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Huang T, Ni C, Ding W, Jin Y, Deng X, Jiang X, Chen Z, Hong X. Risk factors of moderate-severe Post-thrombotic syndrome within 2 years in patients with subacute thrombosis: A case-control study. J Vasc Surg Venous Lymphat Disord 2024:101933. [PMID: 38906457 DOI: 10.1016/j.jvsv.2024.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/31/2024] [Accepted: 06/09/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To study the risk factors influencing the occurrence of moderate-severe post-thrombotic syndrome (PTS) within 2 years in patients with subacute lower extremity deep vein thrombosis (DVT). METHODS Seventy patients who developed moderate-severe PTS within 2 years after subacute lower extremity DVT from June 2018 to June 2022 were retrospectively selected as the case group. They were matched 1:1 by sex and age (±5 years) with 70 patients who did not develop moderate- severe PTS during the same follow-up period as the control group. Multiple logistic regression, stratified analysis, and interaction analyses were used to explore the risk factors for moderate-severe PTS. RESULTS The multiple logistic regression model showed that patients with iliofemoral vein thrombosis had a significantly increased risk of developing moderate-severe PTS within 2 years. Patients who underwent intraluminal intervention treatment during hospitalization had a significantly reduced risk. The odds ratios (ORs) were 4.000 (95%CI 1.597∼10.016) for the femoral-popliteal vein thrombosis and 0.262 (95%CI 0.106∼0.647) for the anticoagulation treatment group. The stratified analysis showed that intraluminal intervention treatment was a protective factor against moderate-severe PTS within 2 years across different strata of hypertension, thrombus type, BMI, duration of anticoagulation, and wearing compression stockings. Additionally, there was an interaction between thrombus type and treatment method, with intraluminal intervention treatment having a more pronounced effect on preventing moderate-severe PTS in patients with iliofemoral vein thrombosis. CONCLUSION Iliofemoral vein thrombosis is a risk factor for the development of moderate-severe PTS within 2 years in patients with subacute lower extremity DVT. Intraluminal intervention treatment can reduce the risk of moderate-severe PTS, especially in patients with iliofemoral vein thrombosis.
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Affiliation(s)
- Tianan Huang
- Department of Interventional Radiology, The Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China
| | - Caifang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Wenbin Ding
- Department of Interventional Radiology, The Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China
| | - Yonghai Jin
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Xiaowen Deng
- Department of Interventional Radiology, The Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China
| | - Xiaodong Jiang
- Department of Interventional Radiology, The Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China
| | - Zhuo Chen
- Department of Interventional Radiology, The Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China
| | - Xin Hong
- Department of Interventional Radiology, The Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China.
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Xiao N, Genet M, Khaja M, Desai KR. Antithrombotic Therapy after Deep Venous Intervention. Semin Intervent Radiol 2022; 39:357-363. [PMID: 36406025 PMCID: PMC9671684 DOI: 10.1055/s-0042-1757340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic deep venous disease (CVD) can result in significant morbidity and impact on quality of life due to a spectrum of symptoms, including lower extremity edema, venous claudication, and venous ulcers. CVD can be secondary to both thrombotic and nonthrombotic disease processes, including postthrombotic syndrome from prior deep vein thrombosis (DVT) or iliac vein compression syndrome. Endovascular therapy has become a mainstay therapy for CVD patients, with venous stent placement frequently performed. However, the management of anticoagulation following venous stent placement is not well-studied, with no large trials or consensus guidelines establishing an optimal regimen. The current knowledge gap in antithrombotic therapy is magnified by heterogeneity in practice and data collection, along with incomplete reporting in available studies. Furthermore, most published datasets are antiquated in the setting of rapid evolution in technique and technology available for deep venous intervention. Herein, we summarize the current available literature and offer an approach to anticoagulation and antiplatelet management following deep venous intervention for CVD.
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Affiliation(s)
- Nicholas Xiao
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Matthew Genet
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Minhaj Khaja
- Division of Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, Virginia
| | - Kush R. Desai
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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Majeed GM, Lodhia K, Carter J, Kingdon J, Morris RI, Gwozdz A, Saratzis A, Saha P. A Systematic Review and Meta-Analysis of 12-Month Patency After Intervention for Iliofemoral Obstruction Using Dedicated or Non-Dedicated Venous Stents. J Endovasc Ther 2021; 29:478-492. [PMID: 34758673 PMCID: PMC9096580 DOI: 10.1177/15266028211057085] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular stenting of the deep venous system has been proposed as a method to treat patients with symptomatic iliofemoral outflow obstruction. The purpose of this systematic review and meta-analysis was to compare the effectiveness of this treatment at 1-year following the development of dedicated venous stents. METHOD AND RESULTS We searched MEDLINE and EMBASE for studies evaluating the effectiveness of venous stent placement. Data were extracted by disease pathogenesis: non-thrombotic iliac vein lesions (NIVL), acute thrombotic (DVT), or post-thrombotic syndrome (PTS). Main outcomes included technical success, stent patency at 1 year and symptom relief. A total of 49 studies reporting outcomes in 5154 patients (NIVL, 1431; DVT, 950; PTS, 2773) were included in the meta-analysis. Technical success rates were comparable among groups (97%-100%). There were no periprocedural deaths. Minor bleeding was reported in up to 5% of patients and major bleeding in 0.5% upon intervention. Transient back pain was noted in 55% of PTS patients following intervention. There was significant heterogeneity between studies reporting outcomes in PTS patients. Primary and cumulative patency at 1 year was: NIVL-96% and 100%; DVT-91% and 97%; PTS (stents above the ligament)-77% and 94%, and; PTS (stents across the ligament)-78% and 94%. There were insufficient data to compare patency outcomes of dedicated and nondedicated venous stents in patients with acute DVT. In NIVL and PTS patients, stent patency was comparable at 1 year. There was inconsistency in the use of validated tools for the measurement of symptoms before and after intervention. When reported, venous claudication, improved in 83% of PTS patients and 90% of NIVL patients, and ulcer healing occurred in 80% of PTS patients and 32% of NIVL patients. CONCLUSIONS The first generation of dedicated venous stents perform comparably in terms of patency and clinical outcomes to non-dedicated technologies at 1 year for the treatment of patients with NIVL and PTS. However, significant heterogeneity exists between studies and standardized criteria are urgently needed to report outcomes in patients undergoing deep venous stenting.
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Affiliation(s)
- Ghulam M Majeed
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Krishan Lodhia
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Jemima Carter
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Jack Kingdon
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Rachael I Morris
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Adam Gwozdz
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | | | - Prakash Saha
- Academic Department of Vascular Surgery, St. Thomas' Hospital, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
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4
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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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Montes MC, Carbonell JP, Gómez-Mesa JE. Endovascular and medical therapy of May-Thurner syndrome: Case series and scoping literature review. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:80-89. [PMID: 33752850 DOI: 10.1016/j.jdmv.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION May-Thurner syndrome has been recognized as a cause of chronic venous insufficiency and a trigger for venous thromboembolism. There is no consensus about the definition, diagnosis, and therapeutic approach. We are aiming to describe its characteristics and a scoping literature review. METHODS A retrospective review of patients with May-Thurner syndrome from March 2010 to May 2018 and scoping literature review were made. RESULTS Seven patients were identified. All patients were female with a median age of 36 (20-60) years. The median time from the first symptom to diagnosis was 3.41 (0.01-9) years. The primary clinical presentation was post-thrombotic syndrome (4 patients). Six patients had at least one risk factor for deep venous thrombosis. All patients underwent angioplasty with stent; patients with acute deep venous thrombosis, furthermore mechanic thrombectomy with or without catheter-directed thrombolysis were done. There were three complications (one patient, lymphedema, and two venous stent thrombosis). Scoping review results were descriptively summarized. CONCLUSION May-Thurner syndrome has a varied spectrum of clinical presentation, and clinical awareness is paramount for diagnosis. Its principal complication is the post-thrombotic syndrome, which is associated with high morbidity. There is no consensus on the antithrombotic treatment approach.
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Affiliation(s)
- M C Montes
- Internal Medicine Department, Cardiology Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J P Carbonell
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J E Gómez-Mesa
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia.
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6
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Apruzzi L, Bilman V, Rinaldi E, Chiesa R, Kahlberg A. Aortic Dissection Secondary to Iliac Venous Stenting in an Elderly Patient. Cardiovasc Intervent Radiol 2021; 44:815-817. [PMID: 33506280 DOI: 10.1007/s00270-020-02746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Luca Apruzzi
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
| | - Victor Bilman
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Enrico Rinaldi
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Roberto Chiesa
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Andrea Kahlberg
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Gwozdz AM, Black SA, Hunt BJ, Lim CS. Post-thrombotic Syndrome: Preventative and Risk Reduction Strategies Following Deep Vein Thrombosis. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Venous disease is common in the general population, with chronic venous disorders affecting 50–85% of the western population and consuming 2–3% of healthcare funding. It, therefore, represents a significant socioeconomic, physical and psychological burden. Acute deep vein thrombosis, although a well-recognised cause of death through pulmonary embolism, can more commonly lead to post-thrombotic syndrome (PTS). This article summarises the pathophysiology and risk factor profile of PTS, and highlights various strategies that may reduce the risk of PTS, and the endovenous management of iliofemoral deep vein thrombosis. The authors summarise the advances in PTS risk reduction strategies and present the latest evidence for discussion.
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Affiliation(s)
- Adam M Gwozdz
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, Guy’s and St Thomas’ NHS Trust, King’s College London, London, UK
| | - Stephen A Black
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, Guy’s and St Thomas’ NHS Trust, King’s College London, London, UK
| | - Beverley J Hunt
- Thrombosis and Haemostasis Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Chung S Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK
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8
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Xiao N, Desai KR. Antithrombotic Therapy after Venous Stent Placement. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2020.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Chronic deep venous disease (CVD) affects millions of Americans and can result in significant morbidity, such as debilitating lower extremity oedema, venous claudication, and in severe cases, venous ulcers. CVD can be caused by thrombotic and non-thrombotic disease processes, such as deep venous thrombosis and iliac compression syndrome. Recently, endovascular intervention with percutaneous transluminal angioplasty and venous stent placement has become the mainstay therapy for these patients, with several studies demonstrating its safety and efficacy. However, anticoagulation management following venous stent placement is largely unstudied, and there are no large randomised controlled trials or official guidelines establishing an optimal regimen. Most published studies are plagued with data heterogeneity and incomplete reporting. This is further complicated by rapidly evolving improvements in technique and dedicated devices in endovenous intervention. In this article, the authors discuss the current literature to date and offer an approach to anticoagulation and antiplatelet management following venous stent placement in CVD.
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Affiliation(s)
| | - Kush R Desai
- Department of Radiology, Northwestern University, Chicago, IL, US
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9
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Li M, Zhang L, Zhang K, Zhu Y, Shi Z, Zhang W, Gao B, Li L, Fang Z, Yin L, Chen B, Liu Z. An efficacy and safety study of rivaroxaban for the prevention of deep vein thrombosis in patients with left iliac vein compression treated with stent implantation (PLICTS): study protocol for a prospective randomized controlled trial. Trials 2020; 21:811. [PMID: 32993773 PMCID: PMC7526216 DOI: 10.1186/s13063-020-04742-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balloon dilatation with stent implantation has been proved to be an effective option for left iliac vein compression syndrome (LIVCS), but thrombosis may still occur after the operation. Currently, warfarin is used for anticoagulant therapy, but long-term monitoring is required, while rivaroxaban does not need laboratory monitoring, which can simplify treatment. Therefore, this study aimed to compare the efficacy and safety of rivaroxaban and warfarin in anticoagulation. METHODS This study is a multicenter, randomized controlled trial. We will recruit 224 patients with thrombotic LIVCS from 9 hospitals. Moreover, these patients will be randomized to either the experimental group (rivaroxaban) or the control group (warfarin plus nadroparin). The primary outcome is stent occlusion rate. Secondary outcomes are quality of life scale survey results, all-cause mortality, anticoagulation-related mortality, and the proportion of participants with stent displacement/fracture, thrombosis, hemorrhage, and other vascular events. DISCUSSION This study will provide reliable, evidence-based clinical evidence for the efficacy and safety of rivaroxaban antithrombotic therapy after stent implantation. TRIAL REGISTRATION ClinicalTrials.gov NCT04067505 . Registered on August 26, 2019.
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Affiliation(s)
- Miaomiao Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China.,School of Medicine, Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Libin Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Kaijie Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, 310016, China
| | - Yuefeng Zhu
- Department of Vascular Surgery, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, 310016, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital of Fudan University, Shanghai, 210023, China
| | - Wan Zhang
- Department of Vascular Surgery, Huadong Hospital of Fudan University, Shanghai, 210023, China
| | - Bin Gao
- Department of Vascular Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Lubin Li
- Department of Vascular Surgery, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Zhengdong Fang
- Department of Vascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - Li Yin
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Bing Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China
| | - Zhenjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310052, China.
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Li W, Yin Y, Gu C, Fan B, Duan P, Jin Y, Ni C. Modified one-session endovascular treatment for deep venous thrombosis with high risk of pulmonary embolism: Short-term outcomes. Phlebology 2020; 35:524-532. [PMID: 32028851 DOI: 10.1177/0268355520904270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the safety and short-term outcomes of the modified one-session endovascular treatment with inferior vena cava filter placement and retrieval in one stage for the treatment of acute lower extremity deep vein thrombosis. METHOD Twenty-three patients with unilateral acute lower extremity deep vein thrombosis underwent modified one-session endovascular treatments, which were performed in one stage. Inferior vena cava filter placement without detachment, thrombectomy, and inferior vena cava filter retrieval were performed in one stage. Angioplasty and stent implantation were performed for patients with iliac vein stenosis. Venography was performed to identify the clearance of the thrombus. Color Doppler ultrasound and/or venography were conducted during the follow-up. RESULTS A total of 20/23 (87%) patients with thrombus removal rate >90% successfully underwent modified one-session endovascular treatment. inferior vena cava filters were detached in 3/23 (13%) patients achieving 50%-90% thrombus removal rate. Twenty-one iliac vein stents were implanted in 21/23 (91%) patients with iliac vein stenosis. After treatment, the differences in the circumferences of the affected limb and the healthy limb both significantly decreased. No procedure-related death, symptomatic pulmonary embolism, or major bleeding occurred. During the 12-25 months of follow-up, iliac vein stents and lower extremity veins maintained patent. CONCLUSIONS The modified one-session endovascular treatment with one-stage inferior vena cava filter placement and retrieval might be safe for the treatment of acute lower extremity deep vein thrombosis, and the early clinical outcomes are satisfactory. Placing and retrieving an inferior vena cava filter in one session could safeguard the endovascular interventions as well as reduce the filter-related complications associated with long dwelling times.
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Affiliation(s)
- Wei Li
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Yin
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chengtao Gu
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Baorui Fan
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Pengfei Duan
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yonghai Jin
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Caifang Ni
- Department of Vascular and Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China
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11
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Ouyang L, Peng X, Chen S. Strategies for the diagnosis and treatment of the iliac vein compression syndrome. J Interv Med 2019; 2:123-127. [PMID: 34805885 PMCID: PMC8562273 DOI: 10.1016/j.jimed.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the diagnosis and treatment strategies for the iliac vein compression syndrome (IVCS) and the factors that affect the treatment outcome. Methods In total, 69 patients with IVCS were enrolled in the study. The patients underwent computed tomography (CT) venography before treatment. CT observations included assessment of the iliac venous channel sagittal diameter (IVCD) before the lower lumbar vertebra, causes of oppression, thrombus density, and embolization range. The patients with IVCS were divided into the simple IVCS (sIVCS, n = 22), lumbar degeneration-related type IVCS (dIVCS, n = 33), and IVCS of other causes (oIVCS, n = 14) including lumbar fracture, hematoma of infection, and abscess wraping around and compressing the iliac vein, groups. The treatment methods included target venous catheter-directed thrombolysis (CDT), a mechanical breaking and sucking treatment for the thrombi, followed by balloon dilatation and iliac vein stent implantation. The factors that may possibly affect the treatment outcomes included IVCS type, duration of disease, thrombus hardness, embolization length, and treatment regimen. Logistic regression was used to analyze the factors that affected the therapeutic efficacy. Results At the first stage, CDT was only effective in 15 cases (5 dIVCSs and 10 oIVCSs) and was ineffective in the remaining 54 cases, which required further mechanical breaking and sucking of the thrombi and intravenous balloon dilatation. In the second stage, combination of thrombi breaking and suction and balloon dilatation was preliminarily effective in 26 cases (6 sIVCSs, 16 dIVCSs and 4 oIVCSs), but during follow-up from 1 to 6 months, treatment was considered futile for 9 recurrent cases (3 sIVCSs and 6 dIVCSs). So, 28 cases of preliminary ineffective treatment and 9 relapse in the second stage were arranged to the third stage of treatment by iliac vein stent implantation. All 37 cases were treated effectively and achieved a satisfactory iliac vein patency, and were followed-up for 24 months without recurrence. Logistic regression analysis showed that IVCS type (β = 4.14; Wald test, P < 0.01), duration of illness (β = -5.33; Wald test, P = 0.02), thrombus density (β = -6.46; Wald test, P = 0.01), embolization length (β = 2.74; Wald test, P = 0.03), and treatment regimens (β = 11.92; Wald test, P = 0.01) all had a significant effect on the treatment outcomes. Conclusion The selection of a suitable intervention treatment regimen for different types of IVCS may aid in improving the curative effect.
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Affiliation(s)
- Lin Ouyang
- Corresponding author. Department of Medical Imaging, 909 Hospital, PLA. (Institute of Medical Imaging, Southeast Hospital, Xiamen University Medical College), 363000, China.
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12
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Che H, Liu G, Yu Y, Sang G, Zhang X. Guidance of Venous Stent Implantation after Catheter-directed Thrombosis in Patients with Acute Left Lower Extremity Deep Venous Thrombosis based on Pressure Gradient Differences between the Iliac Vein and Inferior Vena Cava: A Single-center Retrospective Study. Ann Vasc Surg 2019; 59:217-224. [PMID: 30802569 DOI: 10.1016/j.avsg.2018.12.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/20/2018] [Accepted: 12/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Iliac vein compression syndrome (IVCS) can lead to acute deep venous thrombosis (DVT) and post-thrombotic syndrome (PTS). Endovascular venous stenting has become a preferred treatment for IVCS. In this article, we guide stent implantation by the pressure gradient of iliac vein and inferior vena cava. To evaluate the feasibility of guidance of venous stent implantation based on venous pressure gradient difference. METHODS A retrospective analysis was performed on patients with acute left lower extremity DVT who were treated in our center from March 2012 to December 2017. The patients were divided into 2 groups: group 1: from January 2015 to December 2017, patients were treated with catheter-directed thrombolysis (CDT) and stent implantation was guided by the pressure gradient of iliac vein and inferior vena cava after thrombectomy; group 2: from May 2012 to December 2014, patients underwent CDT treatment without stent implantation. In group 1, the patients were divided into 2 groups according to the difference in pressure gradient after CDT: the stent group (>2 mm Hg) and the control group (≤2 mm Hg). All patients were evaluated by color Doppler ultrasound at 1, 3, and 6 months after the operation to evaluate the patency of the iliofemoral vein. The Villalta score was used to evaluate the incidence of PTS. RESULTS The primary and secondary patency rate of group 1 at 1, 3, and 6 months after operation were higher than that in group 2 (P < 0.05). In group 1, there was no significant difference in the primary and secondary patency rate between the stent group and the control group at 1, 3, and 6 months after the operation. The incidence of PTS in group 1 at 6 months after the operation was lower than that in group 2 (P < 0.05). In group 1, there was no significant difference in the incidence of PTS between the stent group and the control group at 6 months after the operation. CONCLUSIONS Practice proves that it is simple and effective to guide stent implantation according to differences in pressure gradients. Two millimeter of mercury is the traditional standard for venous pressure interference in the pelvic area, and the effectiveness of this method was proved.
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Affiliation(s)
- Haijie Che
- Department of Vascular Surgery, Peking University Second School of Clinical Medicine, Peking University People's Hospital, Beijing, People's Republic of China; Department of Vascular Surgery, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Guolong Liu
- Department of Vascular Surgery, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Ying Yu
- Department of Vascular Surgery, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Guifeng Sang
- Department of Operation, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University Second School of Clinical Medicine, Peking University People's Hospital, Beijing, People's Republic of China.
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J. Padrnos L, Garcia D. May-Thurner syndrome and thrombosis: A systematic review of antithrombotic use after endovascular stent placement. Res Pract Thromb Haemost 2019; 3:70-78. [PMID: 30656278 PMCID: PMC6332820 DOI: 10.1002/rth2.12156] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/27/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND May-Thurner Syndrome (MTS) is caused by compression of the left common iliac vein between the right common iliac artery and the pelvis. It likely predisposes an individual to lower extremity deep vein thrombosis (DVT) as well as symptoms of unilateral lower extremity swelling and discomfort in the absence of a known history of thrombosis. In the case of MTS-associated acute thrombosis, there is low-quality evidence to suggest that endovascular intervention including thrombolysis and endovascular stent placement reduces the risk of recurrent thrombosis. However, the optimal type and duration of antithrombotic therapy after stent placement for left iliofemoral vein stenosis is not known. METHODS A systematic literature search including studies that evaluated the outcome of endovascular stent occlusion and systemic anticoagulant use in patients with MTS associated DVT was performed. The primary outcome of interest was 12-month risk of endovascular stent occlusion or recurrent DVT. RESULTS A total of five studies encompassing 61 patients were included in our study. All studies were retrospective without a comparator group. A variety of anticoagulants and durations were prescribed. Of the 55 patients evaluable, the 12-month rate of endovascular stent occlusion or recurrent DVT ranged from 0% to 40%. The 12-month stent patency rate ranged from 60% to 100%. CONCLUSIONS The published evidence regarding antithrombotic treatment for patients with MTS who have undergone stent placement for a DVT is limited. Further high-quality, prospective studies are needed in this setting to inform clinical decision making.
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Affiliation(s)
| | - David Garcia
- Division of HematologyUniversity of WashingtonSeattleWashington
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14
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Ueda J, Tsuji A, Ogo T, Asano R, Konagai N, Fukui S, Morita Y, Fukuda T, Yasuda S. Beneficial Effect of Endovascular Treatment on Villalta Score in Japanese Patients With Chronic Iliofemoral Venous Thrombosis and Post-Thrombotic Syndrome. Circ J 2018; 82:2640-2646. [PMID: 30033947 DOI: 10.1253/circj.cj-17-1210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS), the most common complication of deep venous thrombosis (DVT), develops in ≥50% of patients with iliofemoral DVT. However, the benefit of endovascular treatment in Japanese patients with chronic DVT and PTS remains unclear. Methods and Results: Between June 2014 and May 2016, endovascular treatment was performed in 11 consecutive Japanese patients with chronic iliofemoral DVT and PTS refractory to anticoagulant therapy and elastic compression stockings. We evaluated the technical success rate, complications, patency, Villalta score, calf circumference, and popliteal vein reflux in both the acute stage (the day following endovascular treatment) and chronic stage (after 6 months). Imaging follow-up included venous duplex scanning and/or magnetic resonance venography. The technical success rate was 81.8%, without complications. In patients with successful intervention, the Villalta score improved significantly, from 9.0±3.7 preoperatively to 3.6±2.5 in the acute phase (P<0.01) and 2.9±2.1 in the chronic phase (P<0.001). The bilateral difference in lower thigh circumference also improved significantly, from 2.6±1.0 cm preoperatively to 1.4±1.0 cm in the chronic phase (P<0.001). However, popliteal vein reflux did not improve. In patients with successful intervention, venous patency rate was 100% at 6 months post-intervention. CONCLUSIONS Endovascular treatment is safe and effective in Japanese patients with chronic iliofemoral DVT and PTS.
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Affiliation(s)
- Jin Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Akihiro Tsuji
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Ogo
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ryotaro Asano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nao Konagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shigefumi Fukui
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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15
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Stent implantation for May–Thurner syndrome with acute deep venous thrombosis: acute and long-term results from the ATOMIC (AcTive stenting for May–Thurner Iliac Compression syndrome) registry. Cardiovasc Interv Ther 2018; 34:131-138. [DOI: 10.1007/s12928-018-0532-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/31/2018] [Indexed: 01/27/2023]
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16
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Madsen CP, Gesla J, Vijdea RL, Serifi MA, Christensen JK, Houlind K. Results of catheter-directed thrombolysis for acute ilio-femoral deep venous thrombosis - A retrospective cohort study. JRSM Cardiovasc Dis 2018; 7:2048004018766801. [PMID: 29623200 PMCID: PMC5881969 DOI: 10.1177/2048004018766801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/09/2018] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
Background Catheter-directed thrombolysis may prevent post-thrombotic syndrome in patients with ilio-femoral deep venous thrombosis. We performed a retrospective review of prospectively collected follow-up data to evaluate the results of catheter-directed thrombolysis at our institution. Method Patients admitted for venous thrombolysis were included in the study and their files screened for information regarding results and technical aspects of treatment and patient status on follow-up. A catheter was inserted under imaging guidance into the thrombosed vein. Through the catheter tissue plasminogen activator was administered. Daily catheter-based venographies were performed to monitor progression in thrombus resolution. After thrombolysis flow-limiting stenosis was stented. Patients started wearing compression stockings and were started on oral anticoagulant therapy. Follow-up visits with ultrasound, magnetic resonance venography and clinical assessment were scheduled at six weeks and three, six, 12 and 24 months. Results A total of 48 patients underwent catheter-directed thrombolysis, including 36 female patients. Median age was 28 years. Complete lysis of the thrombus was achieved in 43 cases and partial lysis in two cases and 26 stents were placed. No deaths or life-threatening bleeding events occurred. Thirty-two of the patients who achieved full lysis and were followed up remained patent at follow-up. At 12 months seven patients had symptoms of post-thrombotic syndrome. Conclusion Catheter-directed thrombolysis represents a safe and effective alternative to systemic anticoagulative treatment of deep venous thrombosis with rapid resolution of the thrombus and few complications. Long-term patency shows good validity and this study suggests that catheter-directed thrombolysis is effective in preventing post-thrombotic syndrome.
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Affiliation(s)
- Christina P Madsen
- 1Department of Vascular Surgery, Kolding Sygehus - Part of Sygehus Lillebaelt, Kolding, Denmark
| | - Jerzy Gesla
- 1Department of Vascular Surgery, Kolding Sygehus - Part of Sygehus Lillebaelt, Kolding, Denmark
| | - Radu L Vijdea
- 2Department of Radiology, Kolding Sygehus - Part of Sygehus Lillebaelt, Kolding, Denmark
| | - Maria A Serifi
- 2Department of Radiology, Kolding Sygehus - Part of Sygehus Lillebaelt, Kolding, Denmark
| | - Johnny K Christensen
- 2Department of Radiology, Kolding Sygehus - Part of Sygehus Lillebaelt, Kolding, Denmark
| | - Kim Houlind
- 1Department of Vascular Surgery, Kolding Sygehus - Part of Sygehus Lillebaelt, Kolding, Denmark
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17
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[Recurrent pain and swelling of the left leg in a 49-year-old male patient]. Internist (Berl) 2017; 59:720-724. [PMID: 29076080 DOI: 10.1007/s00108-017-0346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 49-year-old male patient presented due to recurrent pain and swelling in the left leg. The patient had had deep venous thrombosis with pulmonary embolism 5 years previously. Since then, he had been treated with Vit-k-antagonists. Pronounced paraumbilical collateral circulation of unknown origin was striking. Doppler sonographic evaluation pointed to May-Thurner syndrome. This was confirmed by phlebography. Venous stenting of the stenosis in the left iliac vein achieved long-term symptom improvement. This case report is intended to draw attention to the rare May-Thurner syndrome as an important differential diagnosis of deep vein thrombosis and, at the same time, identify diagnostic and therapeutic treatment strategies.
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18
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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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19
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Chen G, Shi W, He X, Lou W, Chen L, Gu J. Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding. Exp Ther Med 2017; 13:751-758. [PMID: 28352362 DOI: 10.3892/etm.2017.4023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/11/2016] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to examine the feasibility of catheter-directed thrombolysis (CDT) using continuous infusion of low-dose urokinase in combination with low molecular weight heparin (LMWH) for acute iliofemoral venous thrombosis. This retrospective analysis included patients with symptomatic acute iliofemoral venous thrombosis who received CDT using continuous infusion of low-dose urokinase in combination with LMWH within the past four years. Urokinase was administered at 1×104 U/h and 2×104 U/h in patients at high-risk and low-risk of bleeding, respectively. Measurements included urokinase dosage, duration, clinical outcomes and CDT-related complications. A total of 46 patients were included (high-risk, n=17; low-risk, n=29). In the high-risk patients, 64.7% experienced dissolution of ≥50% thrombi after a median CDT duration of 8 days (range, 6-10 days) and median total urokinase dose of 1.92×106 units (range, 1.44-2.4×106 units). In the low-risk patients, 82.8% achieved dissolution of ≥50% thrombi after a median CDT duration of 7 days (range, 4-10 days) and a median total urokinase dose of 3.36×106 units (range, 1.92-4.80×106 units). Remission of clinical symptoms after CDT was achieved in 15 (88.2%) and 28 (96.6%) cases in high-risk and low-risk patients, respectively. No treatment-associated pulmonary embolism or major bleeding was observed. Three (6.5%) subjects (high-risk, n=1; low-risk, n=2) experienced minor bleeding. In conclusion, continuous infusion of low-dose urokinase via CDT in combination with LMWH is effective and safe for acute iliofemoral venous thrombosis in patients with one or more risk factor for bleeding.
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Affiliation(s)
- Guoping Chen
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Wangyin Shi
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Xu He
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Wensheng Lou
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Liang Chen
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Jianping Gu
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
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Underlying Anatomy and Typing Diagnosis of May-Thurner Syndrome and Clinical Significance: An Observation Based on CT. Spine (Phila Pa 1976) 2016; 41:E1284-E1291. [PMID: 27379417 PMCID: PMC5113228 DOI: 10.1097/brs.0000000000001765] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To explore the underlying anatomy of May-Thurner syndrome (MTS) using computed tomography (CT) and discuss its clinical significance for typing diagnosis. SUMMARY OF BACKGROUND DATA Because the anatomical position of the corpse cannot fully illustrate the actual clinical situation in vivo, the diversity of MTS has not been fully elucidated yet. METHODS We retrospectively analyzed the data of 69 patients with MTS. By CT showing, patients were categorized to simple MTS (sMTS, 22 patients), lumbar degeneration-related MTS (dMTS, 33 patients) and other causes MTS (oMTS, 14 patients); meanwhile, a healthy control group were set. Evaluated indexes were onset age, course of disease, diameter of the iliac vein tunnel (IVTD), lumbar degeneration-related iliac vein compression (IVC), therapeutic effect, and diagnostic cutoff of risk IVTD prone to MTS. RESULTS The onset age of sMTS, dMTS, and oMTS were respectively 42.3 ± 6.5 years, 61.5 ± 10.6 years, and 53.1 ± 16.8 years (P < 0.001); courses were respectively 12.1 ± 9.2 days, 22.5 ± 7.6 days, and 6.8 ± 6.7 days (P = 0.002). IVTDs of sMTS, dMTS, oMTS, and the control were respectively 2.52 ± 0.50 mm, 2.29 ± 0.30 mm, 5.93 ± 2.21 mm, and 4.34 ± 1.61 mm (P < 0.001). Lumbar degeneration-related IVC in dMTS occurred at 41 places, including forward bulging or protruding intervertebral discs (51%,17/33), osteophytes (50%,16/33), and spondylolisthesis (19%, 8/33), but none happened in sMTS, oMTS, and the control. Eighty-six percent of sMTSs, 55% dMTSs, and none oMTSs needed intravenous stent-implanted operation to obtain effective treatment. MTS type (Waldχ = 6.092, P = 0.009), course (Waldχ = 4.618, P = 0.032), and treatment plan (Waldχ = 14.748, P < 0.001) markedly influence the therapeutic result. The cutoff of risk IVTD for sMTS and dMTS was 2.98 mm, which diagnostic sensitivity was 90% and specificity 100%. CONCLUSION Owing to the distinct pathoanatomy and causes, diagnosis in classification of MTS by CT is helpful in accurate treatment program. LEVEL OF EVIDENCE 3.
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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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Jiang J, Tu J, Jia Z, Chen J, Cao H, Meng Q, Fuller TA, Tian F. Incidence and Outcomes of Inferior Vena Cava Filter Thrombus during Catheter-directed Thrombolysis for Proximal Deep Venous Thrombosis. Ann Vasc Surg 2016; 38:305-309. [PMID: 27531087 DOI: 10.1016/j.avsg.2016.05.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/04/2016] [Accepted: 05/08/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the study was to retrospectively evaluate the incidence and outcomes of inferior vena cava (IVC) filter thrombus during catheter-directed thrombolysis (CDT) for acute proximal deep venous thrombosis (DVT). METHODS From October 2006 to June 2015, patients diagnosed with acute proximal DVT and received CDT after a retrievable IVC filter was placed were included. The incidence, treatment, and outcomes of IVC filter thrombus during CDT were recorded and analyzed. RESULTS A total of 189 patients (91 women, 98 men; mean age, 57.6 ± 9.8 years; range, 24-85 years) were included in this study. Among the 189 cases, the DVTs involved popliteal iliofemoral veins in 54 patients, iliofemoral veins in 113 patients, and iliac veins in 22 patients, of which 18 patients had thrombus extended into the IVC. Of the 189 patients, a total of 8 (4.2%, 8 of 189) patients were identified with IVC filter thrombus during CDT. The IVC filter thrombus was detected on a median of 2 days (range, 2-4 days) of CDT therapy, including small-size (n = 6) and large-size (n = 2) filter thrombus. Of the 8 patients, CDTs were performed with a mean 7.6 ± 1.1 days (range, 6-11 days) after the presence of symptoms for the treatment of proximal DVT, and all the IVC filter thrombi were lysed during CDT for the proximal DVT. All the IVC filters were removed successfully with a mean of 12.8 ± 0.93 days from placement. There were no procedure- or thrombolysis-related major complications, and no symptomatic pulmonary embolism breakthrough was seen in any of the patients after the filter placement. CONCLUSIONS IVC filter thrombus during CDT for the acute proximal DVT is uncommon, and all of them did not need any additional treatment.
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Affiliation(s)
- Jianguang Jiang
- Department of Cardiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, Jiangsu Province, China
| | - Jianfei Tu
- Department of Radiology and Interventional Radiology, Lishui Central Hospital, Lishui, Zhejiang Province, China
| | - Zhongzhi Jia
- Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, Jiangsu Province, China
| | - Jiezhong Chen
- Department of Cardiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, Jiangsu Province, China
| | - Haitao Cao
- Department of Cardiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, Jiangsu Province, China
| | - Qingli Meng
- Department of Cardiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, Jiangsu Province, China
| | - Tyler A Fuller
- Department of Radiology, Lake Erie College of Osteopathic Medicine, Bradenton, FL
| | - Feng Tian
- Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, Jiangsu Province, China.
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Razavi MK, Jaff MR, Miller LE. Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction: Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2016; 8:e002772. [PMID: 26438686 DOI: 10.1161/circinterventions.115.002772] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Endovenous recanalization of iliofemoral stenosis or occlusion with angioplasty and stent placement has been increasingly used to maintain long-term venous patency in patients with iliofemoral venous outflow obstruction. The purpose of this systematic review and meta-analysis was to determine safety and effectiveness of venous stent placement in patients with iliofemoral venous outflow obstruction. METHODS AND RESULTS We searched MEDLINE and EMBASE for studies evaluating safety or effectiveness of stent placement in patients with iliofemoral venous outflow obstruction. Data were extracted by disease pathogenesis: nonthrombotic, acute thrombotic, or chronic post-thrombotic. Main outcomes included technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years. A total of 37 studies reporting 45 treatment effects (nonthrombotic, 8; acute thrombotic, 19; and chronic post-thrombotic, 18) from 2869 patients (nonthrombotic, 1122; acute thrombotic, 629; and chronic post-thrombotic, 1118) were included. Technical success rates were comparable among groups, ranging from 94% to 96%. Complication rates ranged from 0.3% to 1.1% among groups for major bleeding, from 0.2% to 0.9% for pulmonary embolism, from 0.1% to 0.7% for periprocedural mortality, and from 1.0% to 6.8% for early thrombosis. Patient symptom relief data were reported inconsistently. At 1 year, primary and secondary patency were 96% and 99% for nonthrombotic, 87% and 89% for acute thrombotic, and 79% and 94% for chronic post-thrombotic. CONCLUSIONS Stent placement for iliofemoral venous outflow obstruction results in high technical success and acceptable complication rates regardless of cause of obstruction.
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Affiliation(s)
- Mahmood K Razavi
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.).
| | - Michael R Jaff
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.)
| | - Larry E Miller
- From the Heart and Vascular Center, St. Joseph Hospital, Orange, CA (M.K.R.); Fireman Vascular Center, Massachusetts General Hospital, Boston (M.R.J.); and Miller Scientific Consulting, Inc, Asheville, NC (L.E.M.)
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Yamada N. Editorial: Endovascular treatment for acute proximal deep vein thrombosis. J Cardiol Cases 2015; 11:127-128. [PMID: 30546548 PMCID: PMC6279978 DOI: 10.1016/j.jccase.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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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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26
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Satokawa H. Use of a stent after catheter-directed thrombolysis is very seldom necessary. Circ J 2014; 78:1069-70. [PMID: 24621658 DOI: 10.1253/circj.cj-14-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hirono Satokawa
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine
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