1
|
KIRKHAM EN, HICKSON G, RAMNARINE R, COOPER DG. A ten-year experience of thrombolysis for lower limb ileo-femoral DVTs. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.21.01508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
2
|
Patel KD, Tang AY, Zala AD, Patel R, Parmar KR, Das S. Referral patterns for catheter-directed thrombolysis for iliofemoral deep venous thrombosis. Phlebology 2021; 36:562-569. [PMID: 33428542 DOI: 10.1177/0268355520977281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Post thrombotic syndrome (PTS) is a serious complication of deep venous thromboses (DVTs). PTS occurs more frequently and severely following iliofemoral DVT compared to distal DVTs. Catheter directed thrombolysis (CDT) of iliofemoral DVTs may reduce PTS incidence and severity.We aimed to determine the rate of iliofemoral DVT within our institution, their subsequent management, and compliance with NICE guidelines. METHODS Retrospective review of all DVTs diagnosed over a 3-year period was conducted. Cases of iliofemoral DVT were identified using ICD-10 codes from patient notes, and radiology reports of Duplex scans. Further details were retrieved, such as patient demographics and referrals to vascular services. NICE guidance was applied to determine if patients would have been suitable for CDT. A survey was sent to clinicians within medicine to identify awareness of CDT and local guidelines for iliofemoral DVT management. RESULTS 225 patients with lower limb DVTs were identified. Of these, 96 were radiographically confirmed as iliofemoral DVTs. The median age was 77. 67.7% of iliofemoral DVTs affected the left leg. Right leg DVTs made up 30.2% and 2.1% were bilateral DVTs. Of the 96 iliofemoral DVTs, 21 were deemed eligible for CDT. Only 3 patients (14.3%) were referred to vascular services, and 3 received thrombolysis.From our survey, 95.5% of respondents suggested anticoagulation alone as management for iliofemoral DVT. Only one respondent recommended referral to vascular services. There was a knowledge deficiency regarding venous anatomy, including superficial versus deep veins. CONCLUSIONS CDT and other mechanochemical procedures have been shown to improve outcomes of patients post-iliofemoral DVT, however a lack of awareness regarding CDT as a management option results in under-referral to vascular services. We suggest closer relations between vascular services and their "tributary" DVT clinics, development of guidelines and robust care pathways in the management of iliofemoral DVT.
Collapse
Affiliation(s)
- Kirtan D Patel
- Education Department, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Alison Yy Tang
- Education Department, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Ashik Dj Zala
- Education Department, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Rakesh Patel
- Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.,West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow, UK
| | - Kishan R Parmar
- Department of Geriatric Medicine, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Saroj Das
- Education Department, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.,West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow, UK
| |
Collapse
|
3
|
Black SA, Alvi A, Baker SJ, Beckett D, Breen K, Burfitt NJ, Coles S, Davies AH, Davies N, Diwakar P, Drebes A, Fortin K, Gohel M, Hague J, Hammond CJ, Haslam L, Jones RG, Kearney T, Lehmann ED, Lenton J, Low D, Metcalfe J, Moore H, Odedra BJ, Prabhudesai S, Quigley S, Ratnam L, Richards T, Saha P, Schnatterbeck P, Scurr J, Shaikh U, Shaikh S, Shawyer A, Tippett R, Vrebac S, Ward R, Watts C, Wigham A, Willis AP, Woodward N, Lim CS. Management of acute and chronic iliofemoral venous outflow obstruction: a multidisciplinary team consensus. INT ANGIOL 2020; 39:3-16. [DOI: 10.23736/s0392-9590.19.04278-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
4
|
Saha P, Black S, Breen K, Patel A, Modarai B, Smith A. Contemporary management of acute and chronic deep venous thrombosis. Br Med Bull 2016; 117:107-20. [PMID: 26893407 DOI: 10.1093/bmb/ldw006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This review aims to provide an update on the management of deep vein thrombosis (DVT). SOURCES OF DATA A systematic search of PubMed, Google Scholar and Cochrane databases was carried out. AREAS OF AGREEMENT Direct oral anticoagulants (DOACs) are as effective and easier to use than vitamin K antagonists for the treatment of DVT. Catheter-directed thrombolysis can reduce post thrombotic syndrome in patients with iliofemoral DVT. Compression bandaging can help heal a venous ulcer. AREAS OF CONTROVERSY Compression hosiery to prevent post thrombotic syndrome. Long-term evidence to show clinical benefit of using endovenous therapies to restore deep vein patency. GROWING POINTS Developing imaging methods to identify patients who would benefit from venous thrombolysis. The evolution of dedicated venous stents. AREAS TIMELY FOR DEVELOPING RESEARCH Understanding the mechanisms that lead to stent occlusion and investigation into the appropriate treatments that could prevent in-stent thrombosis is required.
Collapse
Affiliation(s)
- Prakash Saha
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Stephen Black
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Karen Breen
- Department of Thrombosis and Haemostasis, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, London SE1 7EH, UK
| | - Ashish Patel
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Bijan Modarai
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| | - Alberto Smith
- Academic Department of Vascular Surgery, King's College London, St. Thomas' Hospital, London SE1 7EH, UK
| |
Collapse
|
5
|
Zhang C, Fu Q, Zhao Y, Mu S, Liu L. Short-Term Anticoagulant Therapy and Thrombus Location Are Independent Risk Factors for Delayed Recanalization of Deep Vein Thrombosis. Med Sci Monit 2016; 22:219-25. [PMID: 26790571 PMCID: PMC4727491 DOI: 10.12659/msm.895228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Prompt recanalization of the vein containing the thrombus is an important goal during the initial treatment of DVT, and risk factors for delayed recanalization in patients with deep vein thrombosis (DVT) in the lower extremities need to be determined. Material/Methods A total of 174 patients with DVT in lower extremities were recruited from June 2014 to March 2015 at our hospital. Duplex ultrasound scanning was conducted for all patients at 1 and 6 months after baseline evaluation. We divided the patients into recanalization and non-recanalization groups and analyzed risk factors for delayed recanalization. Results The univariate analysis revealed that an oral anticoagulant time of less than 3 months and venous thrombus location were risk factors for delayed recanalization (P<0.01). However, age, gender, hypertension, diabetes, pulmonary embolism, incidence factors, the use of catheter-directed thrombolytic (CDT) drugs, and inferior vena cava filter (IVCF) implantation had no influence on the incidence of delayed recanalization in patients with DVT (P>0.05). The multivariate analysis showed that patients with an anticoagulant time of less than 3 months had a lower incidence of recanalization than those with an anticoagulant time of more than 3 months (OR=2.358, P<0.05). The risk of delayed recanalization in patients with proximal DVT was 7 times higher than that in patients with distal DVT. Conclusions Duration of anticoagulant treatment of less than 3 months and venous thrombus location are independent risk factors for delayed recanalization of DVT in the lower extremities.
Collapse
Affiliation(s)
- Chuanlin Zhang
- School of Nursing, Chongqing Medical University, Chongqing, China (mainland)
| | - Qining Fu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Shaoyu Mu
- School of Nursing, Chongqing Medical University, Chongqing, China (mainland)
| | - Liping Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| |
Collapse
|
6
|
Keeling D, Klok FA, Le Gal G. Controversies in venous thromboembolism--2015. Blood Rev 2015; 30:27-33. [PMID: 26239706 DOI: 10.1016/j.blre.2015.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 01/08/2023]
Abstract
Venous thromboembolism is commonly encountered both in the community and the in-patient setting. Despite major advances in diagnosis and treatment, there remain challenges in several clinical areas as a result of insufficient evidence to guide practice. This review covers six controversial topics, summarizes the best available evidence, and presents recommendations for practice. The clinical relevance of calf vein thrombosis and sub-segmental pulmonary embolism are often questioned; this has implications for both their diagnosis and management. The role of thrombolysis for the treatment of deep vein thrombosis (DVT) is discussed in consideration of the potential benefits and risks. Residual vein obstruction has been proposed as a predictor of recurrent thrombosis; we consider its relevance when determining the duration of anticoagulant treatment. The post-thrombotic syndrome (PTS) can be a disabling and costly consequence of DVT with limited options for prevention and treatment. We review the available evidence related to compression stockings for PTS prevention. Finally, the relationship between cancer and VTE is well recognized and this review considers the value of screening for occult cancer in patients with unprovoked VTE.
Collapse
Affiliation(s)
- David Keeling
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, United Kingdom.
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Grégoire Le Gal
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
7
|
Rich K. Iliofemoral deep vein thrombosis: Percutaneous endovascular treatment options. JOURNAL OF VASCULAR NURSING 2015; 33:47-53. [PMID: 26025147 DOI: 10.1016/j.jvn.2015.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/30/2015] [Indexed: 11/28/2022]
Abstract
Venous thromboembolism is defined as an acute venous thrombotic event that targets two disease entities: deep vein thrombosis (DVT), pulmonary embolism, or both. The most common site of DVT origin is in the lower extremities, with 50% of patients exhibiting no symptoms. Although anticoagulation is the gold standard for DVT, early clot removal, especially of proximal iliofemoral DVT, is felt to reduce the incidence of postthrombotic syndrome (PTS) by preserving valve function. Up to one-half of all patients with an iliofemoral DVT treated only with anticoagulation subsequently develop long-term complications, including PTS. Beside anticoagulation, DVT treatment options may include pharmaceutical and/or mechanical therapies. Mechanical therapies consist of either endovascular percutaneous catheter-directed (PCD) interventions or open operative thrombectomy. There are several different PCD procedures available, consisting of catheter-directed thrombolysis, mechanical thrombectomy, combination pharmacomechanical devices, and postthrombus extraction (angioplasty and/or stenting). Endovascular therapies in the management of acute iliofemoral DVT are evolving with a variety of devices available to treat this disease entity. The purpose of this article is to provide an overview of the PCD therapies used when treating patients experiencing an acute iliofemoral DVT along with associated nursing considerations. Off-label device use is not included.
Collapse
Affiliation(s)
- Kathleen Rich
- IU Health La Porte Hospital, 1007 Lincolnway, La Porte, IN 46350.
| |
Collapse
|
8
|
Lang KJ, Saha P, Roberts LN, Arya R. Changing paradigms in the management of deep vein thrombosis. Br J Haematol 2015; 170:162-74. [DOI: 10.1111/bjh.13431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn J. Lang
- King's Thrombosis Centre; King's College Hospital NHS Foundation Trust; London UK
| | - Prakash Saha
- Guy's Hospital; Guy's and St. Thomas’ NHS Foundation Trust; London UK
| | - Lara N. Roberts
- King's Thrombosis Centre; King's College Hospital NHS Foundation Trust; London UK
| | - Roopen Arya
- King's Thrombosis Centre; King's College Hospital NHS Foundation Trust; London UK
| |
Collapse
|
9
|
Nghiem AZ, Rudarakanchana N, Moore HM, Davies AH. Percutaneous pharmacomechanical thrombectomy for acute iliofemoral deep vein thrombosis: A suitability study. Phlebology 2014; 30:235-41. [DOI: 10.1177/0268355514521607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Percutaneous pharmacomechanical thrombectomy is an emerging therapy for acute deep vein thrombosis and may reduce long-term incidence of post-thrombotic syndrome. This study investigates the proportion of patients presenting with lower limb deep vein thrombosis who are potentially suitable for percutaneous pharmacomechanical thrombectomy. Methods A retrospective review of all duplex ultrasound scans for lower limb deep vein thrombosis over two-year period at a regional vascular unit was conducted. All acute occlusive iliofemoral deep vein thrombosis were screened for percutaneous pharmacomechanical thrombectomy suitability according to predefined criteria. Results There were 2513 duplex ultrasound scans for suspected lower limb deep vein thrombosis in the two-year period. There were 120 cases of acute occlusive iliofemoral deep vein thrombosis. After application of inclusion and exclusion criteria 48 out of 120 (40%) patients were identified as potential candidates for percutaneous pharmacomechanical thrombectomy. Conclusions This indicates that a large randomised trial of percutaneous pharmacomechanical thrombectomy is feasible given expected recruitment rates in a multicentre study.
Collapse
Affiliation(s)
- AZ Nghiem
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - N Rudarakanchana
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - HM Moore
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - AH Davies
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
10
|
Stansby G, Berridge D. Venous thromboembolism. Br J Surg 2013; 100:989-90. [PMID: 23754642 DOI: 10.1002/bjs.9187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/10/2022]
Abstract
Extended treatment
Collapse
Affiliation(s)
- G Stansby
- Department of Vascular Surgery, Northern Vascular Centre, Freeman Hospital, Freeman Road, High Heaton, Newcastle-upon-Tyne NE7 7DN, UK.
| | | |
Collapse
|