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Chernysh IN, Mukhopadhyay S, Johnson TA, Brooks JA, Sarkar R, Weisel JW, Antalis TM. Time-dependent ultrastructural changes during venous thrombogenesis and thrombus resolution. J Thromb Haemost 2024; 22:1675-1688. [PMID: 38492853 PMCID: PMC11139557 DOI: 10.1016/j.jtha.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Deep vein thrombosis is a common vascular event that can result in debilitating morbidity and even death due to pulmonary embolism. Clinically, patients with faster resolution of a venous thrombus have improved prognosis, but the detailed structural information regarding changes that occur in a resolving thrombus over time is lacking. OBJECTIVES To define the spatial-morphologic characteristics of venous thrombus formation, propagation, and resolution at the submicron level over time. METHODS Using a murine model of stasis-induced deep vein thrombosis along with scanning electron microscopy and immunohistology, we determine the specific structural, compositional, and morphologic characteristics of venous thrombi formed after 4 days and identify the changes that take place during resolution by day 7. Comparison is made with the structure and composition of venous thrombi formed in mice genetically deficient in plasminogen activator inhibitor type 1. RESULTS As venous thrombus resolution progresses, fibrin exists in different structural forms, and there are dynamic cellular changes in the compositions of leukocytes, platelet aggregates, and red blood cells. Intrathrombus microvesicles are present that are not evident by histology, and red blood cells in the form of polyhedrocytes are an indicator of clot contraction. Structural evidence of fibrinolysis is observed early during thrombogenesis and is accelerated by plasminogen activator inhibitor type 1 deficiency. CONCLUSION The results reveal unique, detailed ultrastructural and compositional insights along with documentation of the dynamic changes that occur during accelerated resolution that are not evident by standard pathologic procedures and can be applied to inform diagnosis and effectiveness of thrombolytic treatments to improve patient outcomes.
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Affiliation(s)
- Irina N Chernysh
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Subhradip Mukhopadhyay
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tierra A Johnson
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jacob A Brooks
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rajabrata Sarkar
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John W Weisel
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Toni M Antalis
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA; Research & Development Service, United States Department of Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA.
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Teng B, Li F, Wang X, Tian H, Zhao Y, Zeng Q. Central Venous Catheter as a Novel Approach to Postoperative Thrombolysis in Patients with Acute Iliofemoral Deep Venous Thrombosis. Clin Exp Hypertens 2023; 45:2224940. [PMID: 37326510 DOI: 10.1080/10641963.2023.2224940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/19/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS Percutaneous mechanical thrombectomy (PMT) along with postoperative thrombolysis (POT) has been the standard treatment for acute iliofemoral deep venous thrombosis (IFDVT). However, commonly used catheter directed thrombolysis (CDT) approaches for POT carry certain disadvantages, including the need for a sheath, inferior comfortability, and catheter-related complications. Therefore, we propose a new simplified method of POT using a central venous catheter (CVC). METHODS The retrospective study analyzed patients with IFDVT who underwent POT using CVC from January 2020 to August 2021. The treatment modalities included filter placement, thrombus removal, iliac vein obstruction release, postoperative CVC thrombolysis, filter retrieval, and adequate full course anticoagulation. RESULTS A total of 39 patients were included in this retrospective study. All patients underwent PMT surgery with a procedure success rate of 100%. In the post-PMT CVC thrombolysis, the puncture sites were located in the below-knee vein, including 58.97% in the peroneal vein. The mean duration of CVC-directed thrombolysis was 3.69 ± 1.08 days, and the total urokinase dose was 2.27 ± 0.71 MIU. A total of 37 patients (94.87%) had successful thrombolysis with a length of hospital stay of 5.82 ± 2.21 days. During CVC-directed thrombolysis, only four minor bleeding complications occurred, two of which were indwelling catheter-related. During the 12-month follow-up period, the patency rate and post-thrombotic syndrome incidences were 97.44% and 2.56%, respectively. CONCLUSION Thrombolysis through a CVC is a feasible, safe, and effective POT method, and could be an alternative to the conventional CDT approach for patients with IFDVT.
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Affiliation(s)
- Biyun Teng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuehu Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Tian
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiu Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang CR, Lee CH. Pelvic deep venous thrombosis mimicking lower limb cellulitis in systemic lupus erythematosus-associated antiphospholipid syndrome. Lupus 2022; 31:613-618. [PMID: 35293251 DOI: 10.1177/09612033221084230] [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 Systemic lupus erythematosus (SLE) associated with antiphospholipid syndrome (APS) is a complex clinical scenario with thromboembolic events, lupus activity, and related therapeutic complications like infection. In SLE, iliofemoral (IF) deep vein thrombosis (DVT) with fever and erythematous swollen limbs mimic cellulitis over lower extremities. Nevertheless, to distinguish DVT from cellulitis is imperative in clinical practice due to the use of different therapeutic regimens. METHODS A retrospective study was performed to analyze iliofemoral DVT in hospitalized SLE-associated APS patients with fever and erythematous swollen limbs mimicking cellulitis from January 1, 2011 to December 31, 2020. RESULTS Among 896 hospitalized SLE patients, 117 were associated with APS. Three patients had pelvic IF DVT with total vascular occlusion, presenting as fever and erythematous swollen limbs mimicking cellulitis. Despite negative duplex sonographic findings, IF thrombi were demonstrated by using computed tomography and/or catheter venography. Owing to refractory to unfractionated or low-molecular-weight heparin injection, all received the thrombolytic treatment. Complete resolution of thrombi without recurrent DVT and post-thrombotic syndrome was identified in two patients receiving pharmacomechanical thrombectomy or catheter-directed thrombolysis. CONCLUSIONS For differential diagnosis of IF DVT and lower limb cellulitis in SLE-associated APS, our case series underlines the importance of venography to detect an unusual pelvic location of thrombi.
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Affiliation(s)
- Chrong-Reen Wang
- Division of Rheumatology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Cheng-Han Lee
- Division of Cardiology, Department of Internal Medicine, 63461National Cheng Kung University Hospital, Tainan, Taiwan
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Hendley SA, Bhargava A, Holland CK, Wool GD, Ahmed O, Paul JD, Bader KB. (More than) doubling down: Effective fibrinolysis at a reduced rt-PA dose for catheter-directed thrombolysis combined with histotripsy. PLoS One 2022; 17:e0261567. [PMID: 34982784 PMCID: PMC8726487 DOI: 10.1371/journal.pone.0261567] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/04/2021] [Indexed: 02/07/2023] Open
Abstract
Deep vein thrombosis is a major source of morbidity and mortality worldwide. For acute proximal deep vein thrombosis, catheter-directed thrombolytic therapy is an accepted method for vessel recanalization. Thrombolytic therapy is not without risk, including the potential for hemorrhagic bleeding that increases with lytic dose. Histotripsy is a focused ultrasound therapy that generates bubble clouds spontaneously in tissue at depth. The mechanical activity of histotripsy increases the efficacy of thrombolytic therapy at doses consistent with current pharmacomechanical treatments for venous thrombosis. The objective of this study was to determine the influence of lytic dose on histotripsy-enhanced fibrinolysis. Human whole blood clots formed in vitro were exposed to histotripsy and a thrombolytic agent (recombinant tissue plasminogen activator, rt-PA) in a venous flow model perfused with plasma. Lytic was administered into the clot via an infusion catheter at concentrations ranging from 0 (control) to 4.54 μg/mL (a common clinical dose for catheter-directed thrombolysis). Following treatment, perfusate samples were assayed for markers of fibrinolysis, hemolysis, and intact red blood cells and platelets. Fibrinolysis was equivalent between the common clinical dose of rt-PA (4.54 μg/mL) and rt-PA at a reduction to one-twentieth of the common clinical dose (0.23 μg/mL) when combined with histotripsy. Minimal changes were observed in hemolysis for treatment arms with or without histotripsy, potentially due to clot damage from insertion of the infusion catheter. Likewise, histotripsy did not increase the concentration of red blood cells or platelets in the perfusate following treatment compared to rt-PA alone. At the highest lytic dose, a refined histotripsy exposure scheme was implemented to cover larger areas of the clot. The updated exposure scheme improved clot mass loss and fibrinolysis relative to administration of lytic alone. Overall, the data collected in this study indicate the rt-PA dose can be reduced by more than a factor of ten and still promote fibrinolysis when combined with histotripsy.
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Affiliation(s)
- Samuel A. Hendley
- Committee on Medical Physics, University of Chicago, Chicago, Illinois, United States of America
| | - Aarushi Bhargava
- Department of Radiology, University of Chicago, Chicago, Illinois, United States of America
| | - Christy K. Holland
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Geoffrey D. Wool
- Department of Pathology, University of Chicago, Chicago, Illinois, United States of America
| | - Osman Ahmed
- Department of Radiology, University of Chicago, Chicago, Illinois, United States of America
| | - Jonathan D. Paul
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Kenneth B. Bader
- Committee on Medical Physics, University of Chicago, Chicago, Illinois, United States of America
- Department of Radiology, University of Chicago, Chicago, Illinois, United States of America
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Cramer P, Mensah C, DeSancho M, Malhotra A, Winokur R, Kesselman A. Prevalence of hypercoagulable states in stented thrombotic iliac vein compression syndrome with comparison of re-intervention and anticoagulation regimens. World J Radiol 2021; 13:371-379. [PMID: 35070117 PMCID: PMC8716936 DOI: 10.4329/wjr.v13.i12.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/25/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease. Iliac stent patency is multifactorial, and current management is based on best clinical practices, varying by institution.
AIM To evaluate how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression syndromes.
METHODS A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent common iliac vein (CIV) stenting between December 2013 and December 2019 at a large academic center. Search criteria included CIV stenting and iliac vein compression. Non-thrombotic lesions and iliocaval thrombosis and/or occlusions were excluded. A total of 65 patients were selected for final analysis. Demographic information, procedural data points, and post-procedural management and outcomes were collected. Statistical analyses included Fisher's exact and Chi-square tests to compare discrete variables and the Wilcoxon rank-sum test to compare continuous variables between thrombophilia positive and negative patients.
RESULTS 65 patients underwent successful balloon angioplasty and CIV stenting. Of these patients, 33 (50.8%) underwent thrombophilia testing, with 16 (48.5%) testing positive. Stent patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo (92.3% vs 81.3%, P = 0.6), 6 mo (83.3% vs 80%, P > 0.9), or 12 mo (77.8% vs 76.9%, P = 0.8). Immediately after stent placement, thrombophilia patients were more likely to be placed on dual therapy (aspirin and anticoagulation) or triple therapy (aspirin, clopidogrel, and anticoagulation) (50% vs 41.2%, P > 0.9), and remain on dual therapy at 6 mo (25% vs 12.5%, P = 0.5) and 12 mo (25% vs 6.7%, P = 0.6). There was no significant difference in re-intervention rates (25% vs 35.3%, P = 0.7) or number of re-interventions (average 2.3 vs 1.3 per patient, P = 0.4) between thrombophilia positive and negative patients.
CONCLUSION Half of patients with stented thrombotic iliac vein compression syndrome and thrombophilia testing were positive. The presence of thrombophilia did not significantly impact stent patency or re-intervention rates.
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Affiliation(s)
- Peyton Cramer
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
| | - Cheryl Mensah
- Department of Medicine, Division of Hematology-Oncology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
| | - Maria DeSancho
- Department of Medicine, Division of Hematology-Oncology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
| | - Anuj Malhotra
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
| | - Ronald Winokur
- Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, United States
| | - Andrew Kesselman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
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Hendley SA, Paul JD, Maxwell AD, Haworth KJ, Holland CK, Bader KB. Clot Degradation Under the Action of Histotripsy Bubble Activity and a Lytic Drug. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2942-2952. [PMID: 33460375 PMCID: PMC8445066 DOI: 10.1109/tuffc.2021.3052393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Deep vein thrombosis is a major source of morbidity worldwide. For critical obstructions, catheter-directed thrombolytics are the frontline therapy to achieve vessel recanalization. Techniques that aid lytic therapy are under development to improve treatment efficacy and reduce procedure-related complications. Histotripsy is one such adjuvant under development that relies on focused ultrasound for in situ nucleation of bubble clouds. Prior studies have demonstrated synergistic effects for clot dissolution when histotripsy is combined with lytic therapy. The success of this combination approach is hypothesized to promote thrombolytic efficacy via two mechanisms: erythrocyte fractionation (hemolysis) and increased lytic activity (fibrinolysis). In this study, the contributions of hemolysis and fibrinolysis to clot degradation under histotripsy and a lytic were quantified with measurements of hemoglobin and D-dimer, respectively. A linear regression analysis was used to determine the relationship between hemoglobin, D-dimer, and the overall treatment efficacy (clot mass loss). A similar analysis was conducted to gauge the role of bubble activity, which was assessed with passive cavitation imaging, on hemolysis and fibrinolysis. Tabulation of these data demonstrated hemolysis and fibrinolysis contributed equally to clot mass loss. Furthermore, bubble cloud activity promoted the generation of hemoglobin and D-dimer in equal proportion. These studies indicate a multifactorial process for clot degradation under the action of histotripsy and a lytic therapy.
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Charisis N, Harb H, Harb M, Labropoulos N. A systematic review on long-term clinical impact in patients with iliofemoral deep vein thrombosis. Phlebology 2021; 36:710-718. [PMID: 34098805 DOI: 10.1177/02683555211020596] [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: 11/15/2022]
Abstract
OBJECTIVE The aim of this systematic review was to investigate the long-term clinical impact of iliofemoral (IF) deep vein thrombosis (DVT) based on patient reported outcomes, physician administered test measures and compare medical to interventional treatment. METHODS This study was conducted according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Criteria for inclusion were patients with thrombus involving the common femoral vein or more proximal veins, ≥5-year follow-up and physician assessment. Data quality was assessed using the Robins-I tool and Cochrane tool. RESULTS Eight studies that fulfilled our criteria were deemed eligible and provided data for 499 patients. There were 230 patients who received medical treatment and 269 interventional. Two studies were randomized controlled trials and six observational. Venous claudication, where reported, was found in 7.7% (1/13) of interventionally treated patients and 21% (13/62) of medically treated patients. Long term symptom resolution was reported in 58% (18/31) and 24% (12/50) of interventionally and medically treated patients, respectively. Venous ulcers were seen in 5.5% (7/126) of medically treated patients and 5% (5/100)of interventionally treated patients. CONCLUSION A wide range of signs and symptoms was reported at long-term. Interventional treatment appeared to be better than medical one but the evidence was weak. Given the significant lack of patient reported outcomes, objective testing and use of validated instruments, the results should be interpreted in context with these limitations. Data on long-term outcomes after IF DVT have been poorly reported and outcome criteria should be better defined in future studies.
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Affiliation(s)
| | | | | | - Nicos Labropoulos
- Department of Vascular Surgery, Stony Brook University, New York, USA
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Mühlberger D, Falkenstein T, Mumme A, Stücker M, Reich-Schupke S, Hummel T. Stellenwert der operativen multimodalen venösen Thrombektomie bei der Behandlung der akuten iliofemoralen Thrombose. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1424-8388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungFür das Gros aller Patienten mit tiefer Beinvenenthrombose ist ein konservatives Vorgehen mit Antikoagulation und Kompression die Therapie der Wahl. In ausgewählten Fällen kann jedoch auch ein rekanalisierendes Therapieverfahren zum Einsatz kommen. Dies gilt speziell für besonders ausgedehnte Thrombosen mit Beteiligung der Vena cava oder der Beckenetage. Die multimodale operative Thrombektomie kann ein drohendes postthrombotisches Syndrom abwenden. Die Vorteile der operativen Therapie liegen vor allem in der hohen Effektivität und einer breiten Anwendbarkeit, auch bei Kontraindikation zur Fibrinolysetherapie.
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Affiliation(s)
- Dominic Mühlberger
- Klinik für Gefäßchirurgie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
| | - Thomas Falkenstein
- Klinik für Gefäßchirurgie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
| | - Achim Mumme
- Klinik für Gefäßchirurgie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
| | - Markus Stücker
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
- Klinik für Dermatologie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
| | | | - Thomas Hummel
- Klinik für Gefäßchirurgie, St.-Josef-Hospital Bochum, Katholisches Klinikum Bochum, Klinikum der Ruhr-Universität Bochum
- Interdisziplinäres Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken am St.-Maria-Hilf-Krankenhaus Bochum, Katholisches Klinikum Bochum
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Qiu P, Liu J, Wan F, Chen Y, Ye K, Qin J, Huang Q, Lu X. A predictive model for postthrombotic syndrome in proximal deep vein thrombosis patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:558. [PMID: 33987256 DOI: 10.21037/atm-20-3239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Postthrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT). Predictive models for PTS after hospitalized DVT patients, especially those with proximal DVT for whom preventative intervention decisions need to be made, are rare. We aimed to develop and externally validate a clinical predictive model for PTS in patients with proximal DVT. Methods This study was a retrospective, single-center, case-control study. The data used in our model were retrospectively collected from a prospective registry database in which 210 (derivation) and 90 (validation) consecutive patients were first diagnosed with proximal DVT. We developed a nomogram using the multivariate logistic regression model. External validation of our predictive model and previous predictive models in our validation set was assessed by discrimination, calibration, and clinical utility. Results Of the 30 candidate predictors, 5 were significantly associated with PTS in our final multivariable model, including the number of signs and symptoms (OR 1.33, 95% CI: 1.17 to 1.53, P<0.001), male sex (OR 1.79, 95% CI: 1.07 to 3.06, P=0.028), varicose vein history (OR 3.02, 95% CI: 1.04 to 7.60, P<0.001), BMI (OR 1.06, 95% CI: 1.00 to 1.12, P=0.052), and chronic DVT (OR 2.66, 95% CI: 1.49 to 4.79, P<0.001). The area under the curve was 0.724 in our predictive model, indicating suitable external performance. Conclusions A simple-to-use nomogram effectively predicts the risk of PTS in patients with proximal DVT. This predictive model may be considered for use in clinical care.
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Affiliation(s)
- Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junchao Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuzhen Wan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Yuqian Chen
- School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qun Huang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Kwoh E, Helali JM, Kaneshiro C, Betancourt J. A Case Series of Catheter-Directed Thrombolysis With Mechanical Thrombectomy for Treating Severe Deep Vein Thrombosis. Fed Pract 2021; 38:56-61. [PMID: 33716480 DOI: 10.12788/fp.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two cases of extensive symptomatic deep vein thrombosis without phlegmasia cerulea dolens were successfully treated with an endovascular technique that combines catheter-directed thrombolysis and mechanical thrombectomy.
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Affiliation(s)
- Eric Kwoh
- , , and are Hospitalists at the Veterans Affairs Greater Los Angeles Healthcare System. is an Associate Clinical Professor at David Geffen School of Medicine at University of California, Los Angeles
| | - Jonathan M Helali
- , , and are Hospitalists at the Veterans Affairs Greater Los Angeles Healthcare System. is an Associate Clinical Professor at David Geffen School of Medicine at University of California, Los Angeles
| | - Casey Kaneshiro
- , , and are Hospitalists at the Veterans Affairs Greater Los Angeles Healthcare System. is an Associate Clinical Professor at David Geffen School of Medicine at University of California, Los Angeles
| | - Jaime Betancourt
- , , and are Hospitalists at the Veterans Affairs Greater Los Angeles Healthcare System. is an Associate Clinical Professor at David Geffen School of Medicine at University of California, Los Angeles
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11
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Lee JK, Kim KY, Byun SJ. Safety and Efficacy of Aspiration Thrombectomy or Pharmacomechanical Thrombectomy after Catheter-Directed Thrombolysis for the Treatment of Acute Iliofemoral Deep Vein Thrombosis. Vasc Specialist Int 2020; 36:144-150. [PMID: 32990252 PMCID: PMC7531297 DOI: 10.5758/vsi.200041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/21/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of additional aspiration thrombectomy (AT) or pharmacomechanical thrombectomy (PMT) after catheter-directed thrombolysis (CDT) for the treatment of acute iliofemoral deep vein thrombosis (AIFDVT). MATERIALS AND METHODS Between May 2017 and December 2018, 40 patients with AIFDVT were enrolled. Twenty underwent AT after CDT (CDTAT), while the remaining 20 underwent PMT using an AngioJetTM device after CDT (CDTPMT). Thrombus clearance was assessed using computed tomography venography at 1 week after the procedure, as follows: grade I, ≤50%; grade II, 51% to 75%; grade III, >75%. Grade III was considered a successful outcome. Treatment outcomes (thrombus clearance, thrombolytic therapy duration, urokinase dose, major complications, residual filter thrombosis, and Villalta score) were compared between the groups. RESULTS Successful thrombus clearance was achieved in 95% of the patients in both groups. Significant decreases in the thrombolytic therapy duration (P=0.018) and urokinase dose (P=0.014) were noted in the CDTPMT group. Major complications were not noted in both groups. Residual filter thrombi >10 mm were found in 6 filters in the CDTAT group and in 1 filter in the CDTPMT group (P=0.038). The Villalta scores at 6 months were 1.47±1.24 and 1.12±0.92 in the CDTAT and CDTPMT groups, respectively (P=0.372). CONCLUSION Both methods may be safe and effective management options for patients with AIFDVT. CDTPMT can reduce urokinase dosage, time and remained filter thrombus compared to CDTAT. Studies conducted in the future should compare the effects of overnight CDT followed by PMT with those of single-session PMT on patients with AIFDVT.
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Affiliation(s)
- Joong Kwon Lee
- Division of Vascular Surgery, Department of Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Kyung Yun Kim
- Division of Vascular Surgery, Department of Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Seung Jae Byun
- Division of Vascular Surgery, Department of Surgery, Wonkwang University Hospital, Iksan, Korea
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Salahuddin T, Armstrong EJ. Intervention for Iliofemoral Deep Vein Thrombosis and May-Thurner Syndrome. Interv Cardiol Clin 2020; 9:243-254. [PMID: 32147124 DOI: 10.1016/j.iccl.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
May-Thurner syndrome, also known as iliac vein compression syndrome, may cause symptoms of venous hypertension and is a predisposing factor for the development of iliofemoral deep vein thrombosis (DVT). Iliofemoral DVT is associated with high rates of development of postthrombotic syndrome, a potentially debilitating condition associated with development of symptoms related to venous outflow obstruction and resulting in reduced quality of life. In this Clinics article, we review procedural intervention with catheter-directed thrombolysis and stenting for iliofemoral DVT and iliac vein compression.
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Affiliation(s)
- Taufiq Salahuddin
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA
| | - Ehrin J Armstrong
- Cardiology Section, Rocky Mountain Regional VA Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA; Interventional Cardiology, Vascular Laboratory, Rocky Mountain Regional VA, Division of Cardiology, University of Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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Single-Stage Treatment of AngioJet Rheolytic Thrombectomy and Stenting for Iliac Vein Compression Syndrome with Secondary Acute Iliofemoral Deep Vein Thrombosis. Ann Vasc Surg 2019; 61:384-393. [DOI: 10.1016/j.avsg.2019.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/09/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
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Ockert S, von Allmen M, Heidemann M, Brusa J, Duwe J, Seelos R. Acute Venous Iliofemoral Thrombosis: Early Surgical Thrombectomy Is Effective and Durable. Ann Vasc Surg 2017; 46:314-321. [PMID: 28739469 DOI: 10.1016/j.avsg.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The first-line recommendation for the treatment of acute iliofemoral deep vein thrombosis (IFDVT) is catheter-directed thrombolysis or pharmacomechanical thrombolysis. Recent analysis of surgical thrombectomy has shown comparable results. However, this procedure is not commonly given as much importance as interventional techniques. We analyzed the patient outcome of surgical thrombectomy using modern endovascular techniques in both the short and long term. METHODS All consecutive patients who underwent surgical thrombectomy at our institution between April 2008 and April 2017 were included. Only patients with iliofemoral thrombosis, and only those with the first onset of symptoms <10 days, were analyzed. All patients received preoperative duplex ultrasound and contrast-enhanced computed tomography scans for thrombus extension and detection of pulmonary embolism. All operations were performed by vascular surgeons with open and endovascular skills in a C-arm-equipped operating room. During follow-up (FU), all patients received clinical examination for symptoms of postthrombotic syndrome (PTS), as well as duplex ultrasound. RESULTS Within a 9-year period, 21 patients underwent surgical thrombectomy for IFDVT (17 females/4 males). Primary technical success was 100%; 10 (47.6%) patients received additional primary stenting. 30-day mortality was 0%, 3 patients (14.3%) needed reoperation for early rethrombosis, while secondary 30-day patency was 100%. During FU (median, 6 years; range, 1-104 months), 1 patient received additional stenting for stenosis of the common iliac vein. Nineteen patients (90.5%) presented patent iliofemoral veins without signs of rethrombosis. Two patients (9.5%) died during FU of cancer without signs for recurrent IFDVT. All patients with patent veins were free of symptoms for PTS. CONCLUSIONS Surgical thrombectomy for acute IFDVT is a successful, safe, and durable procedure and provides alternative treatment options for acute IFDVT in selected cases.
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Affiliation(s)
- Stefan Ockert
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Matthias von Allmen
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Michaela Heidemann
- Department of Angiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Juliette Brusa
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jan Duwe
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Robert Seelos
- Department of Vascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Dumantepe M, Uyar I. The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis. Phlebology 2017; 33:388-396. [DOI: 10.1177/0268355517711792] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective To evaluate the clinical safety and effectiveness of percutaneous rheolytic thrombectomy in patients with acute lower extremity deep venous thrombosis. Method Sixty-eight consecutive patients with acute massive lower extremity deep venous thrombosis were included in this retrospective study. A percutaneous rheolytic thrombectomy device (Angiojet ® Rheolytic thrombectomy catheter, Boston Scientific, Marlborough, MA, USA) was used in all patients in an angiography suite through ipsilateral popliteal vein access. Thrombus clearance and complications were evaluated. Furthermore, patients underwent a clinical evaluation according to a modified Villalta scale for the investigation of post thrombotic syndrome in follow-up. The Venous Clinical Severity Score, Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Sym questionnaires were completed preoperatively and readministered postoperatively. Results Overall thrombus clearance (complete recanalization was achieved in 58 patients (85.2%) and partial recanalization was achieved in 7 patients (10.2%) confirmed through venographic assessment was achieved in 95.5% of the patient population. The mean Venous Clinical Severity Score preoperatively was 13.1 ± 2.2 and decreased to 4.0 ± 1.3 postoperatively (P < 0.01). The Villalta scale dropped from 12.9 ± 2.8 to 5.5 ± 1.4 postoperatively (P < 0.001). Overall quality of life and symptoms improved as assessed by Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Sym (P < 0.01 and 0.02, respectively). Only three minor bleedings were seen but none of the patients suffered from major bleeding, symptomatic pulmonary embolism, death, or other procedure related complications. Fifty-nine out of 65 patients (90.7%) who were treated successfully with rheolytic thrombectomy remained patent at 12 months according to DUS and five patients (7.3%) developed a mild post thrombotic syndrome. Conclusion Rheolytic thrombectomy with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. This technique is a safe, effective and easily performed method of endovascular treatment with a low rate of major treatment complications and shows promising clinical mid-term results.
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Affiliation(s)
- Mert Dumantepe
- Department of Cardiovascular Surgery, Bahcesehir University, Istanbul, Turkey
| | - Ibrahim Uyar
- Department of Cardiovascular Surgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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A Multicenter, Retrospective Study of the Effectiveness of the Trellis-8 System in the Treatment of Proximal Lower-Extremity Deep Vein Thrombosis. Ann Vasc Surg 2015; 29:1633-41. [PMID: 26256710 DOI: 10.1016/j.avsg.2015.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/20/2015] [Accepted: 05/30/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Deep vein thrombosis (DVT) occurs in up to 600,000 patients in the United States annually and can lead to long-term morbidity because of the post-thrombotic syndrome. The multicenter isolated-pharmacomechanical thrombolysis device (ISOL-8) study was designed to determine the safety and efficacy of the Trellis™-8 peripheral infusion system when used as the primary intervention to achieve DVT thrombolysis in patients with proximal lower-extremity occlusive DVT, and track the incidence and severity of the post-thrombotic syndrome (PTS) symptoms in patients 2 years after treatment. METHODS Data were collected retrospectively from 6 centers on patients treated with the Trellis-8 system, an isolated-pharmacomechanical thrombolysis device (IPMTD). Patients with occlusive lower-extremity DVT involving at least the iliac and/or common femoral vein were included. Patient demographics, medical history, procedure outcomes, complications, and follow-up venous duplex and Venous Clinical Severity Score (VCSS) were collected through 24 months. Data analysis of outcomes were performed at 1 and 12 months. A 24-month analysis was not performed because of the small number of patients for whom 24-month data could be collected. RESULTS A total of 151 limbs in 139 patients were treated with IPMTD. The mean ± standard deviation (SD) procedure time was 122.6 ± 63.4 min. Single session treatment was delivered in 69.9% (93 of 133) of cases. Occlusive DVT extended from the femoral into the external and/or common iliac vessel segments in most of the cases (113 of 151 limbs; 74.8%). Before treatment, 23.2% (35 of 151) of the treated limbs, based on a history of prior ipsilateral DVT or preoperative imaging revealing chronic venous scar, were expected to have some chronic venous disease despite presenting with acute symptoms. After treatment, 43.7% (66 of 151) of the limbs showed evidence of chronic thrombus. The average amount (mean ± SD) of thrombolysis, as determined by venogram, was highest in patients who had acute thrombus (81 ± 19.7%), compared with subacute thrombus (61 ± 22.5%) and complex cases involving acute and/or subacute thrombus on chronic scar (56 ± 26.5%). VCSS scoring showed the number of patients with none and/or mild pain, varicose veins, and skin changes at 1-month remained stable at 12 months whereas the percent of patients with none and/or mild venous edema improved from 71.7% at 1 month (38 of 53) to 86.8% (46 of 53) at 12 months. Twenty-four-month follow-up data were available for only 15% (23 of 151) of patients. No clinically significant pulmonary emboli or major periprocedural bleeding events were reported. CONCLUSIONS Patients with acute lower-extremity DVT involving the proximal veins can be safely and successfully treated with IPMTD. Major procedural bleeding was absent. The occurrence of severe PTS after primary treatment with Trellis-8 system IPMTD is low. Further long-term follow-up data are needed to confirm the benefit of intervention for thrombus removal compared with standard medical management.
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Ackerman J, Kurdziel MD, Dutcheshen NT. Extensive Lower-Extremity Deep Venous Thrombosis Following Arthroscopic Anterior Cruciate Ligament Reconstruction Related to May-Thurner Syndrome: A Case Report. JBJS Case Connect 2015; 5:e49. [PMID: 29252703 DOI: 10.2106/jbjs.cc.n.00202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An extensive iliofemoral-popliteal deep venous thrombosis following arthroscopic anterior cruciate ligament reconstruction presented on the ninth postoperative day as the result of underlying May-Thurner syndrome. The patient was managed with therapeutic anticoagulation and mechanical disruption of the thrombus. The focal stenosis of the left common iliac vein was addressed with angioplasty and stent placement. Repeat venography demonstrated no residual stenosis of the vein. CONCLUSION A multidisciplinary approach remains necessary for treating and reducing the risk of post-thrombotic syndrome. The present case further emphasizes the need for aggressive workup and response when a patient presents with left-sided deep venous thrombosis associated with underlying May-Thurner syndrome.
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Affiliation(s)
- Jeffrey Ackerman
- Department of Orthopaedic Surgery, Beaumont Health System, 3535 West 13 Mile Road, Suite 744, Royal Oak, MI 48073
| | - Michael D Kurdziel
- Department of Orthopaedic Research, Beaumont Health System, 3811 West 13 Mile Road, Suite 404, Royal Oak, MI 48073.
| | - Nicholas T Dutcheshen
- Department of Orthopaedic Surgery, Beaumont Health System, 3535 West 13 Mile Road, Suite 744, Royal Oak, MI 48073
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Maia M, Cruz A, Vidoedo J, Almeida Pinto J. Síndrome pós‐trombótica e qualidade de vida em doentes com trombose venosa ilio‐femoral. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/j.ancv.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Arienti V, Di Giulio R, Cogliati C, Accogli E, Aluigi L, Corazza GR. Bedside ultrasonography (US), Echoscopy and US point of care as a new kind of stethoscope for Internal Medicine Departments: the training program of the Italian Internal Medicine Society (SIMI). Intern Emerg Med 2014; 9:805-14. [PMID: 25145290 DOI: 10.1007/s11739-014-1113-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023]
Abstract
In recent years, thanks to the development of miniaturized ultrasound devices, comparable to personal computers, tablets and even to smart phones, we have seen an increasing use of bedside ultrasound in internal medicine departments as a novel kind of ultrasound stethoscope. The clinical ultrasound-assisted approach has proved to be particularly useful in assessing patients with nodules of the neck, dyspnoea, abdominal pain, and with limb edema. In several cases, it has allowed a simple, rapid and precise diagnosis. Since 2005, the Italian Society of Internal Medicine and its Ultrasound Study Group has been holding a Summer School and training courses in ultrasound for residents in internal medicine. A national network of schools in bedside ultrasound was then organized for internal medicine specialists who want to learn this technique. Because bedside ultrasound is a user-dependent diagnostic method, it is important to define the limits and advantages of different new ultrasound devices, to classify them (i.e. Echoscopy and Point of Care Ultrasound), to establish appropriate different levels of competence and to ensure their specific training. In this review, we describe the point of view of the Italian Internal Medicine Society on these topics.
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Affiliation(s)
- Vincenzo Arienti
- Department of Internal Medicine, Internal Medicine A, Maggiore Hospital, Bologna, Italy,
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Saunders JH, Arya PH, Abisi S, Yong YP, MacSweeney S, Braithwaite B, Altaf N. Catheter-directed thrombolysis for iliofemoral deep vein thrombosis. Br J Surg 2013; 100:1025-9. [PMID: 23696442 DOI: 10.1002/bjs.9158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Recent international guidance recommends the use of catheter-directed thrombolysis (CDT) in selected patients with symptomatic iliofemoral deep vein thrombosis (DVT). The aim of this study was to estimate the potential increase in workload as a result of this recommendation. METHODS Using the radiology database, a review was performed of all DVTs diagnosed between August 2010 and February 2012 at a large tertiary referral hospital. The National Institute for Health and Clinical Excellence and American College of Chest Physicians guidance was applied retrospectively to this cohort, using case-note review by two independent clinicians to determine which patients would have been suitable for CDT. RESULTS Some 563 patients had DVT confirmed radiologically over the 18-month interval. Fifty-three of the 128 patients with iliofemoral DVT would have been eligible for intervention with CDT, equivalent to 4·4 patients per 100 000 per year. Only eight (15 per cent) of the 53 were actually referred to vascular services for treatment. All eight patients had successful CDT, which involved a stay in critical care for monitoring (median 2 (range 1-3) sessions). CONCLUSION Vascular units should be prepared for a major increase in the requirement for CDT for iliofemoral DVT. This increase will affect inpatient beds, the interventional radiology suite, critical care and interhospital referrals.
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Affiliation(s)
- J H Saunders
- Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK.
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Lee JH, Kwun WH, Suh BY. The results of aspiration thrombecomy in the endovascular treatment for iliofemoral deep vein thrombosis. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:292-7. [PMID: 23646315 PMCID: PMC3641369 DOI: 10.4174/jkss.2013.84.5.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/26/2013] [Accepted: 02/12/2013] [Indexed: 12/04/2022]
Abstract
Purpose The aim of this study is to evaluate the results of aspiration thrombectomy (AT) in the endovascular treatment for iliofemoral deep vein thrombosis (DVT) through the comparison of catheter directed thrombolysis (CDT) alone group and CDT with AT group. Methods From November 2001 to April 2011, 100 patients received endovascular treatment with CDT alone or CDT with AT for iliofemoral DVT at Yeungnam University Medical Center. We compared procedure, clinical outcomes and complications between the two groups. Results The mean age of patients was 60.48 ± 14.57 years. The patients consisted of 41 men and 59 women. CDT alone and CDT with AT were performed in 29 and 71 patients, respectively. The mean procedural time of the CDT-alone group was longer than the CDT with AT group (P < 0.001) and dose of urokinase used during the procedure significantly decreased in the CDT with AT group (P < 0.001). There were no statistically significant differences in clinical outcomes between the two groups. Cases of pulmonary embolism was not noted in each group in our series, but entrapped thrombus during procedure was noted in 6 of 37 in the CDT with AT group and 0 of 9 in the CDT-alone group among 46 patients with prophylactic inferior vena cava (IVC) filter insertion. Conclusion In conclusion, CDT with AT is safe and effective for the treatment of an acute iliofemoral DVT. In AT treatment, prophylactic IVC filter insertion should be considered for the prevention of pulmonary embolism by floating thrombi.
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Affiliation(s)
- Jae Hoon Lee
- Division of Vascular Surgery, Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
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