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Duarte-Gamas L, Jácome F, Dias LR, Rocha-Neves J, Yeung KK, Baekgaard N, Dias-Neto M. Catheter-Directed Thrombolysis Protocols for Deep Venous Thrombosis of the Lower Extremities-A Systematic Review and Meta-analysis. Thromb Haemost 2024; 124:89-104. [PMID: 37279794 DOI: 10.1055/a-2106-3754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To summarize characteristics, complications, and success rates of different catheter-directed thrombolysis (CDT) protocols for the treatment of lower extremity deep venous thrombosis (LE-DVT). METHODS A systematic review using electronic databases (MEDLINE, Scopus, and Web of Science) was performed to identify randomized controlled trials and observational studies related to LE-DVT treated with CDT. A random-effects model meta-analysis was performed to obtain the pooled proportions of early complications, postthrombotic syndrome (PTS), and venous patency. RESULTS Forty-six studies met the inclusion criteria reporting 49 protocols (n = 3,028 participants). In studies that addressed the thrombus location (n = 37), LE-DVT had iliofemoral involvement in 90 ± 23% of the cases. Only four series described CDT as the sole intervention for LE-DVT, while 47% received additional thrombectomy (manual, surgical, aspiration, or pharmacomechanical), and 89% used stenting.Definition of venogram success was highly variable, being the Venous Registry Index the most used method (n = 19). Among those, the minimal thrombolysis rate (<50% lysed thrombus) was 0 to 53%, partial thrombolysis (50-90% lysis) was 10 to 71%, and complete thrombolysis (90-100%) was 0 to 88%. Pooled outcomes were 8.7% (95% confidence interval [CI]: 6.6-10.7) for minor bleeding, 1.2% (95% CI: 0.8-1.7%) for major bleeding, 1.1% (95% CI: 0.6-1.6) for pulmonary embolism, and 0.6% (95% CI: 0.3-0.9) for death. Pooled incidences of PTS and of venous patency at up to 1 year of follow-up were 17.6% (95% CI: 11.8-23.4) and 77.5% (95% CI: 68.1-86.9), respectively. CONCLUSION Assessment of the evidence is hampered by the heterogeneity of protocols, which may be reflected in the variation of PTS rates. Despite this, CDT is a low-risk treatment for LE-DVT.
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Affiliation(s)
- Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipa Jácome
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lara Romana Dias
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Biomedicine Department - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Kak K Yeung
- Department of Vascular Surgery, Amsterdam University Medical Centres, location VUmc, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Niels Baekgaard
- Department of Vascular Surgery, Rigshospitalet and Gentofte Hospital, Copenhagen, Denmark
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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İnce S, Özgokçe M, Özkaçmaz S, Dündar İ, Türko E, Ayyıldız VA, Göya C. Comparison of Medical Treatment Efficiency With Shear Wave Elastography Values of Thrombus in Patients With Lower Extremity Deep Vein Thrombosis. Ultrasound Q 2023; 39:158-164. [PMID: 37289425 DOI: 10.1097/ruq.0000000000000643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
ABSTRACT In lower-extremity deep vein thrombosis (DVT), thrombus age is essential for successful treatment. The aim of our study was to compare the shear wave elastography (SWE) values measured before treatment and achieved lumen patency after treatment in lower-extremity DVT patients with total occlusion. Patients diagnosed with DVT in the acute-subacute stage (<4 week) with total thrombosis in lower extremity were included in this prospective study. Shear wave elastography measurements were performed where the thrombus was most prominent and homogeneous. To evaluate patient response to treatment, lumen patency (partial [>25%] or total recanalization) was examined using color Doppler imaging in the first and third months posttreatment. Shear wave elastography values with and without patency were compared using an independent t test. Among 75 patients in this study, at the first-month color Doppler imaging examination, the SWE values were 1.77 ± 0.49 (1.09-3.03) m/s in patients who achieved lumen patency (n = 42) and 2.21 ± 0.54 (1.24-3.36) m/s in those who did not show lumen patency (n = 33). The difference between the groups' mean elastography value was statistically significant ( P < 0.001). At the third-month examination, the SWE values were 1.76 ± 0.46 (1.09-3.03) m/s in patients with lumen patency (n = 55) and 2.52 ± 0.48 (1.74-3.36) in patients without lumen patency (n = 20). The difference between the 2 groups' mean elastography value was statistically significant ( P < 0.001). We concluded that it is more difficult to achieve lumen patency in veins occluded by thrombus with higher elasto values, and endovascular interventional procedures should be considered during the initial treatment of high SWE value thrombosis.
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Affiliation(s)
- Suat İnce
- Department of Radiology, Van Training and Research Hospital
| | - Mesut Özgokçe
- Department of Radiology, Medical Faculty, Van Yuzuncu Yıl University, Van
| | - Sercan Özkaçmaz
- Department of Radiology, Medical Faculty, Van Yuzuncu Yıl University, Van
| | - İlyas Dündar
- Department of Radiology, Medical Faculty, Van Yuzuncu Yıl University, Van
| | - Ensar Türko
- Department of Radiology, Medical Faculty, Van Yuzuncu Yıl University, Van
| | - Veysel A Ayyıldız
- Department of Radiology, Medical Faculty, Süleyman Demirel University, Isparta, Turkey
| | - Cemil Göya
- Department of Radiology, Medical Faculty, Van Yuzuncu Yıl University, Van
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Munakata M, Kanazawa H, Kimura K, Arai T, Sukegawa H, Fukuda K. Assessment of cardiac function in rat endovascular perforation model of subarachnoid hemorrhage; A model of subarachnoid hemorrhage-induced cardiac dysfunction. Front Synaptic Neurosci 2022; 14:919998. [PMID: 36017128 PMCID: PMC9396209 DOI: 10.3389/fnsyn.2022.919998] [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] [Received: 04/14/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Although the association between cardiac dysfunction and subarachnoid hemorrhage (SAH) has been recognized, its precise underlying mechanism remains unknown. Furthermore, no suitable animal models are available to study this association. Here, we established an appropriate animal model of SAH-induced cardiac dysfunction and elucidated its mechanism. In this rat model, contrast-enhanced computed tomography of the brain confirmed successful induction of SAH. Electrocardiography detected abnormalities in 55% of the experimental animals, while echocardiography indicated cardiac dysfunction in 30% of them. Further evaluation of left ventriculography confirmed cardiac dysfunction, which was transient and recovered over time. Additionally, in this SAH model, the expression of the acute phase reaction protein, proto-oncogene c-Fos increased in the paraventricular hypothalamic nucleus (PVN), the sympathetic nerve center of the brain. Polymerase chain reaction analysis revealed that the SAH model with cardiac dysfunction had higher levels of the macrophage-associated chemokine (C-X-C motif) ligand 1 (CXCL-1) and chemokine (C-C motif) ligand 2 (CCL-2) than the SAH model without cardiac dysfunction. Our results suggested that SAH caused inflammation and macrophage activation in the PVN, leading to sympathetic hyperexcitability that might cause cardiac dysfunction directly and indirectly. This animal model may represent a powerful tool to investigate the mechanisms of the brain-heart pathway.
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Affiliation(s)
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Hideaki Kanazawa,
| | | | - Takahide Arai
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Sukegawa
- Division of Cardiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- *Correspondence: Keiichi Fukuda,
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Lu ZX, Wei HL, Shi Y, Huang H, Su H, Chen L. Safety and Efficacy of Endovascular Treatment on Pregnancy-Related Iliofemoral Deep Vein Thrombosis. Clin Appl Thromb Hemost 2022; 28:10760296221124903. [PMID: 36083157 PMCID: PMC9465584 DOI: 10.1177/10760296221124903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: This study investigates the safety and efficacy of
endovascular treatments on pregnancy-related iliofemoral deep vein thrombosis
(DVT). Methods: We retrospectively reviewed data of 46 patients
who had symptomatic pregnancy-related iliofemoral DVT and underwent endovascular
treatment. The patients treated with catheter-directed thrombolysis (CDT) were
classified as the CDT group. In contrast, those treated with CDT combined with
pharmacomechanical thrombectomy (PMT) or angioplasty/stenting were classified as
the pharmacomechanical catheter-directed thrombolysis (PCDT) group.
Results: Based on the immediate post-operative clot burden
reduction rate analysis of 46 patients: 22 cases were completely dissolved
(lysis grades III), 12 were partially dissolved (lysis grades II), and 12 failed
(lysis grades I). There was a statistically significant difference in the rate
of clot burden reduction between the CDT group (n = 19) and the PCDT group
(n = 27) (p = 0.001). There was no statistically significant
difference in the number of bleeding events between the two groups
(p = 0.989). At 24 months, cumulative venous patency in the
CDT group was 50.0%, compared to 78.2% in the PCDT group. Furthermore, there was
a statistically significant difference in Villalta score
(p = 0.001) and venous severity scoring (VCSS score)
(p = 0.005) between the two groups.
Conclusions: CDT treatment combined with PMT or
angioplasty/stenting is comparatively safe and effective for pregnant-related
DVT patients. PCDT outperforms CDT in terms of immediate efficacy and reduces
the incidence of post-thrombotic syndrome with better midterm outcomes.
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Affiliation(s)
- Zhao-Xuan Lu
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Heng-Le Wei
- Department of Radiology, 579164The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Yadong Shi
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Huang
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haobo Su
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Yu H, Du X, Li W, Song D, Li X, Gao P. The Midterm Effect of Iliac Vein Stenting following Catheter-directed Thrombolysis for the Treatment of Deep Vein Thrombosis. Ann Vasc Surg 2018; 50:1-7. [PMID: 29496568 DOI: 10.1016/j.avsg.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 09/12/2017] [Accepted: 01/27/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND When following catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT), the stenosed iliac veins is controversy. To evaluate the mid-term outcomes of CDT with or without stent implantation for DVT in the presence of iliac vein compression. METHODS Seventy-three patients with iliac vein compression following CDT for acute lower extremity DVT from January 2009 to December 2014 were retrospectively analyzed. There were 32 males and 41 females, with average age of 53.57 ± 15.60 years (median: 45 years, range: 20-79 years). After CDT, patients with iliac vein compression were divided into 2 groups: the stenting group (n = 40) and the nonstenting group (n = 33). Patency rate of the deep vein, chronic change of vessels, clinical, etiological, anatomical, and pathological elements (CEAP) classification, venous clinical severity score, and Villalta scale were chosen to evaluate the midterm and long-term outcomes. RESULTS Eighty-eight limbs among the patients (58 unilateral and 15 bilateral) were followed with mean time of 38.38 ± 14.91 months. The difference in vein patency between 2 groups (85.17 ± 25.62 vs. 54.61 ± 40.42) was statistically significant (P < 0.05). According to the C in CEAP classification, the difference in clinical manifestations between the 2 groups was statistically significant (P < 0.05). In addition, the Villalta scale scores were also significantly different between the 2 groups (1.73 ± 2.86 vs. 4.39 ± 5.16, P < 0.05). CONCLUSIONS Stent implantation in severely stenosed iliac segments following CDT for lower extremity DVT increased the patency of deep veins and improved midterm quality of life compared with that of nonstenting.
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Affiliation(s)
- Huiying Yu
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Vascular Surgery, Jining No. 1 People's Hospital, Jining, China
| | - Xiaolong Du
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wendong Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dandan Song
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoqiang Li
- Department of Vascular Surgery, The Affiliated Nanjing Drum Tower Hosopital of Nanjing University Medical School, Nanjing, China.
| | - Peng Gao
- Department of Vascular Surgery, Jining No. 1 People's Hospital, Jining, China.
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Vedantham S, Sista AK, Klein SJ, Nayak L, Razavi MK, Kalva SP, Saad WE, Dariushnia SR, Caplin DM, Chao CP, Ganguli S, Walker TG, Nikolic B. Quality Improvement Guidelines for the Treatment of Lower-Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. J Vasc Interv Radiol 2014; 25:1317-25. [DOI: 10.1016/j.jvir.2014.04.019] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 02/07/2023] Open
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Abstract
Purpose: This study aimed to determine whether deep vein thrombosis (DVT) predominantly occurred on a particular side in the pelvic and lower extremity veins. Materials and Methods: Among 259 consecutive patients with leg swelling, 65 were confirmed to have DVT in the pelvis and lower extremities, and enrolled in this study. The serum levels of initial D-dimer, antithrombin III, tissue plasminogen activator, factor VIII, proteins C and S, anticardiolipin antibodies immunoglobulin (Ig) G and IgM and lupus anticoagulant were measured and analyzed retrospectively. Lower extremity venous system was divided into 11 anatomic segments on each side, and thrombotic involvement in each segment was recorded to determine the laterality of thrombotic involvement for each patient. The presence of thrombus in a specific vein was assigned using a Thrombus Scoring System (TSS) score of 1. Predominant direction was determined based on the TSS score for each side. Results: Left-side predominat DVT (57%) was most frequent. Patients with both-side equivalent DVT had the highest total TSS score (P=0.022). The predominant side was significantly different between men (right 44.1%) and women (left 74.2%) (P=0.022). Patients with both-side equivalent DVT had the highest mean age (69.3±9.9 years) as well as the highest mean levels of initial D-dimer (13.8±20.7 μg/mL) and anticardiolipin antibody IgM (13.4±22.8 MPL) indicating increased coagulability. Conclusion: In the current study, left-side predominant DVT is most frequent in pelvis and lower extremities, and this phenomenon is more apparent in women. And both-side equivalent DVT is associated with the most advanced age and hypercoagulability.
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Affiliation(s)
- Ha Song Shin
- Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jong Kwon Park
- Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
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Cohen A, Chiu KM, Park K, Jeyaindran S, Tambunan KL, Ward C, Wong R, Yoon SS. Managing venous thromboembolism in Asia: Winds of change in the era of new oral anticoagulants. Thromb Res 2012; 130:291-301. [DOI: 10.1016/j.thromres.2012.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/24/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
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Pappy R, Hanna EB, Abu-Fadel MS, Hennebry TA. Isolated pharmacomechanical thrombectomy for the management of chronic DVT. J Interv Cardiol 2010; 24:99-104. [PMID: 20735709 DOI: 10.1111/j.1540-8183.2010.00596.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Thrombo-reduction in the setting of deep vein thrombosis (DVT) to prevent the postthrombotic syndrome has not been traditionally managed by interventional cardiologists. We report a case series of successful chronic DVT management with pharmacomechanical thrombectomy utilizing the Trellis device.
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Affiliation(s)
- Reji Pappy
- University of Oklahoma Health Sciences Center, Department of Medicine, Section of Cardiovascular Medicine, Oklahoma City, Oklahoma, USA.
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No HK, Kim JS, Kim JY, Kim KR, Shin SH, Ahn SI, Cho YU, Kim SJ, Lee KY, Hur YS, Choi SK, Choe YM, Jeon YS, Cho SG, Hong KC. Inferior Vena Cava (IVC) Filter Retrieval Rates after Catheter Directed Thrombolysis or Pharmacomechanical Thrombectomy in Deep Vein Thrombosis (DVT) and Its Characteristics. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.6.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hyo Keun No
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Joong Suck Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Jang Yong Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Kyung Rae Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Seok-Hwan Shin
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Seung-Ik Ahn
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Young Up Cho
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Sei Joong Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Keon-Young Lee
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Yoon-Seok Hur
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Sun Keun Choi
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Yun-Mee Choe
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
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