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Dake MD, O'Sullivan G, Shammas NW, Lichtenberg M, Mwipatayi BP, Settlage RA. Three-Year Results from the Venovo Venous Stent Study for the Treatment of Iliac and Femoral Vein Obstruction. Cardiovasc Intervent Radiol 2021; 44:1918-1929. [PMID: 34545448 PMCID: PMC8451739 DOI: 10.1007/s00270-021-02975-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
Purpose To assess safety and patency of the Venovo venous stent for the treatment of iliofemoral vein obstruction. Materials and Methods Twenty-two international centers enrolled 170 patients in the VERNACULAR study (93 post-thrombotic syndrome; 77 non-thrombotic iliac vein lesions). Primary outcome measures were major adverse events at 30 days and 12-month primary patency (freedom from target vessel revascularization, thrombotic occlusion, or stenosis > 50%). Secondary outcomes included the Venous Clinical Severity Score Pain Assessment and Chronic Venous Quality-of-Life Questionnaire assessments (hypothesis tested). Secondary observations included primary patency, target vessel and lesion revascularization (TVR/TLR), and assessment of stent integrity through 36 months. Results Freedom from major adverse events through 30 days was 93.5%, statistically higher than a pre-specified performance goal of 89% (p = 0.032) while primary patency at 12 months was 88.6%, also statistically higher than a performance goal of 74% (p < 0.0001). Mean quality-of-life measures were statistically improved compared to baseline values at 12 months (p < 0.0001). Primary patency at 36 months was 84% (Kaplan–Meier analysis) while freedom from TVR/TLR was 88.1%. There was no stent embolization/migration, and no core laboratory assessed stent fractures reported through 36 months. Six deaths were reported; none adjudicated as device or procedure related. Conclusion The Venovo venous stent was successfully deployed in obstructive iliofemoral vein lesions and met the pre-specified primary outcome measures through 12 months. At 3 years, primary patency was 84%, reintervention rates were low, standardized quality-of-life and pain measures improved from baseline, and there was no stent migration or fractures. Level of Evidence Level 2—prospective, multicenter, controlled clinical study without a concurrent control or randomization. Pre-specified endpoints were hypothesis-tested to performance goals derived from peer-reviewed clinical literature. Registration clinicaltrials.gov Unique Identifier NCT02655887.
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Affiliation(s)
- Michael D Dake
- University of Arizona Health Sciences, Health Sciences Innovation Building, 9Th Floor SVP Suite,1670 E. Drachman Street, P.O. Box 210216, Tucson, AZ, 85721-0216, USA.
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2
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The clinical outcome of a one-stop procedure for patients with iliac vein compression combined with varicose veins. J Vasc Surg Venous Lymphat Disord 2019; 6:696-701. [PMID: 30336899 DOI: 10.1016/j.jvsv.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/08/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Primary iliac vein compression syndrome (IVCS) often is manifested with varicose veins (VVs), but the treatment of patients with IVCS combined with VVs remains unclear. The aim of this study was to investigate the outcome of a one-stop procedure for patients with IVCS and VVs. METHODS The 32 enrolled patients underwent iliac stenting first and then endovenous laser ablation for VVs. The reflux time of the femoral vein, peak reflux velocity, and mean flow velocity were measured, and the effect on quality of life was also assessed using the Aberdeen Varicose Vein Questionnaire and Venous Clinical Severity Score. All clinical data have been recorded and analyzed. RESULTS The success rate of the procedures was 100%. No serious complications occurred. The Aberdeen Varicose Vein Questionnaire score and Venous Clinical Severity Score of patients were significantly lower at 1 month, 6 months, and 12 months after the procedure compared with scores before the procedure (P < .01). The reflux time and peak reflux velocity were lower at 6 and 12 months after the procedure (P < .01), and the mean flow velocity was higher at 6 and 12 months after the procedure (P < .05). The patency rate of the iliac vein stent was 100% during follow-up, and one patient (3.13%) had a restenosis without symptoms. CONCLUSIONS The one-stop procedure for patients with IVCS combined with VVs is a safe and effective method that might be a therapy choice for these patients.
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Abstract
The surgical treatment of deep venous thrombosis (DVT) has significantly evolved and is focused on different strategies of early thrombus removal in the acute phase and deep venous recanalization or bypass in the chronic phase. Along with the use of anticoagulation agents, endovascular techniques based on catheter-directed thrombolysis and pharmacomechanical thrombectomy have been increasingly used in patients with acute extensive DVT. Patient selection is crucial to provide optimal outcomes and minimize complications.
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Affiliation(s)
- Cassius Iyad Ochoa Chaar
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar street, Boardman 204, New Haven, CT 06510, USA.
| | - Afsha Aurshina
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar street, Boardman 204, New Haven, CT 06510, USA
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Li W, Chuanlin Z, Shaoyu M, Yeh CH, Liqun C, Zeju Z. Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis. Rev Lat Am Enfermagem 2018; 26:e2990. [PMID: 29947719 PMCID: PMC6047892 DOI: 10.1590/1518-8345.2309.2990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023] Open
Abstract
Objectives: To evaluate case series studies that quantitatively assess the effects of
catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and
anticoagulation in patients with acute lower extremity deep vein thrombosis
(DVT). Methods: Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and
Scopus, were searched through January 2017. The inclusion criteria were
applied to select patients with acute lower extremity DVT treated with CDT
or with anticoagulation. In the case series studies, the pooled estimates of
efficacy outcomes for patency rate, complete lysis, rethrombosis and
post-thrombotic syndrome (PTS) were calculated across the studies. In
studies comparing CDT with anticoagulation, summary odds ratios (ORs) were
calculated. Results: Twenty-five articles (six comparing CDT with anticoagulation and 19 case
series) including 2254 patients met the eligibility criteria. In the case
series studies, the pooled results were a patency rate of 0.87 (95% CI:
0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95%
CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the
efficacy outcomes of CDT and anticoagulation showed that CDT was associated
with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and a higher
patency rate (OR 4.76, 95%CI 2.14-10.56, p<0.0001). Conclusion: Acute lower extremity DVT patients receiving CDT were found to have a lower
incidence of PTS and a higher incidence of patency rate. In our
meta-analysis, CDT is shown to be an effective treatment for acute lower
extremity DVT patients.
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Affiliation(s)
- Wang Li
- MSc, RN, School of Nursing, Chongqing Medical University, Chongqing, Chongqing, China
| | - Zhang Chuanlin
- MSc, RN, The First Affiliated Hospital, Chongqing Medical University, Chongqing, Chongqing, China
| | - Mu Shaoyu
- Professor, School of Nursing, Chongqing Medical University, Chongqing, Chongqing, China
| | - Chao Hsing Yeh
- PhD, Professor, School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Chen Liqun
- MSc, RN, School of Nursing, Chongqing Medical University, Chongqing, Chongqing, China
| | - Zhang Zeju
- MSc, RN, School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, Chongqing, China
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5
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Wang L, Zhang C, Mu S, Yeh CH, Chen L, Zhang Z, Wang X. Safety of catheter-directed thrombolysis for the treatment of acute lower extremity deep vein thrombosis: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7922. [PMID: 28858115 PMCID: PMC5585509 DOI: 10.1097/md.0000000000007922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite established guidelines, catheter-directed thrombolysis (CDT) for the management of acute lower extremity deep vein thrombosis (DVT) should not be overstated because the risks of CDT are uncertain. We performed a meta-analysis to comprehensively and quantitatively evaluate the safety of CDT for patients with acute lower extremity DVT. METHODS Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE, and Scopus, were searched up to January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated by CDT or compared CDT with anticoagulation. In case series studies, the pooled estimates of safety outcomes for complications, pulmonary embolism (PE), and mortality were calculated across studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. RESULTS Of the 1696 citations identified, 24 studies (6 comparing CDT with anticoagulation and 18 case series) including 9157 patients met the eligibility criteria. In the case series studies, the pooled risks of major, minor, and total complications were 0.03 (95% confidence interval [CI]: 0.02-0.04), 0.07 (95% CI: 0.05-0.08), and 0.09 (95% CI: 0.08-0.11), respectively; other pooled risk results were 0.00 for PE (95% CI: 0.00-0.01) and 0.07 for mortality (95% CI: 0.03-0.11). Our meta-analysis of 6 studies comparing the risk of complications and PE related to CDT with those related to anticoagulation showed that CDT was associated with an increased risk of complications (OR = 4.36; 95% CI: 2.94-6.47) and PE (OR = 1.57; 95% CI: 1.37-1.79). CONCLUSION Acute lower extremity DVT patients receiving CDT are associated with a low risk of complications. However, compared with anticoagulation, CDT is associated with a higher risk of complications and PE. Rare mortality related to thrombolytic therapy was reported. More evidence should be accumulated to prove the safety of CDT.
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Affiliation(s)
- Li Wang
- School of Nursing, Chongqing Medical University
| | - Chuanlin Zhang
- Intensive Care Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Shaoyu Mu
- School of Nursing, Chongqing Medical University
| | | | - Liqun Chen
- School of Nursing, Chongqing Medical University
| | - Zeju Zhang
- School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, PR China
| | - Xueqin Wang
- Intensive Care Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Effectiveness of catheter directed thrombolysis and stent implantation on iliofemoral vein thrombosis caused by iliac vein compression. J Thromb Thrombolysis 2017; 44:254-260. [DOI: 10.1007/s11239-017-1515-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Iliofemoral stenting for chronic venous occlusive disease: Initial and mid-term outcomes in single institution. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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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9
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Klitfod L, Just S, Foegh P, Baekgaard N. Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome. Acta Radiol Open 2015; 4:2058460115592164. [PMID: 26445677 PMCID: PMC4580121 DOI: 10.1177/2058460115592164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022] Open
Abstract
Background Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired quality of life in more than 50%. Endovascular treatment for iliac vein obstruction using stents is known to alleviate PTS symptoms in selected patients. Purpose To report the Danish long-term results of endovascular treatment with iliac stenting. Material and Methods From 2000 to 2013 consecutive patients were evaluated and 19 patients with severe venous claudication were identified and subsequently underwent angioplasty and stenting. AC treatment was prescribed for 6 months, and knee-high class II compression stocking recommended for 1 year. Scheduled follow-up was done in the outpatient clinic at 6 weeks, 3 months, and annually thereafter. Results Nineteen patients, all women, all with left-sided iliac vein obstruction, and all with severe PTS symptoms were included. The median follow-up time was 81 months (range, 1–146 months; mean, 69 months). Primary patency rate of the inserted iliac stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. Conclusion Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS.
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Affiliation(s)
- Lotte Klitfod
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Sven Just
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Pia Foegh
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
| | - Niels Baekgaard
- Vascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark
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Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis: a prospective study with venous Doppler follow-up at 1-year. Cardiovasc Interv Ther 2015; 30:320-6. [DOI: 10.1007/s12928-015-0317-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/08/2015] [Indexed: 11/26/2022]
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11
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Caliste XA, Clark AL, Doyle AJ, Cullen JP, Gillespie DL. The incidence of contralateral iliac venous thrombosis after stenting across the iliocaval confluence in patients with acute or chronic venous outflow obstruction. J Vasc Surg Venous Lymphat Disord 2014; 2:253-9. [DOI: 10.1016/j.jvsv.2013.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/03/2013] [Accepted: 12/22/2013] [Indexed: 12/01/2022]
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