency predictive factors in three groups of patients with history of lower limb (LL) vein thrombosis: non-thrombotic iliac vein lesion (NIVL), acute deep vein thrombosis (aDVT), and post-thrombotic syndrome (PTS). METHODS Consecutive patients from January 2014 to December 2020 with history of LL vein stenting from seven hospitals were included. All patients received an iliac or common femoral venous stent and had at least a six month follow up available with stent imaging. Anticoagulant and antiplatelet therapy strategies employed after venous stenting are reported and compared between groups. RESULTS This study included 377 patients: 134 NIVL, 55 aDVT, and 188 PTS. Primary patency was statistically significantly higher in the NIVL group (99.3%) compared with the PTS group (68.6%) (p < .001) and the aDVT group (83.6%) (p = .002). PTS patients received a statistically significantly greater number of stents (p < .001) and had more stents below the inguinal ligament (p < .001). Median follow up was 28.8 months (IQR 16, 47). Discontinuation of antiplatelet therapy at the last assessment was 83.6% for NIVL, 100% for aDVT, and 95.7% for the PTS group (p < .001). Discontinuation of anticoagulation therapy at the last assessment was 93.2% for NIVL, 25.0% for aDVT, and 70.3% for the PTS group (p < .001). The only predictor of worse primary patency in the aDVT group was long term anticoagulation before stenting. CONCLUSION Patients with NIVL have better primary patency after venous stenting than patients with venous thrombotic disorders. Long term anticoagulation before stenting was the only factor associated with poorer primary patency in patients with aDVT.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France.
| | - Frédéric Douane
- Nantes Université, CHU Nantes, Department of Radiology, Nantes, France
| | | | | | | | | | - Annaïg Miossec
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
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O'Sullivan G, Smith S. Deep venous stenting in females. CVIR Endovasc 2023; 6:14. [PMID: 36920544 PMCID: PMC10017898 DOI: 10.1186/s42155-023-00354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/08/2023] [Indexed: 03/16/2023] Open
Abstract
Deep venous stenting has gained increasing prominence in recent years. This issue focuses on special considerations in female patients. The specific challenge relates to the fact that these patients are often much younger than those in whom arterial stents are placed. The stents have to perform adequately over potentially 60 years- and there is no data of that length available.
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Affiliation(s)
- Gerry O'Sullivan
- Interventional Radiology, Galway University Hospitals, Galway, Ireland.
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12
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Saleem T, Raju S. An overview of in-stent restenosis in iliofemoral venous stents. J Vasc Surg Venous Lymphat Disord 2021; 10:492-503.e2. [PMID: 34774813 DOI: 10.1016/j.jvsv.2021.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/13/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although endovenous stents have been associated with overall low morbidity, they can require reinterventions to correct stent malfunction due to in-stent restenosis (ISR). ISR has often occurred iliofemoral venous stents but has not been well described. It has been reported to develop in >70% of patients who have undergone iliofemoral venous stenting. We sought to provide an overview of ISR in iliofemoral venous stents, including the pathologic, diagnostic, and management considerations and the identification of several areas of potential research in the future. METHODS A search of reported English-language studies was performed in PubMed and the Cochrane Library. "In-stent restenosis," "vein," "venous," "iliac," and "iliofemoral" were used as keywords. The pertinent reports included in the present review had addressed the pathology, diagnosis, and current management options for ISR. RESULTS ISR refers to the narrowing of the luminal caliber of the stent owing to the development of stenosis inside the stent itself. ISR should be differentiated from stent compression. Two main types of ISR have been described: soft and hard lesions. These lesions respond differently to angioplasty. Stent inflow and shear stress are important factors in the development of ISR. The treatment options available at present include balloon angioplasty (hyperdilation or isodilation), laser ablation, atherectomy, and Z-stent placement. CONCLUSIONS Reintervention for ISR should be determined by the presence of residual or recurrent symptoms and not simply by a numeric value obtained from an imaging study. Overall stent occlusion due to ISR is rare, and no role exists for prophylactic angioplasty to treat asymptomatic ISR. The current treatment options for ISR are mostly durable and effective. However, more research is needed on methods to prevent the development of ISR. The role of antiplatelet and anticoagulant agents in the prevention of ISR requires further investigation, with particular attention to unique subset of patients (after thrombosis vs nonthrombotic iliac vein lesions). For high-risk, post-thrombotic patients, anticoagulation can be considered to prevent ISR. The role of triple therapy (anticoagulation and dual antiplatelet therapy) in the prevention of ISR remains unclear.
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Affiliation(s)
- Taimur Saleem
- The RANE Center for Venous and Lymphatic Diseases, Jackson, Miss.
| | - Seshadri Raju
- The RANE Center for Venous and Lymphatic Diseases, Jackson, Miss
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Notten P, ten Cate H, ten Cate‐Hoek AJ. Postinterventional antithrombotic management after venous stenting of the iliofemoral tract in acute and chronic thrombosis: A systematic review. J Thromb Haemost 2021; 19:753-796. [PMID: 33249698 PMCID: PMC7986750 DOI: 10.1111/jth.15197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022]
Abstract
Venous stenting has become a common treatment option for central deep venous outflow obstructions and postthrombotic syndrome. Following successful recanalization and stenting, stent patency is endangered by in-stent thrombosis and recurrent venous thromboembolism. Antithrombotic therapy might reduce patency loss. This systematic review summarizes the literature on antithrombotic therapy following (post)thrombotic venous stenting. A systematic PubMed, MEDLINE, EMBASE, and Cochrane search was performed for studies addressing antithrombotic therapy prescribed following venous stenting of the iliofemoral tract indicated by acute or chronic thrombotic pathology. A total of 277 articles was identified of which 64 (56 original studies) were selected. Overall, a mean primary patency rate of 82.3% was seen 1 year after the intervention, which decreased to 73.3% after 2 years. In the majority (43 of 56 studies, 77%), treatment was based on use of vitamin K antagonists, either with (18%) or without (59%) use of antiplatelet drugs. Only two studies (4%) directly assessed the effect of antithrombotic therapy on treatment outcomes. The impact of postinterventional antithrombotic therapy on stent patency remains unknown because of limited and insufficient data available in current literature. Further clinical research should more clearly address the role of antithrombotic therapy for preservation of long-term patency following venous stenting.
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Affiliation(s)
- Pascale Notten
- Department of Vascular SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
- School for Cardiovascular DiseasesCARIM, Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Hugo ten Cate
- School for Cardiovascular DiseasesCARIM, Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
- Laboratory of Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
- Thrombosis Expertise CentreHeart Vascular CentreMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Arina J. ten Cate‐Hoek
- School for Cardiovascular DiseasesCARIM, Cardiovascular Research Institute MaastrichtMaastricht University Medical CentreMaastrichtThe Netherlands
- Laboratory of Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
- Thrombosis Expertise CentreHeart Vascular CentreMaastricht University Medical CentreMaastrichtThe Netherlands
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