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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]
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Catheter-Directed Thrombolysis Along with Mechanical Thromboaspiration versus Anticoagulation Alone in the Management of Lower Limb Deep Venous Thrombosis-A Comparative Study. Int J Angiol 2014; 23:247-54. [PMID: 25484556 DOI: 10.1055/s-0034-1382157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Catheter-directed thrombolysis (CDT) with assisted mechanical thrombolysis is now considered as the standard of medical care for deep vein thrombosis (DVT). The study was conducted to describe the immediate and long-term (6 months) safety and effectiveness of CDT in patient with lower limb DVT compared with the routine anticoagulation alone. All 12 to 85 years old patients with recent (0-8 weeks) DVT were included. In CDT group, thrombus was aspirated mechanically and streptokinase (STK) was given along with unfractionated heparin (UFH). After 6 months, deep venous patency and postthrombotic syndrome (PTS) was assessed by using duplex ultrasound and Villalta scale, respectively. Among 51 patients with completed data, 25 patients were allocated additional CDT given for a mean duration of 108 ± 32 hours and 26 patients were allocated standard treatment alone. Grade III (complete) lysis was achieved in 37% patients and grade II (50-90%) lysis in 63% of patients. Patients with partial lysis underwent percutaneous transluminal angioplasty and/or venous stenting. After 6 months, iliofemoral patency was found in 20 (80%) in the CDT group versus 7 (23%) in anticoagulation alone group (p < 0.01). PTS was seen in 5 (20%) in the CDT group versus 19 (77%) in anticoagulation alone group (p < 0.01). We conclude that CDT and conventional manual aspiration thrombectomy are an effective treatment for lower extremity DVT. STK infusion can be safely given up to 6 days. As addition of UFH can cause thrombocytopenia, so daily monitoring of complete blood counts is needed during CDT.
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Patra S, Srinivas BC, Nagesh CM, Reddy B, Manjunath CN. Endovascular management of proximal lower limb deep venous thrombosis - A prospective study with six-month follow-up. Phlebology 2014; 30:441-8. [PMID: 24898308 DOI: 10.1177/0268355514538423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Catheter-directed thrombolysis with assisted mechanical thrombolysis is the standard of medical care for proximal deep vein thrombosis. We studied the immediate and intermediate (six months) safety and effectiveness of catheter-directed thrombolysis in patients with proximal lower limb deep vein thrombosis. METHODOLOGY Thirty consecutive patients aged between 20 and 70 years with proximal lower limb deep vein thrombosis formed the study group. Catheter-directed thrombolysis was done with streptokinase infuse through a catheter kept in the ipsilateral popliteal vein. Unfractionated heparin was given along with streptokinase. Mechanical thromboaspiration using guiding catheter was performed in addition to thrombolytic therapy. After six months, post-thrombotic syndrome and deep venous patency were assessed by using Villalta scale and duplex ultrasound, respectively. RESULTS Thirty patients with proximal lower limb deep vein thrombosis were treated with catheter-directed thrombolysis. Mean age of the study patients was 41.7 ± 15 years. Mean duration of illness was 13.3 ± 12 days. The mean duration of thrombolysis was 4.5 ± 1.3 days. Grade III (complete) lysis was achieved in 10 (33%) and Grade II (50-90%) lysis in 20 (67%) of patients. Patients with significant residual lesion in Grade II lysis following catheter-directed thrombolysis underwent percutaneous transluminal angioplasty alone (12/20) or venous stenting (8/20). All patients improved clinically following catheter-directed thrombolysis or assisted catheter-directed thrombolysis. Four patients (13%) developed pulmonary embolism during course of hospital stay and among them two (6.5%) patients died. Eleven patients (37%) had minor bleeding or hematoma at local site, and seven (23%) developed anemia requiring blood transfusion and four (13%) patients had thrombocytopenia. After six months, iliofemoral patency was found in 20 (72%) and post-thrombotic syndrome was seen in six (21%) patients. Two (6.5%) patients died during follow-up due to nephrotic syndrome and carcinoma breast. CONCLUSION Catheter-directed thrombolysis and conventional manual aspiration thrombectomy are an effective treatment for proximal lower extremity deep vein thrombosis with good short and intermediate outcome.
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Affiliation(s)
- S Patra
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - B C Srinivas
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - C M Nagesh
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - B Reddy
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - C N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
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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.
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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
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Interventionelle Therapie einer deszendierenden Beckenvenenthrombose bei einer jungen Frau. PHLEBOLOGIE 2013. [DOI: 10.12687/phleb2174-6-2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungWir schildern den Fall einer 15-jährigen Patientin mit deszendierender Beckenvenenthrombose des linken Beines bei einer ilio-cavalen Gefäßanomalie, bei der nach zunächst frustraner Thrombektomie in einem zweiten Schritt, dann in einem spezialisierten Zentrum, eine kombinierte Behandlung im Sinne einer Spätthrombektomie mit lokoregionärer Thrombolyse, AV-Fistelanlage und Stentim-plantation durchgeführt wurde. Im Langzeitverlauf ist die Patientin beschwerdefrei ohne klinische oder meßtechnische Zeichen eines postthrombotischen Syndroms.Die Möglichkeit einer interventionellen Therapie proximaler Thrombosen sollte insbesondere bei jüngeren Patienten häufiger als heute üblich in Erwägung gezogen werden. Dabei sollte immer an die Möglichkeit von Gefäßanomalien und anatomischen Varian-ten gedacht und eine entsprechend subtile Diagnostik präinterventionell vorgenommen werden. Nach den derzeitigen Empfehlungen kommt in etwa zwei Drittel der Fälle solcher Thrombosen eine restitutive Therapie in Betracht.
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Saunders JH, Arya PH, Abisi S, Yong YP, MacSweeney S, Braithwaite B, Altaf N. Catheter-directed thrombolysis for iliofemoral deep vein thrombosis. Br J Surg 2013; 100:1025-9. [PMID: 23696442 DOI: 10.1002/bjs.9158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Recent international guidance recommends the use of catheter-directed thrombolysis (CDT) in selected patients with symptomatic iliofemoral deep vein thrombosis (DVT). The aim of this study was to estimate the potential increase in workload as a result of this recommendation. METHODS Using the radiology database, a review was performed of all DVTs diagnosed between August 2010 and February 2012 at a large tertiary referral hospital. The National Institute for Health and Clinical Excellence and American College of Chest Physicians guidance was applied retrospectively to this cohort, using case-note review by two independent clinicians to determine which patients would have been suitable for CDT. RESULTS Some 563 patients had DVT confirmed radiologically over the 18-month interval. Fifty-three of the 128 patients with iliofemoral DVT would have been eligible for intervention with CDT, equivalent to 4·4 patients per 100 000 per year. Only eight (15 per cent) of the 53 were actually referred to vascular services for treatment. All eight patients had successful CDT, which involved a stay in critical care for monitoring (median 2 (range 1-3) sessions). CONCLUSION Vascular units should be prepared for a major increase in the requirement for CDT for iliofemoral DVT. This increase will affect inpatient beds, the interventional radiology suite, critical care and interhospital referrals.
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Affiliation(s)
- J H Saunders
- Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK.
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Chandra E, Ahmadi M, Bailey MA, Griffin KJ, Berridge DC, Coughlin PA, Scott DJA. Early re-presentations and the potential role of catheter-directed thrombolysis in patients diagnosed with a lower limb deep vein thrombosis: a single-centre experience. Phlebology 2013; 28:404-8. [DOI: 10.1258/phleb.2012.012078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (DVT) restores venous patency, reduces the risk of the post-thrombotic syndrome and may reduce longer term treatment costs. This study assessed the potential role of CDT in patients with DVT with regard to representation following the index event. Methods A retrospective review of all patients with a positive lower limb DVT scan. Potential suitability of each patient to undergo CDT was based on well-recognized inclusion/exclusion criteria. Results In total, 1689 patients underwent a DVT-specific lower limb venous duplex. A total of 269 were found to have a DVT. Fifty-three of these patients met the inclusion criteria for CDT (only 2 underwent CDT). Fifty-nine of the 269 patients with an index DVT re-presented to our institution with a venous thromboembolism-related clinical event. These patients were significantly younger than those who did not reattend. A higher proportion of patients who represented were deemed suitable for CDT for the index DVT compared with those who did not represent (17/59 versus 36/210; P = 0.04). Conclusion This pragmatic study highlights the fact that significant number of patients return to secondary care with actual/perceived complications following initial diagnosis and treatment of a DVT which may have been amenable to CDT.
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Affiliation(s)
- E Chandra
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - M Ahmadi
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - M A Bailey
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - K J Griffin
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - D C Berridge
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
| | - P A Coughlin
- Department of Vascular Surgery, Addenbrookes Hospital, Cambridge, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds
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Patterson BO, Karthikesalingam A, Morgan R, Hunt BJ, Thompson MM, Holt PJE. Management strategies for acute proximal deep vein thrombosis: a Delphi consensus. Phlebology 2012; 27:423-9. [PMID: 22332143 DOI: 10.1258/phleb.2011.011074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Deep vein thrombosis (DVT) is a leading cause of cardiovascular disease. We tested the hypothesis that there is a consensus regarding the treatment of acute DVT among clinicians experienced in DVT management. METHOD A Delphi consensus approach was used to gather expert opinion regarding attitudes towards the treatment of acute proximal DVT and management of specific cases. Strength of preference for various treatment strategies across a number of case scenarios was quantified. Univariate and multivariate analyses were performed to quantify the influence of various factors on treatment modality selected. RESULTS Respondents strongly agreed that DVT was a significant health problem and that further research was a priority. A multidisciplinary team approach with access to various treatment strategies was encouraged. Pregnancy and recent surgery independently predicted preference for medical treatment, whereas proximal DVT and May-Thurner syndrome were associated with interventional strategies. CONCLUSION Acute proximal DVT is a significant health problem for which a variety of treatments are available. This study demonstrates that no consensus exists as to the optimum strategy for certain patient groups. Trends in opinion based on local experience and case-series exist, but the results of ongoing randomized trials will ultimately inform best practice.
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Affiliation(s)
- B O Patterson
- Department of Outcomes Research, St George's Vascular Institute, London SW17 0QT, UK
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