Catheter-directed intra-arterial thrombolysis in the treatment of acute thrombosis of below-the-knee arteries

Popliteal aneurysms are rare and tend to occur in older men with significant co-morbidity. Historically, management of popliteal aneurysms can be considered in three broad groups: (i) the technique of Antyllus; (ii) techniques relying upon a collateral circulation; and (iii) techniques involving maintenance or restoration of circulation. Bypass and exclusion is currently been challenged by endovascuiar techniques which show promise in selected cases. Current controversies in popliteal aneurysms management are: when to repair asymptomatic aneurysms, what operation to do and how to manage acute thrombosis. These have been addressed by studying, prospectively, 73 patients presenting with 116 popliteal aneurysms. Diameter greater than 2 cm is often stated as being an indication for elective operation in asymptomatic popliteal aneurysms. However, distortion of the aneurysm appears to be at least as important as size in determining whether symptoms are likely to develop. Of 17 popliteal aneurysms followed for a median of 34 months with a diameter 2–3 cm and distortion less than 45°, none thrombosed. This is no worse than patency following elective bypass (P= 0.064). Popliteal aneurysms greater than 3 cm in diameter in patients who are unfit or who declined an operation were significantly more likely to develop thrombosis or any other symptom (P = 0.01 and P = 0.004, respectively). Popliteal aneurysms less than 3 cm in diameter with distortion less than 45° can safely be managed by ultrasound surveillance. Popliteal aneurysms with greater diameter or distortion are best operated upon. Bypass, combined with proximal and distal ligation of the aneurysm, resulted in 5-year graft patency of 78% and 65% for popliteal aneurysms originally patent or thrombosed, respectively, with good long-term exclusion of the aneurysm. In addition to the general complications of intra-arterial thrombolysis, acute deterioration of the limb during lysis appears to be a particular problem when dealing with thrombosed popliteal aneurysms. It occurs in about 13% of cases which compares with 2% when dealing with thrombosed grafts or native arteries. Intra-arterial thrombolysis for thrombosed popliteal aneurysms is associated with unacceptabiy high numbers of complications and thrombolysis should be reserved for intra-operative use only.

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SP596INTRA-ARTERIAL THROMBOLYSIS FOR ACUTE THROMBOSIS OF ARTERIO-VENOUS FISTULA: A TERTIARY CARE CENTRE EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy104.sp596 ◽

2018 ◽

Vol 33 (suppl_1) ◽

pp. i548-i548

Author(s):

Sree Bhushan Raju Devaraju ◽

Kiran Kumar Mukku ◽

Vamsi Krishna Nagalla

Keyword(s):

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Acute Thrombosis ◽

Venous Fistula ◽

Arterial Thrombolysis

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TCTAP A-087 Acute Thrombosis of AV Fistula in Chronic Kidney Disease Patients – Effect of Intra-Arterial Thrombolysis: Our Experience

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.03.149 ◽

2015 ◽

Vol 65 (17) ◽

pp. S45-S46

Author(s):

Ramesh Gadepalli

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Av Fistula ◽

Acute Thrombosis ◽

Arterial Thrombolysis

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Surface Heparinization Profoundly Decreases Acute Thrombosis on Crown and Mini-Crown Stents in the Baboon Arteriovenous Shunt Model

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)85495-2 ◽

1998 ◽

Vol 31 (2) ◽

pp. 413A ◽

Cited By ~ 1

Author(s):

N Chronos

Keyword(s):

Arteriovenous Shunt ◽

Acute Thrombosis

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Malignant tumours as a rare cause of recurrent thrombophlebitis of the great saphenous vein

Phlebologie ◽

10.1055/s-0037-1622244 ◽

2008 ◽

Vol 37 (06) ◽

pp. 297-300

Author(s):

N. König ◽

H. J. Stark ◽

P.-M. Baier

Keyword(s):

Differential Diagnosis ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Case Reports ◽

Malignant Tumours ◽

Nerve Sheath Tumour ◽

Below The Knee ◽

Nerve Sheath ◽

Unfavourable Prognosis ◽

Peripheral Nerve Sheath Tumour

SummaryWe present two case reports concerning patients who had to undergone surgical treatment according tp the diagnosis of thrombophlebitis with insufficiency of the greater saphenous vein and putative encapsulated haematoma in the lower left leg area. During the operation we found tumours with urgent suspicion of malignancy. The histological examination revealed the diagnosis of mesenchymal chondrosarcoma and malignant peripheral nerve sheath tumour which are extremely malignant, but very rare neoplasmas with unfavourable prognosis. Conclusion: Since both types of tumours are often located below the knee, phlebotomists and vascular surgeons should take them into account as differential diagnosis.

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Recurrent varicose veins below the knee after varicose vein surgery

Phlebologie ◽

10.1055/s-0037-1622175 ◽

2007 ◽

Vol 36 (03) ◽

pp. 132-136

Author(s):

M. W. de Haan ◽

J. C. J. M. Veraart ◽

H. A. M. Neumann ◽

P. A. F. A. van Neer

Keyword(s):

Varicose Vein ◽

Varicose Veins ◽

Varicose Vein Surgery ◽

Proximal Point ◽

Perforating Veins ◽

Recurrent Varicose Veins ◽

Below The Knee ◽

Duplex Imaging ◽

Additional Value

SummaryThe objectives of this observational study were to investigate whether varicography has additional value to CFDI in clarifying the nature and source of recurrent varicose veins below the knee after varicose vein surgery and to investigate the possible role of incompetent perforating veins (IPV) in these recurrent varicose veins. Patients, material, methods: 24 limbs (21 patients) were included. All patients were assessed by a preoperative clinical examination and CFDI (colour flow duplex imaging). Re-evaluation (clinical and CFDI) was done two years after surgery and varicography was performed. Primary endpoint of the study was the varicographic pattern of these visible varicose veins. Secondary endpoint was the connection between these varicose veins and incompetent perforating veins. Results: In 18 limbs (75%) the varicose veins were part of a network, in six limbs (25%) the varicose vein appeared to be a solitary vein. In three limbs (12.5%) an incompetent sapheno-femoral junction was found on CFDI and on varicography in the same patients. In 10 limbs (41%) the varicose veins showed a connection with the persistent below knee GSV on varicography. In nine of these 10 limbs CFDI also showed reflux of this below knee GSV. In four limbs (16%) the varicose veins showed a connection with the small saphenous vein (SSV). In three limbs this reflux was dtected with CFDI after surgery. An IPV was found to be the proximal point of the varicose vein in six limbs (25%) and half of these IPV were detected with CFDI as well. Conclusion: Varicography has less value than CFDI in detecting the source of reflux in patients with recurrent varicose veins after surgery, except in a few cases where IPV are suspected to play a role and CFDI is unable to detect these IPV.

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Fibrinolytic Activity of Human Veins in Arms and Legs

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651264 ◽

1968 ◽

Vol 20 (01/02) ◽

pp. 247-256 ◽

Cited By ~ 24

Author(s):

M Pandolfi ◽

B Robertson ◽

S Isacson ◽

Inga Marie Nilsson

Keyword(s):

Saphenous Vein ◽

Fibrinolytic Activity ◽

Great Saphenous Vein ◽

Normal Subjects ◽

Vasa Vasorum ◽

Tissue Sections ◽

Below The Knee ◽

The Media

SummaryA modification of the fibrin slide method of Todd permitting a semiquantitative estimation of the fibrinolytic activity in tissue sections is described. By means of this technique, the authors have studied the fibrinolytic activity of the great saphenous vein and of superficial veins of the arm and leg in patients suffering from varices and in normal subjects. It was found that:1. Fibrinolytic activity is localized, in these vessels, mainly to the vasa vasorum of the adventitia. The media is moderately active. Intimal cells are active only when detached.2. The great saphenous vein is more active above than below the knee.3. The veins of the arm are definitely more active than the veins of the leg.4. The activator of plasminogen demonstrated in the sections by the fibrin slide method is a fairly stable enzyme still active after exposure to 60° C and resistent to moderate variations of pH.

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Combined Thrombin and Platelet Inhibition Treatment for HIT Patients

Hämostaseologie ◽

10.1055/s-0038-1660400 ◽

1999 ◽

Vol 19 (03) ◽

pp. 128-133 ◽

Cited By ~ 1

Author(s):

B.E. Lewis ◽

W. P. Jeske ◽

F. Leya ◽

Diane Wallis ◽

M. Bakhos ◽

...

Keyword(s):

Standard Dose ◽

Combined Therapy ◽

Platelet Inhibition ◽

Thrombin Inhibitors ◽

Thrombin Inhibitor ◽

Heparin Induced Thrombocytopenia ◽

Acute Thrombosis ◽

Anti Platelet Drug ◽

Receptor Inhibitor

SummaryDespite the use of potent anticoagulants such as r-hirudin and argatroban, the morbidity and mortality in heparin-induced thrombocytopenia (HIT) patients remains unacceptable. Data from our in vitro investigations show that thrombin inhibitors do not block platelet activation induced by heparin antibodies and heparin but that GPIIb/IIIa receptor inhibitors do block this process. We have treated four HIT positive patients with a combined therapy of thrombin inhibitor and GPIIb/IIIa receptor inhibitor when treatment with thrombin inhibitor alone failed to alleviate acute thrombosis. Combination therapies included r-hirudin (Refludan®) with tirofiban (Aggrastat®) and argatroban (Novastan®) with abciximab (ReoPro®). A reduced dose of the thrombin inhibitor was used with the standard dose of the anti-platelet drug. In all cases, there was no overt bleeding which required intervention, and all patients exhibited clinical improvement or full recovery. These case studies suggest that treatment of active thrombosis in HIT patients with adjunct GPIIb/IIIa receptor inhibitor therapy may be more effective than thrombin inhibitor treatment alone.

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