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Iding AFJ, Limpens TMP, Ten Cate H, Ten Cate-Hoek AJ. Chronic inflammatory diseases increase the risk of post-thrombotic syndrome: A prospective cohort study. Eur J Intern Med 2024; 120:85-91. [PMID: 37852838 DOI: 10.1016/j.ejim.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Clinical management of patients with deep vein thrombosis (DVT) is centered around their risk of recurrent venous thromboembolism (VTE) and post-thrombotic syndrome (PTS). While chronic inflammatory disease (CID) has been established as a risk factor of (recurrent) VTE, research about its potential impact on PTS is lacking. OBJECTIVES We aimed to assess the risk of PTS in patients with CID, stratifying for the use of anti-inflammatory treatment. PATIENTS/METHODS Consecutive patients with proximal DVT and no active cancer between 2003 and 2018 received a two-year prospective follow-up. CID included inflammatory bowel disease, rheumatic diseases, and gout. Residual venous obstruction (RVO) was assessed by compressive ultrasound after 3-6 months. PTS was diagnosed using the Villalta score after 6-24 months. Hazard ratios (HR) and odds ratios (OR) were adjusted for patient characteristics. The medical ethics committee approved this study. RESULTS In total 82 of 801 patients had CID (10.2 %). PTS more often developed in patients with CID (35.4% vs. 18.9 %, p < 0.001) than in those without CID (HR 1.72 [1.15-2.58]). The prevalence of RVO was similar in patients with and without CID (36.8% vs. 41.4 %), and RVO was strongly associated with PTS in patients with CID (OR 3.21 [1.14-9.03]). Moreover, patients with untreated CID (44 %, n = 36) more often had RVO than those with treated CID (51.6% vs. 26.7 %, p = 0.027), and accordingly had a higher risk of PTS (HR 2.18 [1.04-4.58]). CONCLUSIONS Patients with CID had an increased risk of developing PTS, especially those without anti-inflammatory treatment, possibly due to an unfavorable impact on RVO-related venous pathology.
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Affiliation(s)
- Aaron F J Iding
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Thibaut M P Limpens
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arina J Ten Cate-Hoek
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Thrombosis Expertise Center, Heart+Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
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2
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Jung G, Breiding PS, Schmitz-Rixen T, Hakimi M. [Pelvic vein thrombosis : Current treatment options and importance of recanalization procedures]. Chirurgie (Heidelb) 2024; 95:87-98. [PMID: 37792045 DOI: 10.1007/s00104-023-01964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 10/05/2023]
Abstract
Venous thrombosis is a frequent disorder. A distinction is made between an acute phase of the disease and a chronic manifestation, the postthrombotic syndrome. In particular, proximal venous thrombosis/pelvic vein thrombosis can cause a life-threatening pulmonary embolism during the acute phase of the disease. The postthrombotic syndrome is characterized by the remodeling of the affected venous section, which is often caused by inflammation. Locally, the typical clinical finding is caused by scarred stricture of the vein with restricted drainage and peripheral venous hypertension. Acute thrombosis should be primarily treated by therapeutic anticoagulation and compression therapy of the affected extremity. The duration of these measures depends on clinical presentation, cause (provoked, unprovoked) and risk factors for venous thrombosis/recurrent thrombosis. Venous revascularization procedures are important both in the acute phase of the disease and in the treatment of postthrombotic syndrome. The recanalization treatment is mostly carried out as an endovascular or hybrid intervention and venous bypass procedures are reserved for special situations.
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Affiliation(s)
- G Jung
- Klinik für Gefässchirurgie, Luzerner Kantonsspital, Spitalstr., 6000, Luzern 16, Schweiz.
| | - P S Breiding
- Radiologie, Sektion interventionelle Radiologie, Luzerner Kantonsspital, Spitalstr., 6000, Luzern 16, Schweiz
| | - T Schmitz-Rixen
- Deutsche Gesellschaft für Chirurgie, Luisenstr. 58-58, 10117, Berlin, Deutschland
| | - M Hakimi
- Klinik für Gefässchirurgie, Luzerner Kantonsspital, Spitalstr., 6000, Luzern 16, Schweiz
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3
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Shaikh A, Zybulewski A, Paulisin J, Bisharat M, Mouawad NJ, Raskin A, Ichinose E, Abramowitz S, Lindquist J, Azene E, Shah N, Nguyen J, Cockrell J, Khalsa B, Khetarpaul V, Murrey DA, Veerina K, Skripochnik E, Maldonado TS, Bunte MC, Annambhotla S, Schor J, Kado H, Mojibian H, Dexter D. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol 2023; 46:1571-1580. [PMID: 37580422 PMCID: PMC10615929 DOI: 10.1007/s00270-023-03509-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE Mechanical thrombectomy for the treatment of deep vein thrombosis (DVT) is being increasingly utilized to reduce symptoms and prevent postthrombotic syndrome (PTS), but more data on clinical outcomes are needed. Mechanical thrombectomy was studied in the ClotTriever Outcomes (CLOUT) registry with 6-month full analysis outcomes reported herein. MATERIALS AND METHODS The CLOUT registry is a prospective, all-comer study that enrolled 500 lower extremity DVT patients across 43 US sites treated with mechanical thrombectomy using the ClotTriever System. Core-lab assessed Marder scores and physician-assessed venous patency by duplex ultrasound, PTS assessment using Villalta score, venous symptom severity, pain, and quality of life scores through 6 months were analyzed. Adverse events were identified and independently adjudicated. RESULTS All-cause mortality at 30 days was 0.9%, and 8.6% of subjects experienced a serious adverse event (SAE) within the first 30 days, 1 of which (0.2%) was device related. SAE rethrombosis/residual thrombus incidence was 4.8% at 30 days and 8.0% at 6 months. Between baseline and 6 months, venous flow increased from 27.2% to 92.5% of limbs (P < 0.0001), and venous compressibility improved from 28.0% to 91.8% (P < 0.0001), while median Villalta scores improved from 9.0 at baseline to 1.0 at 6 months (P < 0.0001). Significant improvements in venous symptom severity, pain, and quality of life were also demonstrated. Outcomes from iliofemoral and isolated femoral-popliteal segments showed similar improvements. CONCLUSION Outcomes from the CLOUT study, a large prospective registry for DVT, indicate that mechanical thrombectomy is safe and demonstrates significant improvement in symptoms and health status through 6 months. Level of Evidence 3: Non-randomized controlled cohort/follow-up study.
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Affiliation(s)
- Abdullah Shaikh
- Allegheny Health Network Research Institute, 4 Allegheny Square East, Pittsburgh, PA, 15212, USA.
| | | | | | | | | | - Adam Raskin
- Mercy Health - The Heart Institute, Cincinnati, OH, USA
| | | | | | | | | | - Neil Shah
- Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | | | | | - Bhavraj Khalsa
- Heart and Vascular Center, Providence St. Joseph Hospital, Orange, CA, USA
| | | | - Douglas A Murrey
- Inland Imaging at Providence Sacred Heart Medical Center, Spokane, WA, USA
| | | | | | | | - Matthew C Bunte
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA
| | | | - Jonathan Schor
- Northwell Health, Staten Island University Hospital, Staten Island, NY, USA
| | - Herman Kado
- William Beaumont Hospital, Royal Oak, MI, USA
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Sassaki VS, Fukaya E. Varicose Veins: Approach, Assessment, and Management to the Patient with Chronic Venous Disease. Med Clin North Am 2023; 107:895-909. [PMID: 37541715 DOI: 10.1016/j.mcna.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Varicose veins are tortuous and dilated veins commonly seen in chronic venous disease. This article will review chronic venous disease, including its differential diagnosis, workup, and treatment.
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Affiliation(s)
- Viviane Seki Sassaki
- Stanford Heart and Vascular Clinic- Vascular Laboratory, Stanford, CA 94305, USA
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Pishgahi M, Ghane Fard S, Lak Tabriz R, Karimi Toudeshki K, Talebi Z. The Effects of 3-Month Rosuvastatin Adjuvant Therapy on Post Thrombotic Syndrome following Deep Vein Thrombosis; a Randomized Clinical Trial. Arch Acad Emerg Med 2023; 11:e43. [PMID: 37609533 PMCID: PMC10440755 DOI: 10.22037/aaem.v11i1.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Introduction Statins are known to have anticoagulation and anti-inflammatory effects. This study aimed to investigate the effect of Rosuvastatin in reduction of post thrombotic syndrome (PTS) following deep vein thrombosis (DVT). Methods In this randomized clinical trial, patients who were diagnosed with DVT of lower extremity were randomly assigned to 4 treatment groups: group 1: Warfarin, group 2: Warfarin + Rosuvastatin, group 3: Rivaroxaban, and group 4: Rivaroxaban + Rosuvastatin. The treatments were followed for 3 months and prevalence of PTS (as primary outcome), as well as the changes in serum levels of D-dimer and C reactive protein (CRP), and the extent of thrombosis before and after the intervention (as secondary outcomes) were compared between groups. Results 182 patients with the mean age of 55.22 ± 4.1 years finished the trial period (51.64% male). There was no significant difference between the groups regarding the baseline characteristics. Based on the Brandjes score, 31 (17.03%) patients had PTS at the end of the study. The occurrence of PTS was significantly lower in the groups taking statins (p<0.0001). Although the change in the mean difference of legs circumference before and after intervention, were significant in all groups (p < 0.05), the differences was more prominent in groups 2 and 4 (p < 0.0001). After 3 months of taking medication, decrease of CRP was more prominent in the statin groups (p = 0.001), and most cases with normal CRP were in statin groups. Among the patients with the serum D-dimer level above 10000 ng/mL, patients in the statin groups experienced significantly more reduction in D-dimer levels than the other groups (p<0.001). Conclusion Rosuvastatin administration in combination with rivaroxaban or warfarin significantly reduces the level of inflammatory factors including CRP and D-dimer, compared to patients receiving anticoagulants alone. Rosuvastatin administration can significantly reduce the incidence of PTS and cause a difference in the size of the lower limbs within 3 months.
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Affiliation(s)
- Mehdi Pishgahi
- Department of Cardiology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Ghane Fard
- Pediatric Endocrinologist, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rahil Lak Tabriz
- Department of Cardiology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Karimi Toudeshki
- Department of Cardiology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Talebi
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Kahle B. [Postthrombotic syndome-a complex clinical picture]. Dermatologie (Heidelb) 2023; 74:158-162. [PMID: 36749360 DOI: 10.1007/s00105-023-05111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/08/2023]
Abstract
Postthrombotic syndrome (PTS), which comprises a range of symptoms and signs following the development of deep vein thrombosis, is associated with varied clinical presentation. The functional limitations associated with PTS may be persistent, and following deep vein thrombosis, the patient may require lifelong anticoagulation. Venous ulceration is often regarded as a complication of PTS. However, the development of venous ulceration strictly depends on underlying venous hypertension, which is not always present. Due to the heterogenous clinical presentation of PTS, diagnosis may be difficult. Nevertheless, accurate diagnosis is vital and modern imaging techniques can help establish the diagnosis and play a role in monitoring treatment response. Thus, in addition to new strategies in compression therapy, (endo)vascular interventions are established treatment modalities in the management of PTS.
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Affiliation(s)
- Birgit Kahle
- Klinik für Dermatologie, Venerologie und Allergologie, Universitäts-Klinikum Schleswig-Holstein (UKSH) Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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7
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Körfer D, Uhl C, Meisenbacher K, Dufner M, Frey N, Böckler D, Bischoff MS. [Deep vein thrombosis as a primary symptom of abdominal aortic aneurysm : Bilateral deep vein thrombosis caused by infrarenal abdominal aortic aneurysm (15 cm in diameter) with complete compression of the inferior vena cava]. Internist (Berl) 2022; 63:786-789. [PMID: 35175371 DOI: 10.1007/s00108-022-01282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 12/01/2022]
Abstract
This article presents the case of a 70-year-old obese patient with severe bilateral leg pain due to deep vein thrombosis. After unsuccessful venous recanalization, computed tomography angiography revealed an abdominal aortic aneurysm 15 cm in diameter with total compression of the inferior vena cava. For venous decompression as well as rupture prophylaxis, conventional open surgical repair was performed.
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Affiliation(s)
- D Körfer
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
| | - C Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - K Meisenbacher
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - M Dufner
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - N Frey
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - D Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - M S Bischoff
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
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David A, Thony F, Del Giudice C, Goyault G, Loffroy R, Guillen K, Le Bras Y, Marcelin C, Monnin-Bares V, Heautot JF, Lablee A, Marek P, Rousseau H, Martinelli T, Thouveny F, Barral PA, Le Pennec V, Chabrot P, Rogopoulos A, Guillien A, Sapoval M, Rodière M, Espitia O, Douane F; Société Française d’Imagerie Cardiovasculaire Diagnostique et Interventionnelle. Short- and Mid-Term Outcomes of Endovascular Stenting for the Treatment of Post-Thrombotic Syndrome due to Iliofemoral and Caval Occlusive Disease: A Multi-Centric Study from the French Society of Diagnostic and Interventional Cardiovascular Imaging (SFICV). Cardiovasc Intervent Radiol 2022. [PMID: 34981196 DOI: 10.1007/s00270-021-03038-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/01/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the results of endovascular treatment in a large population of patients suffering from post-thrombotic syndrome (PTS) due to iliocaval occlusive disease. METHODS In this retrospective multi-center study, 698 patients treated by stenting for PTS in 15 French centers were analyzed. Primary, primary assisted, and secondary patency rates were assessed, and clinical efficacy was evaluated using Villalta and Chronic Venous Insufficiency Questionnaire in 20 questions (CIVIQ-20) scores. Outcomes were compared against pre-operative CT-based severity of the post-thrombotic lesions in the thigh (4 grades). RESULTS Technical success, defined as successful recanalization and stent deployment restoring rapid anterograde flow in the targeted vessel, was obtained in 668 (95.7%) patients with a complication rate of 3.9%. After a mean follow-up of 21.0 months, primary patency, primary assisted patency, and secondary patency were achieved in 537 (80.4%), 566 (84.7%), and 616 (92.2%) of the 668 patients, respectively. Venous patency was strongly correlated to the grade of post-thrombotic changes in the thigh, with secondary patency rates of 96.0%, 92.9%, 88.4%, and 78.9%, respectively, for grades 0 to 3 (p = .0008). The mean improvements of Villalta and CIVIQ-20 scores were 7.0 ± 4.7 points (p < .0001) and 19.1 ± 14.8 points (p < .0001), respectively. CONCLUSION Endovascular stenting as a treatment option for PTS due to chronic iliocaval venous occlusion generates a high technical success, low morbidity, high midterm patency rate, and clinical improvement. Venous patency was strongly correlated to the severity of post-thrombotic lesions in the thigh.
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9
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Abstract
Patients with neurologic disease are at high risk of venous thromboembolism (VTE). The converse risk of neurological complications in concert or following peripheral VTE is rarely considered. The major neurologic complication following pulmonary embolism or peripheral VTE is intracranial hemorrhage that occurs following anticoagulation therapy for VTE. Ischemic stroke may occur concomitantly with VTE. VT occurrence may also be a marker for a future increased risk of stroke. Peripheral neuropathy may occur or neuropathic pain may occur as a result of thrombophlebitis following deep venous thrombosis. Other sequelae of VTE are somewhat theoretical including the discovery of central nervous system malignancies after incident VTE.
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Affiliation(s)
- Michael J Schneck
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States.
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Notten P, Strijkers RHW, Toonder I, Ten Cate H, Ten Cate-Hoek AJ. Prevalence of venous obstructions in (recurrent) venous thromboembolism: a case-control study. Thromb J 2020; 18:23. [PMID: 32973405 PMCID: PMC7493864 DOI: 10.1186/s12959-020-00238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background The role of venous obstructions as a risk factor for recurrent venous thromboembolism has never been evaluated. This study aimed to determine whether there is a difference in prevalence of venous obstructions between patients with and without recurrent venous thromboembolism. Furthermore, its influence on the development of post-thrombotic syndrome and patient-reported quality of life was assessed. Methods This matched nested case-control study included 32 patients with recurrent venous thromboembolism (26 recurrent deep-vein thrombosis and 6 pulmonary embolism) from an existing prospective cohort of deep-vein thrombosis patients and compared them to 24 age and sex matched deep-vein thrombosis patients without recurrent venous thromboembolism. All participants received standard post-thrombotic management and underwent an additional extensive duplex ultrasonography. Post-thrombotic syndrome was assessed by the Villalta-scale and quality of life was measured using the SF36v2 and VEINES-QOL/Sym-questionnaires. Results Venous obstruction was found in 6 patients (18.8%) with recurrent venous thromboembolism compared to 5 patients (20.8%) without recurrent venous thromboembolism (Odds ratio 0.88, 95%CI 0.23–3.30, p = 1.000). After a median follow-up of 60.0 months (IQR 41.3–103.5) the mean Villalta-score was 5.55 ± 3.02 versus 5.26 ± 2.63 (p = 0.909) and post-thrombotic syndrome developed in 20 (62.5%) versus 14 (58.3%) patients, respectively (Odds ratio 1.19, 95%CI 0.40–3.51, p = 0.752). If venous obstruction was present, it was mainly located in the common iliac vein (n = 7, 63.6%). In patients with an objectified venous obstruction the mean Villalta-score was 5.11 ± 2.80 versus 5.49 ± 2.87 in patients without venous obstruction (p = 0.639). Post-thrombotic syndrome developed in 6 (54.5%) versus 28 (62.2%) patients, respectively (Odds ratio 1.37, 95%CI 0.36–5.20, p = 0.736). No significant differences were seen regarding patient-reported quality of life between either groups. Conclusions In this exploratory case-control study patients with recurrent venous thromboembolism did not have a higher prevalence of venous obstruction compared to patients without recurrent venous thromboembolism. The presence of recurrent venous thromboembolism or venous obstruction had no impact on the development of post-thrombotic syndrome or the patient-reported quality of life.
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Affiliation(s)
- Pascale Notten
- Department of Vascular Surgery, Maastricht University Medical Centre, P.O. Box 5800, Maastricht, 6202 AZ the Netherlands.,CARIM, Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University Medical Centre, P.O. Box 616, Maastricht, 6200 MD the Netherlands
| | - Rob H W Strijkers
- Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, P.O. Box 616, Maastricht, 6200 MD The Netherlands
| | - Irwin Toonder
- Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, P.O. Box 616, Maastricht, 6200 MD The Netherlands
| | - Hugo Ten Cate
- CARIM, Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University Medical Centre, P.O. Box 616, Maastricht, 6200 MD the Netherlands.,Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, P.O. Box 616, Maastricht, 6200 MD The Netherlands.,Thrombosis Expertise Centre, Heart + Vascular Centre, Maastricht University Medical Centre, P.O. Box 5800, Maastricht, 6202 AZ the Netherlands
| | - Arina J Ten Cate-Hoek
- CARIM, Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University Medical Centre, P.O. Box 616, Maastricht, 6200 MD the Netherlands.,Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, P.O. Box 616, Maastricht, 6200 MD The Netherlands.,Thrombosis Expertise Centre, Heart + Vascular Centre, Maastricht University Medical Centre, P.O. Box 5800, Maastricht, 6202 AZ the Netherlands.,Thrombosis Expertise Centre, Heart + Vascular Centre, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6229 HX the Netherlands
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11
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Ko H, Ahn S, Min S, Hur S, Jae HJ, Min SK. Recanalization of an Occluded Vena Cava Filter and Iliac Veins with Kissing Stents to Treat Postthrombotic Syndrome with a Venous Stasis Ulcer. Vasc Specialist Int 2020; 36:116-121. [PMID: 32611844 PMCID: PMC7333087 DOI: 10.5758/vsi.200010] [Citation(s) in RCA: 1] [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: 02/28/2020] [Revised: 05/18/2020] [Accepted: 05/28/2020] [Indexed: 11/20/2022] Open
Abstract
Inferior vena cava filters (IVCFs) are effective in preventing pulmonary embolism and their usage has rapidly increased over the past decades. However, complications have also significantly increased, as IVCF occlusion causes serious chronic venous insufficiency. Herein, we report a case of infrarenal IVCF occlusion that was successfully treated with the introduction of kissing stents through the IVCF into both iliac veins. A 54-year-old male presented with non-healing ulcers on his left leg. He had undergone IVCF implantation and warfarin medication due to deep vein thrombosis 4 years earlier in another hospital. Computed tomography (CT) revealed the filter-bearing IVC occlusion. Endovascular IVCF removal was attempted but failed. Kissing stents were deployed across the IVCF and extended into both iliac veins. Cone beam CT showed well-deployed stents just behind the occluded IVCF. Venous flow was restored without complications, and the recurrent ulcer healed immediately.
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Affiliation(s)
- Hyunmin Ko
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Saebeom Hur
- Departments of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hwan Jun Jae
- Departments of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Departments of Surgery, Seoul National University College of Medicine, Seoul, Korea
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12
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Zhao BX, He X, Gu JP, Lou WS, Chen L, Gong MF. [Stent placement for filter-related chronic occlusion of the inferior vena cava]. Zhonghua Yi Xue Za Zhi 2019; 99:3403-3407. [PMID: 31752467 DOI: 10.3760/cma.j.issn.0376-2491.2019.43.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To assess the technical success rate, stent patency, clinical efficacy and complications of stent placement for filter-related chronic occlusion of the inferior vena cava. Methods: A retrospective analysis was carried out for 12 patients with filter-related chronic occlusion of the inferior vena cava associated with severe post-thrombotic syndrome, who underwent stent placement after ineffective conservative therapy at Nanjing First Hospital from March 2016 to December 2018,9 males and 3 females, aged from 48 to 77 years, mean age 60 years, six had bilateral lower extremity symptoms and six had unilateral lower extremity symptoms.Technical success rate, stent patency, clinical efficacy and complications of stent placement were recorded. Clinical success was defined as relief of symptoms and a decrease in clinical, etiology, anatomy, and pathophysiology (CEAP) score for at least grade 1. Results: Stent placement in the unilateral or bilateral iliocaval occlusion was successful in 11 patients. The cause of technical failure in the single patient with failed stent placement was an inability to cross the occluded left iliacvein and the patient was treated with stent placement in the right iliocaval vein.There were 7 patients with inferior vena cava and unilateral iliocaval stent placement; 5 patients with inferior vena cava and bilateral iliocaval stent placement. Acute stent thrombosis occlusion occurred in 1 case after the operation, the blood flow recanalized after catheter-directed thrombolysis and re-stenting. All patients were followed up for 6 to 24 months, with an average of (13±6) months. During the follow-up period, CTV or venography of lower limbs showed that the blood flow in the stent was unobstructed. At the last follow-up, 12 patients were evaluated as clinically effective. Three patients had transient treatment of lateral lumbar pain during operation, which alleviated by themselves.No significant abdominal pain, severe hemorrhage, symptomatic pulmonary embolism and other complications related to treatment occurred in all patients during perioperative period and follow-up. Conclusion: Stent placement is safe and feasible in the treatment of filter-related chronic occlusion of the inferior vena cava, which can alleviate the clinical symptoms of severe post-thrombotic syndrome.
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Affiliation(s)
- B X Zhao
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
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13
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Klok FA, Barco S, Siegerink B. Measuring functional limitations after venous thromboembolism: A call to action. Thromb Res 2019; 178:59-62. [PMID: 30980999 DOI: 10.1016/j.thromres.2019.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 12/27/2022]
Abstract
The main objectives of therapeutic trials in venous thromboembolism (VTE) are to prevent recurrent VTE, major bleeding and death. While these outcomes are indeed highly relevant, they are also rare and do not fully capture the overall functional outcome of VTE patients. Importantly, functional limitations after VTE are prevalent after both deep vein thrombosis and pulmonary embolism occurring in up to 50% of patients. These post-VTE syndromes are associated with a decreased quality of life, higher risk of depressive disorders, unemployment and increased utilization of healthcare resources. Because of the major impact of functional limitations on individual patients and society as a whole, development of tools able to capture functional outcomes in clinical trials are urgently needed. We anticipate that a standardized post-VTE functional status scale will aid in demarcating effective and ineffective VTE therapies on functional outcomes in trials with appropriately powered sample sizes, as well as pave the road for value-based healthcare. The scale that we have in mind covers the entire spectrum of functional outcomes ranging from no symptoms to death. Moreover, it focuses on both limitations in usual activity as well as changes in lifestyle. The scale is not meant to replace current diagnostic or prognostic scores for post-VTE syndromes, but to be used as an outcome measure to evaluate the overall consequences of VTE on functional status. This review is a call for action to the VTE community to join forces and support further development of the proposed scale, a process of which we summarize the necessary steps.
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Affiliation(s)
- Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
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14
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Haji Zeinali AM, Jenab Y, Ariannejad H, Kassaian SE, Alidoosti M, Aghajani H, Zafarghandi MR. Catheter-Directed Thrombolysis in Acute Iliofemoral Deep Vein Thrombosis with or without Stenting: A Case Series. J Tehran Heart Cent 2018; 13:186-190. [PMID: 30972118 PMCID: PMC6450815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Iliofemoral deep vein thrombosis (IFDVT) is a potentially devastating condition comprising a quarter of all cases of lower extremity DVT. It can lead to serious consequences such as pulmonary embolism, limb malperfusion, and post-thrombotic syndrome (PTS), which is a chronic sequela of IFDVT. We herewith present 18 IFDVT cases managed with catheter-directed thrombolysis at our hospital. Nine of these patients underwent stenting of the involved iliac veins. The remaining 9, who did not receive stenting, had a residual stenosis of more than 50% in the common femoral or iliac veins following the procedure. Based on a final residual stenosis of less than 50% in the iliac veins, we had 9 successful (patients with stenting) and 9 unsuccessful procedures (patients without stenting). In subsequent follow-ups at a median follow-up of 39.5 months, using the Villalta score, while only 2 out of the 9 patients who underwent stenting suffered PTS, 4 patients among the other 9 patients comprising the non-stenting group developed PTS. Our results support the notion that stenting might have a role in decreasing the PTS risk in patients undergoing catheter-directed thrombolysis.
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Affiliation(s)
| | - Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Yaser Jenab, Associate Professor of Cardiology, Tehran Heart Center, North Kargar Street, Tehran, Iran. 1411713138. Tel: +98 21 88029256. Fax: +98 21 88029256.E-mail: .
| | - Hamid Ariannejad
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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15
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Abstract
The surgical treatment of deep venous thrombosis (DVT) has significantly evolved and is focused on different strategies of early thrombus removal in the acute phase and deep venous recanalization or bypass in the chronic phase. Along with the use of anticoagulation agents, endovascular techniques based on catheter-directed thrombolysis and pharmacomechanical thrombectomy have been increasingly used in patients with acute extensive DVT. Patient selection is crucial to provide optimal outcomes and minimize complications.
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Affiliation(s)
- Cassius Iyad Ochoa Chaar
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar street, Boardman 204, New Haven, CT 06510, USA.
| | - Afsha Aurshina
- Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar street, Boardman 204, New Haven, CT 06510, USA
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16
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Kim YA, Yang SS, Yun WS. Does Catheter-Directed Thrombolysis Prevent Postthrombotic Syndrome? Vasc Specialist Int 2018; 34:26-30. [PMID: 29984214 PMCID: PMC6027801 DOI: 10.5758/vsi.2018.34.2.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of this study is to identify risk factors of postthrombotic syndrome (PTS) and evaluate the efficacy of catheter-directed thrombolysis (CDT) for preventing the development of PTS in patients with lower extremity deep vein thrombosis (DVT). Materials and Methods From 2005 January to 2013 December, 139 limbs of 126 patients were included in this study who had the first episode of proximal DVT at the affected limb and who had visited our out-patient clinic. CDT was performed on 55 limbs (39.6%). We achieved complete recanalization in 39 limbs (70.9%) and partial recanalization (residual thrombus <50.0%) in 16 limbs (29.1%). We retrospectively reviewed medical records for possible predictors of PTS. Results Median follow-up duration was 83 months (range, 30–136 months). No differences were found between the CDT and non-CDT group in age, gender, duration of symptom, use of anticoagulation and recurrence of DVT. A significantly higher thrombotic burden was observed in the CDT group (P=0.009). In a binary logistic regression model, patients with PTS had significantly higher body mass index (BMI) (odds ratio [OR], 1.303; 95% confidence interval [CI], 1.079–1.574; P=0.006) and longer thrombotic burden involved in ilio-femoro-popliteal DVT (OR, 3.666; 95% CI, 1.093–12.296; P=0.035). CDT did not influence the risk of PTS (P>0.05). Conclusion We suggest that CDT is not effective in preventing PTS, while higher BMI and longer thrombotic burden are associated with the development of PTS in patients with DVT.
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Affiliation(s)
- Young-Ah Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Shin-Seok Yang
- Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Woo-Sung Yun
- Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
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17
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Moustafa A, Alim HM, Chowdhury MA, Eltahawy EA. Postthrombotic Syndrome: Long-Term Sequela of Deep Venous Thrombosis. Am J Med Sci 2018; 356:152-158. [PMID: 29779730 DOI: 10.1016/j.amjms.2018.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/20/2018] [Accepted: 03/01/2018] [Indexed: 12/23/2022]
Abstract
Postthrombotic syndrome is a common long-term complication of proximal lower extremity deep venous thrombosis, which not only significantly affects the quality of life of patients but also imposes a substantial financial burden on our healthcare system. Due to limited awareness and inability of physicians to recognize and treat this condition early, its prevalence is steadily increasing. In this article, we review the pathophysiology, the risk factors involved, diagnostic workup, and the various management options available to treat this condition.
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Affiliation(s)
- Abdelmoniem Moustafa
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Hussam Mohammad Alim
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - Ehab A Eltahawy
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio.
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18
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Abstract
Venous stenting for CVD is being increasingly used as more evidence accumulates supporting the open vein hypothesis and supporting the safety, efficacy, and durability of these interventions. As such, they can be offered to patients with advanced age and complex comorbidities. Future studies should focus on reporting outcomes specific to the underlying venous pathologic condition (thrombotic vs nonthrombotic and acute vs chronic) to provide better evidence for stenting in CVD, and the outcomes of new stent design with dedicated venous indications.
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19
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Abstract
Several serpins function as potent inhibitors of thrombolytic serine proteases. Venous thrombosis is a common and debilitating condition whose incidence is on the rise. Studies using genetically modified mice and inhibitors have shown that the plasminogen activator inhibitors (PAI), PAI-1 and PAI-2, are primary regulators of plasminogen activation and contribute to regulating the resolution of experimental venous thrombi, via inflammatory mechanisms, vascular remodeling, and inhibition of fibrinolysis. Therapies to accelerate venous thrombus resolution would be beneficial, since delayed or incomplete clot resolution frequently leads to postthrombotic syndrome, a long-term complication associated with debilitating limb swelling, pain, and recurrent skin ulceration. Here we describe a useful and reproducible mouse model for the study of venous thrombus resolution involving ligation of the inferior vena cava and elucidation of the molecular and cellular determinants of venous thrombus formation and resolution.
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Affiliation(s)
- Subhradip Mukhopadhyay
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, USA.,Departments of Surgery and Physiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tierra A Johnson
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rajabrata Sarkar
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, USA.,Departments of Surgery and Physiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Toni M Antalis
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, USA. .,Departments of Surgery and Physiology, University of Maryland School of Medicine, Baltimore, MD, USA. .,Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
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20
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Boc A, Boc V, Kozak M. May-Thurner syndrome: old acquaintance, new perspective : Case report. Wien Klin Wochenschr 2017; 129:362-5. [PMID: 28321560 DOI: 10.1007/s00508-017-1188-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/04/2017] [Indexed: 12/31/2022]
Abstract
May-Thurner syndrome (MTS) results from a frequent anatomic variant in which compression of the left common iliac vein between the body of the fifth lumbar vertebra and the pulsating right common iliac artery can cause deep venous thrombosis (DVT) of the left lower limb. While anticoagulation remains the mainstay treatment of acute DVT, catheter-directed thrombolysis combined with stenting provides a safe and effective method for relieving acute symptoms and preventing postthrombotic syndrome in patients with MTS. In this article the diagnostic and treatment methods are presented in the case report of a 65-year-old woman with MTS who suffered iliofemoral DVT. Knowledge of anatomy is crucial for understanding and recognizing MTS as well as for treating MTS with endovascular procedures.
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21
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Blomgren L, Engström J, Rosfors S. A comparison of magnetic resonance venography findings and venous occlusion plethysmography variables in postthrombotic syndrome. Vascular 2017; 25:406-411. [PMID: 28121279 DOI: 10.1177/1708538116689352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The relation between venous morphology and venous function in postthrombotic syndrome is poorly understood. The aim of this study was to compare obstruction and collateralization as seen with magnetic resonance venography with variables of venous occlusion plethysmography in patients with postthrombotic syndrome. Methods Medical records, magnetic resonance venography and venous occlusion plethysmography data were analyzed in 28 patients (33 legs). Magnetic resonance venography images were scored for degree of obstruction and collateralization in segments of pelvic and abdominal veins and correlated to venous occlusion plethysmography data. Results Obstruction of the inferior vena cava correlated with an overall increase of collaterals ( p < 0.001). The summary scores of collaterals or obstructions did not correlate with venous occlusion plethysmography variables. Relative expelled volume at 4 s correlated inversely with obstruction of the inferior vena cava ( p = 0.045) and vertebral collateralization ( p = 0.033). Conclusions Modest correlations were found between magnetic resonance venography scores and venous occlusion plethysmography variables. Prospective studies with refined scoring and magnetic resonance venography techniques may increase our knowledge further.
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Affiliation(s)
- Lena Blomgren
- 1 Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.,2 Karolinska Instutet, Stockholm, Sweden
| | - Jan Engström
- 3 Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Rosfors
- 2 Karolinska Instutet, Stockholm, Sweden.,4 Department of Clinical Physiology, Södersjukhuset, Stockholm, Sweden
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22
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Jalaie H, Schleimer K, Barbati ME, Gombert A, Grommes J, de Wolf MAF, de Graaf R, Wittens CHA. Interventional treatment of postthrombotic syndrome. Gefasschirurgie 2016; 21:37-44. [PMID: 27546987 PMCID: PMC4974289 DOI: 10.1007/s00772-016-0156-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Postthrombotic syndrome (PTS) is the development of symptoms and signs of chronic venous insufficiency following deep vein thrombosis (DVT) and has a significant negative effect on the quality of life. The current understanding is that the clinical manifestation of PTS is related more to venous obstruction than it is to venous reflux. The use of interventional techniques for the treatment of venous obstruction and/or venous occlusion has rapidly increased in recent years. Objective This article summarizes the current concept of endovenous and hybrid interventions and presents the optimized treatment of choice in patients with chronic symptomatic venous obstruction. Methods We performed a systematic literature search in the Medline database to identify relevant studies on the treatment of patients with PTS. Results A meta-analysis of the relevant studies showed that this minimally invasive procedure is an effective treatment option with low morbidity and no mortality. Use of the newly developed dedicated venous stents showed promising results with good mid-term patency rates and a significant decrease in related symptoms. Conclusion Interventional therapy for the treatment of symptomatic chronic venous obstruction has become the method of choice in recent years. More studies are needed to evaluate the long-term success rate of dedicated venous stents.
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Affiliation(s)
- H Jalaie
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - K Schleimer
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - M E Barbati
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - A Gombert
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - J Grommes
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany
| | - M A F de Wolf
- European Vascular Center Aachen-Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R de Graaf
- European Vascular Center Aachen-Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C H A Wittens
- Klinik für Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Europäisches Gefäßzentrum Aachen-Maastricht, Pauwelstr. 30, 52074 Aachen, Germany ; European Vascular Center Aachen-Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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23
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Berntsen CF, Kristiansen A, Akl EA, Sandset PM, Jacobsen EM, Guyatt G, Vandvik PO. Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis. Am J Med 2016; 129:447.e1-447.e20. [PMID: 26747198 DOI: 10.1016/j.amjmed.2015.11.031] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to address benefits and harms of using elastic compression stockings after lower-extremity deep vein thrombosis. METHODS We searched 7 electronic databases through January 15, 2015, including randomized controlled trials (RCTs)/quasi-randomized trials reporting on elastic compression stocking efficacy on postthrombotic syndrome incidence, recurrent venous thromboembolism, mortality, and acute pain after deep vein thrombosis. Two reviewers independently screened records, extracted data, assessed risk of bias, and assessed confidence in effect estimates using Grading of Recommendations Assessment, Development, and Evaluation methodology. We applied random-effects meta-analysis models. RESULTS We included 5 RCTs (n = 1418) reporting on postthrombotic syndrome. The hazard ratio (HR) for postthrombotic syndrome with elastic compression stockings was 0.69 (95% confidence interval [CI], 0.47-1.02). We have very low confidence in this estimate due to heterogeneity and inclusion of unblinded studies at high risk of bias. Excluding high risk of bias studies, a single large RCT at low risk of bias provided moderate-quality evidence of no effect on postthrombotic syndrome (HR 1.00; 95% CI, 0.81-1.24). Moderate-quality evidence including all 5 studies suggests no effect of elastic compression stockings on recurrent venous thromboembolism (relative risk [RR] 0.88; 95% CI, 0.63-1.24) or mortality (RR 1.00; 95% CI, 0.73-1.37, 5 studies). Moderate-quality evidence from one large RCT does not suggest effect on acute pain after deep vein thrombosis. CONCLUSIONS The highest-quality evidence available suggests no effect of elastic compression stockings on postthrombotic syndrome or pain relief, from a single large RCT. However, results for preventing postthrombotic syndrome differ substantially across studies, and future guideline updates should reflect uncertainty about treatment effects. Elastic compression stockings are unlikely to prevent death or recurrent venous thromboembolism.
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Affiliation(s)
- Christopher Friis Berntsen
- Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Annette Kristiansen
- Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Lebanon
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Eva-Marie Jacobsen
- Department of Haematology, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Per Olav Vandvik
- Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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24
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Gauthier K, Le Gal G, Shivakumar S, Anderson D, Chagnon I, Solymoss S, Ortel T, Yeo E, Kearon C, Rodger M. Inter-observer reliability of the HERDOO2 clinical decision rule. Thromb Res 2016; 141:136-8. [PMID: 27031923 DOI: 10.1016/j.thromres.2016.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/08/2016] [Accepted: 03/12/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Karine Gauthier
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Grégoire Le Gal
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada; Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - David Anderson
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Isabelle Chagnon
- Department of Medicine, Hôpital du Sacré-Coeur, University of Montreal, Montreal, QC, Canada
| | - Susan Solymoss
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Erik Yeo
- Division of Hematology, University Health Network, Toronto, ON, Canada
| | - Clive Kearon
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
| | - Marc Rodger
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada; Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
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25
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Abstract
Summary We give an overview on the current literature concerning compression in the prevention of postthrombotic syndrome, including our own investigations of the hemodynamic changes over time in female and male patients. We also describe the evaluation of a combined reflux-occlusion score to predict occurrence of new pigmentation (C4).
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Affiliation(s)
- Christina Jeanneret
- Division of Angiology, University Clinic of Internal Medicine Bruderholz, KSBL, 4101 Bruderholz, Switzerland
| | | | - Daniel Staub
- Division of Angiology, University of Basel, 4031 Basel, Switzerland
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26
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Czihal M, Paul S, Rademacher A, Bernau C, Hoffmann U. Lack of association between venous hemodynamics, venous morphology and the postthrombotic syndrome after upper extremity deep venous thrombosis. Phlebology 2013; 30:105-12. [PMID: 24327655 DOI: 10.1177/0268355513517226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore the association of the postthrombotic syndrome with venous hemodynamics and morphological abnormalities after upper extremity deep venous thrombosis. METHODS Thirty-seven patients with a history of upper extremity deep venous thrombosis treated with anticoagulation alone underwent a single study visit (mean time after diagnosis: 44.4 ± 28.1 months). Presence and severity postthrombotic syndrome were classified according to the modified Villalta score. Venous volume and venous emptying were determined by strain-gauge plethysmography. The arm veins were assessed for postthrombotic abnormalities by ultrasonography. The relationship between postthrombotic syndrome and hemodynamic and morphological sequelae was evaluated using univariate significance tests and Spearman's correlation analysis. RESULTS Fifteen of 37 patients (40.5%) developed postthrombotic syndrome. Venous volume and venous emptying of the arm affected by upper extremity deep venous thrombosis did not correlate with the Villalta score (rho = 0.17 and 0.19; p = 0.31 and 0.25, respectively). Residual morphological abnormalities, as assessed by ultrasonography, did not differ significantly between patients with and without postthrombotic syndrome (77.3% vs. 86.7%, p = 0.68). CONCLUSIONS Postthrombotic syndrome after upper extremity deep venous thrombosis is not associated with venous hemodynamics or residual morphological abnormalities.
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Affiliation(s)
- M Czihal
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Munich University Hospital, Germany
| | - S Paul
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Munich University Hospital, Germany
| | - A Rademacher
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Munich University Hospital, Germany
| | - C Bernau
- Department of Medical Informatics, Biometry and Epidemiology, Munich University Hospital, Germany
| | - U Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Munich University Hospital, Germany
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Albisetti M, Kellenberger CJ, Bergsträsser E, Niggli F, Kroiss S, Rizzi M, Schmugge M. Port-a-cath-related thrombosis and postthrombotic syndrome in pediatric oncology patients. J Pediatr 2013; 163:1340-6. [PMID: 23992671 DOI: 10.1016/j.jpeds.2013.06.076] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/13/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate Port-A-Cath (PAC)-related thrombosis and postthrombotic syndrome (PTS) in children with cancer. STUDY DESIGN The study population was a consecutive cohort of children diagnosed with cancer and a PAC implanted at diagnosis. Children were evaluated for the presence of PAC-related thrombosis by magnetic resonance venography and the presence of congenital prothrombotic risk factors and PTS. RESULTS A total of 114 children (median age, 6.04 years) were included. Of these children, 48 (42%) were treated for solid tumors and 66 (58%) were treated for hematopoietic tumors, including 38 for acute lymphoblastic leukemia. At the time of magnetic resonance venography, 42 children (37%) had the PAC still in place, and 72 (63%) had the PAC removed. Overall, PACs were in place for a total of 324.92 PAC-years. PAC-related thrombosis was detected in 45 children (39.5%) with a current or previous PAC. Of these, 21 (47%) had a solid tumor, 14 (31%) had acute lymphoblastic leukemia, and 10 (22%) had another hematopoietic tumor. Younger age at diagnosis, female sex, duration of PAC use, and left-side PAC placement were independently associated with an increased risk of thrombosis, whereas asparaginase therapy and the presence of inherited prothrombotic risk factors were not. Mild PTS (ie, presence of prominent collateral vessels in the skin) was present in 5.6% of the children. CONCLUSION PAC-related thrombosis is common in pediatric oncology patients. In some children, thrombotic complications can lead to the development of PTS.
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Affiliation(s)
- Manuela Albisetti
- Division of Hematology, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland.
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Park SJ, Park HJ, Kwon EK, Kim SJ, Cho HR. Extrinsic compression of left iliac vein does not predict the development of post thrombotic syndrome in left side deep venous thrombosis. J Korean Surg Soc 2012; 82:370-3. [PMID: 22708099 PMCID: PMC3373987 DOI: 10.4174/jkss.2012.82.6.370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 03/27/2012] [Accepted: 04/12/2012] [Indexed: 11/30/2022]
Abstract
Purpose Left side deep venous thrombosis (DVT) is associated with May-Thurner's anatomical variation and is often instigated by invasive treatment. The aim of this study is to analyze the influence of left iliac vein narrowness on incidence of post thrombotic syndrome (PTS) that developed after left side DVT. Methods Forty-one left side DVT cases that were followed up for more than 1 year were enrolled. The iliac vein narrowness was measured by the shortest distance from the right iliac artery to the 5th lumbar vertebra overlying left iliac vein in computed tomography (CT) scan. The incidence of PTS was measured by phone-call history taking for specific symptoms of PTS. The means of the shortest distance were compared by independent t-test. Results The number of PTS cases was eleven (26.8%). The level of thrombus, demographic data and other risk factors were similar in both PTS and non-PTS groups except the mean risk factor score. The mean of the shortest distance of PTS group and non-PTS group were 5.56 mm and 5.89 mm, respectively. Conclusion The degree of left iliac vein narrowness measured by the shortest distance from the right iliac artery and the 5th lumbar vertebral body was not a predictive factor for PTS.
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Affiliation(s)
- Sang Jun Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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