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Grøtta O, Enden T, Sandbæk G, Gjerdalen GF, Slagsvold CE, Bay D, Kløw NE, Rosales A. Infrainguinal inflow assessment and endovenous stent placement in iliofemoral post-thrombotic obstructions. CVIR Endovasc 2018; 1:29. [PMID: 30652160 PMCID: PMC6319667 DOI: 10.1186/s42155-018-0038-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/31/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess the technical success, patency, and clinical outcome, following assessment of inflow and infrainguinal endovenous stent placement in patients with iliofemoral post-thrombotic obstruction with infrainguinal involvement. Methods A retrospective analysis of 39 patients with iliofemoral post-thrombotic venous obstruction accepted for infrainguinal stent placement in the period November 2009–December 2016. The clinical status was categorized according to the Clinical Etiological Anatomical Pathophysiological (CEAP) classification and symptom severity was assessed using Venous Clinical Severity Score (VCSS). The inflow was categorized as “good”, “fair”, or “poor” depending on vein caliber and extent of post-thrombotic changes in the inflow vessel(s). Stent patency was assessed by duplex ultrasound. Median follow-up was 44 months (range 2–90 months). Results Stent placement was successful in all 39 patients. Primary patency after 24 months was 78%. Thirty of 39 patients (77%) had open stents at final follow-up. Re-interventions were performed in four patients and included catheter-directed thrombolysis (CDT) in all and adjunctive stenting in two. Twenty-eight of 39 patients (72%) reported a sustained clinical improvement. Patients with “good” inflow had better patency compared to those with “fair”/“poor” (p = 0.01). One patient experienced acute contralateral iliofemoral thrombosis; this segment was successfully treated with CDT and stenting. No other complications required intervention. Conclusion Infrainguinal endovenous stent placement was a feasible and safe treatment with good patency and clinical results, and should be considered in patients with substantial symptoms from post-thrombotic obstructions with infrainguinal involvement. Stents with good inflow have better patency and inflow assessment is essential in deciding the optimal stent landing zone.
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Affiliation(s)
- Ole Grøtta
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.,4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway
| | - Tone Enden
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Gunnar Sandbæk
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.,4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway
| | - Gard Filip Gjerdalen
- 3Section of Vascular Investigations, Department of Vascular Surgery, Oslo University Hospital Aker, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Carl-Erik Slagsvold
- 3Section of Vascular Investigations, Department of Vascular Surgery, Oslo University Hospital Aker, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Dag Bay
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway
| | - Nils-Einar Kløw
- 1Division of Radiology and Nuclear Medicine, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway.,4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 1171, Blindern, 0318 Oslo, Norway
| | - Antonio Rosales
- 2Department of Vascular Surgery, Oslo University Hospital, PO Box 4950, Nydalen, N-0424 Oslo, Norway
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Grøtta O, Enden T, Sandbæk G, Gjerdalen G, Slagsvold CE, Bay D, Kløw NE, Rosales A. Patency and Clinical Outcome After Stent Placement for Chronic Obstruction of the Inferior Vena Cava. Eur J Vasc Endovasc Surg 2017; 54:620-628. [DOI: 10.1016/j.ejvs.2017.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
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Næss PA, Engeseth K, Grøtta O, Andersen GØ, Gaarder C. Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report. J Med Case Rep 2016; 10:132. [PMID: 27236329 PMCID: PMC4884622 DOI: 10.1186/s13256-016-0926-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022] Open
Abstract
Background Life-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery. Case presentation A 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient’s blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient’s arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was hemodynamically stable. She was weaned off mechanical ventilation 2 days later and made an uneventful recovery. She was discharged to a local hospital on day 13 without neurological disability. Conclusions Although rare, bleeding caused by liver injury due to chest compressions can be life-threatening after successful cardiopulmonary resuscitation. Reported mortality is high after surgical intervention, and patients may benefit from less invasive treatment strategies such as those presented in this case report.
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Affiliation(s)
- Pål Aksel Næss
- Department of Traumatology, Oslo University Hospital Ullevål, Nydalen Postbox 4956, N-0424, Oslo, Norway. .,Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital Ullevål, Oslo, Norway.
| | - Kristian Engeseth
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Ole Grøtta
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ullevål, Nydalen Postbox 4956, N-0424, Oslo, Norway
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Haig Y, Enden T, Grøtta O, Kløw NE, Slagsvold CE, Ghanima W, Sandvik L, Hafsahl G, Holme PA, Holmen LO, Njaaastad AM, Sandbæk G, Sandset PM. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol 2016; 3:e64-71. [PMID: 26853645 DOI: 10.1016/s2352-3026(15)00248-3] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Post-thrombotic syndrome is a common complication after acute proximal deep vein thrombosis (DVT) and is associated with reduced quality of life and a substantial cost burden. In the 2-year results of the CaVenT study, additional catheter-directed thrombolysis reduced the risk of post-thrombotic syndrome by 14% compared with conventional therapy, but did not affect quality of life. In this study we report results at the 5-year follow-up, aiming to assess whether findings for post-thrombotic syndrome and quality of life have persisted. METHODS Between Jan 3, 2006, and Dec 22, 2009, we recruited patients aged 18-75 years with a first-time high proximal leg DVT from 20 hospitals in the Norwegian southeastern health region. With sealed envelopes, participants were randomly assigned (1:1) to standard treatment with compression stockings and anticoagulants (control group) or to standard treatment plus catheter-directed thrombolysis with alteplase within 21 days from symptom onset. Pre-specified outcomes in this analysis were post-thrombotic syndrome at 5 years as assessed with the Villalta score and scores for quality of life at 5 years with EQ-5D and the disease-specific VEINES-QOL/Sym. Analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00251771. FINDINGS At 5 year follow-up (last date Oct 14, 2014), data were available for 176 patients (84% of the 209 patients originally randomised)--87 originally assigned to catheter-directed thrombolysis and 89 originally assigned to the control group. 37 patients (43%; 95% CI 33-53) allocated to catheter-directed thrombolysis developed post-thrombotic syndrome, compared with 63 (71%; 95% CI 61-79) allocated to the control group (p<0·0001), corresponding to an absolute risk reduction of 28% (95% CI 14-42) and a number needed to treat of 4 (95% CI 2-7). Four (5%) patients assigned to catheter-directed thrombolysis and one (1%) to standard treatment had severe post-thrombotic syndrome (Villalta score ≥ 15 or presence of an ulcer). Quality-of-life scores with either assessment scale did not differ between the treatment groups. INTERPRETATION Additional catheter-directed thrombolysis resulted in a persistent and increased clinical benefit during follow-up for up to 5 years, supporting the use of additional catheter-directed thrombolysis in patients with extensive proximal DVT. However, allocation to this therapy did not lead to better quality of life. The optimal endovascular thrombolytic approach needs further investigation. FUNDING Southeastern Norway Regional Health Authority, the Research Council of Norway, University of Oslo, Oslo University Hospital.
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Affiliation(s)
- Ylva Haig
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Tone Enden
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ole Grøtta
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Nils-Einar Kløw
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Waleed Ghanima
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway
| | - Leiv Sandvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Hafsahl
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål Andre Holme
- Department of Haematology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Olaf Holmen
- Department of Radiology, Østfold Hospital Trust, Fredrikstad, Norway
| | | | - Gunnar Sandbæk
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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