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Bissacco D, Mandigers TJ, Romagnoli S, Aprea T, Lomazzi C, D'Alessio I, Ascenti V, Ierardi AM, Domanin M, Tolva VS, Carrafiello G, Trimarchi S. Acute venous problems: Integrating medical, surgical, and interventional treatments. Semin Vasc Surg 2023; 36:307-318. [PMID: 37330243 DOI: 10.1053/j.semvascsurg.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
"Acute venous problems" refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment. Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.
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Affiliation(s)
- Daniele Bissacco
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy.
| | - Tim J Mandigers
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Romagnoli
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Aprea
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilenia D'Alessio
- Vascular Surgery Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Gianpaolo Carrafiello
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
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Fang D, Li T, Wu Z, Wang Q, Wan M, Zhou M, Mao C. Dual drive mode polydopamine nanomotors for continuous treatment of an inferior vena cava thrombus. J Mater Chem B 2021; 9:8659-8666. [PMID: 34608926 DOI: 10.1039/d1tb01202a] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It is of great significance to find effective thrombolytic treatments due to the harm caused by thrombosis to human health. Based on the formation mechanism and complex microenvironment of a thrombus, polydopamine nanomotors (PDANMs) modified by the peptide of Arg-Gly-Asp (RGD) and loaded with urokinase (UK) were designed and prepared. A polydopamine (PDA) substrate has a good photothermal conversion effect. Under near-infrared (NIR) light irradiation, it can not only perform photothermal therapy (PTT) on thrombus, but also provide the driving force of PDANMs. Thrombolytic drug UK was loaded in the mesoporous structure of the PDA substrate and can be released at the thrombus site for drug therapy. The modified RGD can target the thrombus site, moreover, benefiting from the guanidine group of L-arginine in the peptide chain, and RGD can interact with reactive oxygen species (ROS) in the thrombus microenvironment to produce nitric oxide (NO). NO not only propelled the movement of nanomotors, but also promoted the growth of vascular endothelial cells to repair damaged blood vessels. The experimental results show that NIR and NO can provide dual driving sources for the nanosystem to achieve continuous and deep penetration of the drug-loaded nanomotors at the thrombus site, while realizing the photothermal and drug synergistic therapy to enhance the therapeutic effect and promote the growth of vascular endothelium cells. This kind of thrombus treatment strategy based on nanomotor drug delivery systems will provide good technical support for the clinical treatment of inferior vena cava thrombus.
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Affiliation(s)
- Dan Fang
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, 210023, China.
| | - Ting Li
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, 210023, China.
| | - Ziyu Wu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qi Wang
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, 210023, China.
| | - Mimi Wan
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, 210023, China.
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Chun Mao
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, 210023, China.
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İNANGİL G. Pulmoner emboli vakalarında AngioJet yardımı ile yapılan reolitik farmako-mekanik trombektomi uygulamalarında anestezi deneyimimiz. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.990587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Evaluation of ultrasonic intravascular thrombectomy system on a rabbit model in the treatment of deep vein thrombosis. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.974368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Li GQ, Wang L, Zhang XC. AngioJet Thrombectomy Versus Catheter-Directed Thrombolysis for Lower Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials. Clin Appl Thromb Hemost 2021; 27:10760296211005548. [PMID: 33813903 PMCID: PMC8024451 DOI: 10.1177/10760296211005548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Early catheter-directed thrombolysis (CDT) for lower extremity deep vein thrombosis (LEDVT) can reduce post-thrombotic morbidity and the AngioJet thrombectomy is a new therapy that can be selected for the treatment of LEDVT. We performed a systematic review and meta-analysis of clinical trials comparing AngioJet versus CDT to assess the efficacy and safety of AngioJet thrombectomy. We systematically searched PubMed and Embase for clinical trials that published before November 1, 2020 and compared AngioJet thrombectomy and CDT in the treatment of LEDVT. We meta-analyzed effective rate of treatment, serious complications, PTS, Villalta score, duration of treatment and drug dose. AngioJet does not result in a significant difference in the effective rate (OR 1.00, CI 0.73-1.36, P = 0.98; I2 = 0%) and complications (OR 1.16 CI 0.84-1.61, P = 0.36; I2 = 39%) compare to CDT. And there was a statistically significant decrease in incidence of PTS (OR 0.58 CI 0.37-0.91, P = 0.02; I2 = 0%) and Villalta score (OR −1.86 CI −3.49 to −0.24, P = 0.02; I2 = 34%) for AngioJet compared to CDT. In addition, there was a statistically significant decrease in duration of the treatment (OR −2.45 CI −2.75 to −2.15, P < 0.0001; I2 = 95%) and drug dose (OR −3.15 CI −3.38 to −2.93, P < 0.0001; I2 = 98%) between AngioJet and CDT. AngioJet results in a low severity of PTS compared to CDT therapy. Moreover, the average duration of treatment and thrombolysis time was shorter in the AngioJet group compared to the CDT group. However, the AngioJet group was not significantly different in effective rate of treatment and serious complications compared to the CDT group.
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Affiliation(s)
- Guan Qiang Li
- Dalian Medical University, Dalian, China
- Department of Vascular Surgery, Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Lei Wang
- Department of Vascular Surgery, Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Xi Cheng Zhang
- Department of Vascular Surgery, Northern Jiangsu People’s Hospital, Yangzhou, China
- Dushu Lake Hospital Affiliated to Soochow University, Soochow, China
- Xi Cheng Zhang, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China.
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Jung SH, Son RC, Kim HK. Trans-jugular AngioJet rheolytic thrombectomy for acute deep vein thrombosis: Alternative to overcome the limitation of patient's position. J Vasc Access 2020; 22:701-706. [PMID: 32972290 DOI: 10.1177/1129729820959931] [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: 11/16/2022] Open
Abstract
BACKGROUND To introduce a transjugular retrograde approach for AngioJet rheolytic thrombectomy (RT) just after transjugular placement of inferior vena cava filter (IVCF) to treat acute deep vein thrombosis (DVT). METHODS From September 2018 to April 2019, transjugular Angiojet RT using pulse spray method was performed just after transjugular placement of IVCF in five patients (M:F = 3:2, mean age 70 years). Patients less than 165 cm in height with acute (<14 days) iliofemoral DVT were unable to assume a prone position. All patients underwent pre- and postprocedural venography to estimate thrombus reduction grade. Computed tomography angiograms at 3 and 6 months postoperative were compared with baseline scans. Post-thrombotic syndrome (PTS) symptoms were evaluated according to Villalta score during 12-month follow-up. RESULTS Mean procedure time for all procedures was 1.4 h. Thrombus was completely reduced in three patients and 50% to 99% reduction was noted in the other two. No patients had major complications during the hospital stay and follow-up period. Distal migration of IVCF occurred in one patient during the procedure and immediate IVCF repositioning was performed. No DVT remained in follow-up computed tomography scans of all patients. PTS did not develop in any patients during the follow-up period. CONCLUSION In patients who are unable to assume a prone position, a transjugular retrograde approach with AngioJet RT just after transjugular placement of IVCF to treat acute lower extremity DVT was a time-saving and easy alternative. During the procedure, attention to the guiding catheter position and AngioJet device movement was required to avoid affecting the IVCF.
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Affiliation(s)
- Sang-Hoon Jung
- Department of Radiology, Chamjoeun Hospital, Gwangju, Gyeonggi-do, Republic of Korea.,Department of Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam, Gyeonggi-do, Republic of Korea
| | - Rak Chae Son
- Department of Radiology, Chamjoeun Hospital, Gwangju, Gyeonggi-do, Republic of Korea
| | - Hyun Kyu Kim
- Department of Vascular Surgery, Chamjoeun Hospital, Gwangju, Gyeonggi-do, Republic of Korea
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Lu SY, Dalia AA, Lang M, Fitzsimons MG. Perioperative Outcomes of Thrombectomy Patients Using Venovenous Bypass and Suction Filtration With General Anesthesia. J Cardiothorac Vasc Anesth 2020; 35:1040-1045. [PMID: 33051147 DOI: 10.1053/j.jvca.2020.09.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/23/2020] [Accepted: 09/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE AngioVac (Angiodynamics, Latham, NY) is a novel drainage system that offers a less-invasive approach compared with open surgical thromboembolectomy to remove intracardiac and intravascular thrombotic and embolic material. For this study, the authors' single-center experience with patients undergoing thromboembolectomy using the AngioVac system was reviewed retrospectively to evaluate anesthetic management and postoperative complications. DESIGN Retrospective, observational study. SETTING Single institution, quaternary care hospital. PARTICIPANTS The study comprised 20 consecutive patients whose treatment included the AngioVac between January 2016 and November 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty patients underwent AngioVac suction filtration. The mean age was 56 years, and women comprised 35% of the patient cohort. Indications for AngioVac suction filtration included deep venous thrombosis involving the inferior vena cava (n = 12 [60%]), right atrial mass/thrombus (n = 11 [55%]), right ventricular mass/thrombus (n = 3 [15%]), and pulmonary embolism(n = 2 [10%]). All patients required vasopressor support, and nine patients (45%) required blood transfusion during the procedure. There was no intraoperative death or cardiac arrest associated with the procedure. The 30-day mortality was zero, and in-hospital mortality was 5% (1/20). Significant postoperative complications occurred in 11/20 patients (55%). Postoperative left ventricular dysfunction (36% v 0%; p < 0.05), preoperative shock requiring vasopressors (36% v 0%; p < 0.05), postoperative blood transfusion (100% v 56%; p < 0.05), and having undergone recent surgery (64% v 11%; p < 0.05) were associated with increased odds of experiencing postoperative complications. CONCLUSIONS The rate of intraoperative complication during AngioVac suction filtration is low, but vasopressors and blood transfusions often are required. Patients at increased risk of developing postoperative complications potentially can be identified as having undergone recent surgery, experiencing preoperative shock requiring vasopressors or postoperative left ventricular dysfunction, and requiring postoperative blood transfusion.
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Affiliation(s)
- Shu Y Lu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Adam A Dalia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
| | - Maximilian Lang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Michael G Fitzsimons
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
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Li W, Li Q, Zhai S, Li T, Cheshire N, Zhang Z, Liang K. In vitro investigation of a new thrombus aspiration and autologous blood reinfusion system. J Interv Med 2019; 2:12-15. [PMID: 34805863 PMCID: PMC8562152 DOI: 10.1016/j.jimed.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The aim of the study was to evaluate the feasibility of a new venous-thrombus aspiration and autologous blood (auto-blood) reinfusion system. Materials and methods We constructed the venous model from polyvinyl chloride (PVC) tubes and three-way unions using a fresh clot of chicken blood as the venous thrombus. Eight French and 12F aspiration catheters were used to aspirate the thrombus in the right–pulmonary-artery model, 8 French and 14F aspiration catheters were used in the inferior–vena cava model, and 8 French and 10F aspiration catheters were used in the left–iliofemoral-vein model. A thrombus filtration and auto-blood reinfusion bottle was used to filter the thrombus and re-infuse auto-blood. We evaluated the thrombus aspiration capability of each catheter by comparing pre-aspirated with the post-aspirated thrombus volume, and we evaluated the difference in aspiration capability between the two catheters in each model by comparing their thrombus aspiration rates. We used Student's t-test for statistical analysis. Results Differences between pre-aspirated and post-aspirated thrombus volumes for each catheter were insignificant, as were those between the thrombus aspiration rates of the two catheters in each venous model. Using the thrombus aspiration and auto-blood reinfusion system, each aspiration catheter could fluently aspirate the thrombus out of the venous model. Conclusion In this study, we designed a new venous-thrombus aspiration system. This system could be used to aspirate acute venous thrombi and re-infuse autologous blood.
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Wang W, Sun R, Chen Y, Liu C. Meta-analysis and systematic review of percutaneous mechanical thrombectomy for lower extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2018; 6:788-800. [DOI: 10.1016/j.jvsv.2018.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/05/2018] [Indexed: 01/01/2023]
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Wang H, Qi X, Luo H, Zhang Q, Chen Y, Sun J. Catheter-directed thrombolysis through anterior tibial vein for treating acute extensive deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2018; 6:681-688. [PMID: 30126796 DOI: 10.1016/j.jvsv.2018.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility, efficacy, and safety of catheter-directed thrombolysis (CDT) through an anterior tibial vein approach for acute extensive lower extremity deep venous thrombosis (DVT). METHODS There were 125 consecutive patients with acute extensive lower extremity DVT who received CDT through an anterior tibial vein approach between October 2014 and June 2017. The patients with iliac vein compression syndrome were treated with balloon dilation and stent implantation after CDT. The thrombus score differences, limb circumference differences, venous patency, and complications were retrospectively analyzed. RESULTS The anterior tibial vein approach was successfully achieved in 118 patients (94.40% [118/125]). The mean thrombolysis time was 5.28 ± 1.10 days, and the average dose of urokinase was 3,903,400 ± 766,900 IU. Metal stents were placed in 50 patients (42.37% [50/118]). There were 109 patients (92.37% [109/118]) who had successful lysis (grade II and grade III lysis); 31 patients (91.18% [31/34]) achieved grade III lysis (no residual thrombus) within 3 days of symptom onset. In contrast, only 33.96% (18/53) of those treated within 4 to 7 days and 9.68% (3/31) of those treated after 7 days achieved grade III lysis. Compared with findings before CDT, the limb circumference above and below the knee was significantly reduced (7.22 ± 2.54 cm vs 1.58 ± 0.75 cm and 5.14 ± 1.41 cm vs 1.19 ± 0.49 cm, respectively). The incidence of bleeding was 10.17% (12/118). Six patients had puncture site bleeding, and three patients suffered major bleeding. One puncture site infection and two catheter-directed infections were observed during treatment. Two patients had accidental anterior tibial artery injury and recovered without complications, and no nerve injury occurred. During a follow-up of 19.39 ± 7.47 months (6-32 months), femoral venous insufficiency and popliteal venous insufficiency were present in 21.65% (21/97) and 30.93% (30/97) of the patients. The overall patency and post-thrombotic syndrome rates were 83.51% (81/97) and 21.65% (21/97). CONCLUSIONS CDT through an anterior tibial vein approach is a feasible, effective, and safe method for acute extensive lower extremity DVT patients. In addition, the anterior tibial vein approach can be an alternative to the traditional CDT approach.
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Affiliation(s)
- Haiyang Wang
- Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaotong Qi
- Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hailong Luo
- Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qian Zhang
- Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yikuan Chen
- Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jianming Sun
- Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
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Wang H, Qi X, Chen Y, Sun J. A Retrospective Study Comparing 2 Approaches to Catheter-Directed Thrombolysis for Acute Deep Venous Thrombosis. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2017.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Marietta M, Romagnoli E, Cosmi B, Coluccio V, Luppi M. Is there a role for intervention radiology for the treatment of lower limb deep vein thrombosis in the era of direct oral anticoagulants? A comprehensive review. Eur J Intern Med 2018; 52:13-21. [PMID: 29655806 DOI: 10.1016/j.ejim.2018.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
Despite recent advances in the treatment of Deep Vein Thrombosis (DVT) provided by Direct Oral Anticoagulants (DOAC), a substantial proportion of lower limb DVT patients will develop some degree of post-thrombotic syndrome (PTS) within 2 years. Systemic thrombolysis, although effective in reducing the risk of PTS and leg ulceration, is associated with a high risk of major bleeding, making it unsuitable for the vast majority of patients. A local approach, aimed at delivering the fibrinolytic drug directly into, or near to, the thrombus surface, is attractive because of the possibility of lowering of the administered drug dose, thus reducing the bleeding risks. However, even after the recent publication of the ATTRACT trial, only weak evidence is available about the efficacy and safety of Catheter Directed Thrombolysis (CDT), either alone (pharmacological technique) or in combination with additional endovascular approaches (pharmacomechanical technique, PMT) including percutaneous mechanical thrombectomy, angioplasty with or without stenting and ultrasound-assisted CDT. The present review is aimed at providing the physicians with a comprehensive evaluation of the current evidence about this relevant topic, in order to build a reliable conceptual framework for a more appropriate use of this resource.
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Affiliation(s)
- Marco Marietta
- Hematology Unit, Azienda Ospedaliero-Universitaria di Modena, Italy.
| | - Elisa Romagnoli
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Benilde Cosmi
- Department of Angiology & Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Valeria Coluccio
- Hematology Unit, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Mario Luppi
- Hematology Unit, Azienda Ospedaliero-Universitaria di Modena, Italy; Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Italy
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Ram H, Gerlach RM, Hernandez Conte A, Ramzy D, Jaramillo-Huff AR, Gerstein NS. The AngioVac Device and Its Anesthetic Implications. J Cardiothorac Vasc Anesth 2017; 31:1091-1102. [DOI: 10.1053/j.jvca.2016.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Indexed: 11/11/2022]
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Yuksel A, Tuydes O. Midterm Outcomes of Pharmacomechanical Thrombectomy in the Treatment of Lower Extremity Deep Vein Thrombosis With a Rotational Thrombectomy Device. Vasc Endovascular Surg 2017; 51:301-306. [DOI: 10.1177/1538574417708726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study was to assess the safety and efficacy with midterm outcomes of pharmacomechanical thrombectomy (PMT) performed by using a relatively new thrombectomy device in the treatment of lower extremity deep vein thrombosis (DVT). Methods: Between February 2014 and February 2016, a total of 46 patients with lower extremity DVT were treated with PMT by using Cleaner rotational thrombectomy system. Preprocedural, intraprocedural, postprocedural, and follow-up records of patients were collected and retrospectively analyzed. Results: Mean age of patients was 50.5 (14.8) years, and 58.7% of them were female. Technical success rate of procedure was 91.3%. Mean procedure time was 81.8 (40.3) minutes. Early clinical improvement was observed in all patients with successful treatment. No serious adverse event related to procedure and mortality was observed. Mean follow-up time was 16.0 (7.9) months. Reocclusion was observed in 7 (17.5%) patients during the follow-up period. Venous patency rates of patients at 1-, 3-, 6-, and 12-month follow-up visits were 95%, 92.5%, 89.7%, and 79.5%, respectively. Mild, moderate, and severe postthrombotic syndrome were observed in 8 (20%) patients, 4 (10%) patients, and 1 (2.5%) patient, respectively. Postthrombotic syndrome–free survival rate was 67.5%. Conclusion: Cleaner rotational thrombectomy system appears to be safe and effective in the treatment of lower extremity DVT. Further larger randomized studies are needed to determine the long-term outcomes of this treatment modality.
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Affiliation(s)
- Ahmet Yuksel
- Department of Cardiovascular Surgery, Bursa State Hospital, Bursa, Turkey
| | - Oktay Tuydes
- Department of Cardiovascular Surgery, Bingol State Hospital, Bingol, Turkey
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Development of a new catheter prototype for laser thrombolysis under guidance of optical coherence tomography (OCT): validation of feasibility and efficacy in a preclinical model. J Thromb Thrombolysis 2017; 43:352-360. [DOI: 10.1007/s11239-016-1470-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Deep venous thrombosis (DVT) occurs in approximately one in 1000 adults every year, and has an annual mortality of 14.6%. In particular, iliofemoral DVT can lead to recurrent thrombosis and post-thrombotic syndrome (PTS), a painful condition which can lead to chronic venous insufficiency, oedema, and ulceration. It causes significant disability, impaired quality of life, and economic burden. Early thrombus removal techniques have been advocated in patients with an iliofemoral DVT in order to improve vein patency, prevent valvular dysfunction, and reduce future complications, such as post-thrombotic syndrome and venous ulceration. One such technique is pharmacomechanical thrombectomy, a combination of catheter-based thrombectomy and catheter-directed thrombolysis. OBJECTIVES To assess the effects of pharmacomechanical thrombectomy versus anticoagulation (alone or with compression stockings), mechanical thrombectomy, thrombolysis, or other endovascular techniques in the management of people with acute DVT of the iliofemoral vein. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Specialised Register (last searched December 2015) and the Cochrane Register of Studies (last searched December 2015). We searched clinical trials databases for details of ongoing or unpublished studies and the reference lists of relevant articles retrieved by electronic searches for additional citations. SELECTION CRITERIA Randomised controlled trials in which patients with an iliofemoral deep vein thrombosis were allocated to receive pharmacomechanical thrombectomy versus anticoagulation, mechanical thrombectomy, thrombolysis (systemic or catheter directed thrombolysis), or other endovascular techniques for the treatment of iliofemoral DVT. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies identified for potential inclusion. MAIN RESULTS We found no randomised controlled trials that met the eligibility criteria for this review. We identified one ongoing study. AUTHORS' CONCLUSIONS There were no randomised controlled trials that assessed the effects of pharmacomechanical thrombectomy versus anticoagulation (alone or with compression stockings), mechanical thrombectomy, thrombolysis, or other endovascular techniques in the management of people with acute DVT of the iliofemoral vein that met the eligibility criteria for this review. Further high quality randomised controlled trials are needed.
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Affiliation(s)
- Lindsay Robertson
- Freeman HospitalDepartment of Vascular SurgeryNewcastle upon Tyne Hospitals NHS Foundation TrustHigh HeatonNewcastle upon TyneUKNE7 7DN
| | - Olivia McBride
- Royal Infirmary of EdinburghDepartment of Vascular SurgeryEdinburghUK
| | - Anne Burdess
- Royal Infirmary of EdinburghDepartment of Vascular SurgeryEdinburghUK
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