P1450Deep vein thrombosis after right sided catheter ablation; more common then previously thought?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Bruce ◽  
S Rogers ◽  
K Saraf ◽  
G Kirkwood ◽  
N Kirkland ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Femoral Vein ◽  
Accessory Pathway ◽  
Significant Proportion ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Iliac Vein ◽  
P Value ◽  
Cardiac Catheter ◽  
Vein Thrombosis

Abstract Funding Acknowledgements Bristol-Myers Squibb Background Right sided cardiac catheter ablation has become an indispensable tool to treat supraventricular cardiac dysrhythmias, with ablation of certain arrhythmias having cure rates over 90%. Due to this the frequency of these procedures is increasing annually and it is imperative we understand the incidence of all complication. One lesser studied complication is that of deep vein thrombosis (DVT), for which catheter ablation demonstrates all elements of Virchow"s triad.  As right sided ablations are carried out to treat troublesome palpitations, not to reduce mortality, it is important all risks are identified, especially those which are themselves potentially life threatening and can be modified. Purpose   To determine the incidence of DVT after right sided cardiac catheter ablation. Methods   We undertook a prospective multi-center study recruiting adult patients undergoing clinically indicated cardiac ablation for atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia with right sided accessory pathway. Important exclusion criteria included patients on anticoagulation or antiplatelet therapy. Participants underwent bilateral compression venous duplex ultrasonography from the inferior vena cava to the popliteal vein to access for DVT at 24 hours and between 10 to 14 days post-procedure. The uncannulated contralateral leg acted as a control. Result   At interim analysis 71 participants had completed the study with average age 47 year (+/- 14), procedure duration 67 minutes, and with a female predominance. Seven patients developed acute DVT in either the femoral or internal iliac vein in the access leg. No thrombus was seen in the control leg. This gives an incidence of 10% (95% CI 4-19%) with p value of 0.023 on Chi-square testing. Conclusion We found a statistically significant proportion of patients undergoing right sided cardiac catheter ablation developed acute proximal DVT on ultrasound. All patients were treated with 3 to 6 months of anticoagulation therapy in accordance with NICE guidelines. These results suggest that DVT may occur at a high frequency then previously thought in this cohort and supports the consideration of peri-procedural prophylactic anticoagulation. Abstract Figure. Acute thrombus in the femoral vein

scholarly journals External iliac vein compression and lower-extremity swelling caused by an iliopectineal ganglion: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Kiyokazu Fukui ◽  
Ayumi Kaneuji ◽  
Norio Kawahara
Keyword(s):  
Lower Extremity ◽  
Femoral Vein ◽  
Signs And Symptoms ◽  
Iliac Vein ◽  
Needle Aspiration ◽  
Case Presentation ◽  
Vein Thrombosis ◽  
External Iliac Vein ◽  
Iliac Vein Compression ◽  
Deep Vein

Abstract Background A hip joint ganglion is a rare cause of lower-extremity swelling. Case presentation We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis. Conclusions Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.

scholarly journals Inferior Vena Cava Agenesis and Deep Vein Thrombosis: A Pharmacological Alternative to Vitamin K Antagonists

2019 ◽  
Author(s):  
Inês Esteves Cruz ◽  
Pedro Ferreira ◽  
Raquel Silva ◽  
Francisco Silva ◽  
Isabel Madruga
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Inferior Vena ◽  
Vitamin K Antagonists ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Deep Vein

Inferior vena cava (IVC) agenesis is a rare congenital abnormality affecting the infrarenal segment, the suprarenal or the whole of the IVC. It has an estimated prevalence of up to 1% in the general population that can rise to 8.7% when abnormalities of the left renal vein are considered. Most IVC malformations are asymptomatic but may be associated with nonspecific symptoms or present as deep vein thrombosis (DVT). Up to 5% of young individuals under 30 years of age with unprovoked DVT are found to have this condition. Regarding the treatment of IVC agenesis-associated DVT, there are no standard guidelines. Treatment is directed towards preventing thrombosis or its recurrence. Low molecular weight heparin and oral anticoagulation medication, in particular vitamin K antagonists (VKAs) are the mainstay of therapy. Given the high risk of DVT recurrence in these patients, oral anticoagulation therapy is suggested to be pursued indefinitely. As far as we know, this is the first case reporting the use of a direct factor Xa inhibitor in IVC agenesis-associated DVT. Given VKA monitoring limitations, the use of a direct Xa inhibitor could be an alternative in young individuals with anatomical defects without thrombophilia, but further studies will be needed to confirm its efficacy and safety.

Modified Sling Technique for Difficult Filter Retrieval

2021 ◽  
Vol 39 ◽  
Author(s):  
Pasquale Grillo ◽  
◽  
Giuseppe Granata ◽  
Anna Savoldi ◽  
Giovanni Rodà ◽  
...  
Keyword(s):  
Vena Cava ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Filter Retrieval ◽  
Ivc Filters ◽  
The Common ◽  
Deep Vein ◽  
Removal Technique ◽  
Loop Snare

Caval filters are placed in the inferior vena cava (IVC) to prevent pulmonary thromboembolism in patients with deep vein thrombosis. If there is no indication for thrombo-embolic risk prevention, the filter can be removed to reduce potential filter-related complications. Advanced endovascular techniques are frequently used to retrieve IVC filters. We describe an alternative filter-removal technique for use when standard techniques are not practicable. In our method, the filter hook is embedded within the IVC wall. To retrieve it, a long introducer is inserted; a guidewire and the "loop snare" retrieval system are then advanced through it with a coaxial system and positioned below the filter at the level of the common iliac vein confluence. The guidewire is then passed through the loop, creating a "sling" around the filter which allows the application of traction from the bottom upwards, releasing the hook from the wall. The loop is then held under tension with the filter aligned in the IVC lumen, and the introducer is advanced distally to completely cover the filter, allowing complete retrieval of the filter without damaging the vessel walls. This modified Sling technique is a safe and feasible method for complicated IVC filter retrieval.

scholarly journals May-Thurner Syndrome with Large Abdominal Varicosity, Treated Successfully Using Multiple Approaches

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Lori Jia ◽  
Jason Alexander ◽  
Nedaa Skeik
Keyword(s):  
Vena Cava ◽  
Iliac Vein ◽  
Postthrombotic Syndrome ◽  
Common Iliac Vein ◽  
Filter Placement ◽  
Vein Thrombosis ◽  
Left Common Iliac Vein ◽  
Venous Outflow Obstruction ◽  
Angioplasty And Stenting ◽  
Deep Vein

May-Thurner syndrome (MTS) is a venous outflow obstruction disorder characterized by compression of the left common iliac vein by an overriding right common iliac artery. MTS primarily affects young to middle-aged women, although many patients remain entirely asymptomatic. Anatomic variations of MTS, while uncommon, have been described. Treatment usually involves endovascular management, including thrombolysis and/or thrombectomy with or without inferior vena cava filter placement, followed by angioplasty and stenting of the left common iliac vein. We report a unique case of a 31-year-old woman who presented with MTS-related deep vein thrombosis accompanied by symptomatic abdominal and pelvic varicosities. The varicosities were treated successfully using multiple procedures, resulting in complete resolution of all symptoms. Our case discusses a treatment approach for an unusual presentation of MTS-related postthrombotic syndrome, and provides a brief literature review of MTS complications and management.

Inferior Vena Cava Compression Caused by Ruptured Abdominal Aortic Aneurysms: Report of Two Cases

1997 ◽  
Vol 12 (3) ◽  
pp. 112-114
Author(s):  
J. I. Martínez-León ◽  
J. C. Bohórquez-Sierra ◽  
A. R. Sánchez-Guzmán ◽  
F. N. Arribas-Aguilar ◽  
F. Ceijas-Lloreda ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Abdominal Aortic Aneurysms ◽  
Iliac Vein ◽  
Aortic Aneurysms ◽  
Vein Thrombosis ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms ◽  
Iliac Vein Thrombosis

Objective: To report two cases of inferior vena cava (IVC) and iliac vein thrombosis secondary to expansive and ruptured abdominal aortic aneurysms. Design: Case report. Setting: Angiology and Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain. Patients: Patients with clinical and radiological evidence of IVC and iliac vein thrombosis secondary to a sealed rupture from expanding aortic aneurysms. Interventions: Surgical repair in one case and conservative management in the second case. Conclusions: Venous compression was relieved, avoiding the risk associated with anticoagulant therapy in the presence of an aortic aneurysm. Ultrasound scanning is useful in assessing deep venous thrombosis and detecting compressive masses such as aortic and iliac aneurysms. Inappropriate management of patients with venous obstruction from undiagnosed arterial aneurysms may cause serious complications.

Endovascular Treatment of an Extensive Iliocaval and Renal Vein Thrombosis Secondary to Inferior Vena Cava Stenosis and May-Thurner Type Iliac Vein Compression: A Case Report

2020 ◽  
Vol 54 (3) ◽  
pp. 297-300 ◽  
Author(s):  
Thomas Frederick Barge ◽  
Emma Wilton ◽  
Andrew Wigham
Keyword(s):  
Inferior Vena Cava ◽  
Renal Vein ◽  
Inferior Vena ◽  
Left Renal Vein ◽  
Vena Cava ◽  
Iliac Vein ◽  
Renal Vein Thrombosis ◽  
Endovascular Techniques ◽  
Vein Thrombosis ◽  
Iliac Vein Compression

A 23-year-old presenting with an acute history of back pain, leg swelling, and claudication was diagnosed with an extensive iliocaval thrombosis, extending from the popliteal veins into the inferior vena cava (IVC) and left renal vein. He was treated with a combination of endovascular techniques, including EKOS and AngioJet. An underlying congenital IVC stenosis and May-Thurner type iliac vein compression were subsequently treated with venoplasty and stenting. To our knowledge, this is the first report of the use of EKOS for renal vein thrombosis and we highlight the complementary nature of different endovascular techniques for managing complex venous thrombotic disease.

High utilization rate of vena cava filters in deep vein thrombosis

2005 ◽  
Vol 93 (06) ◽  
pp. 1117-1119 ◽  
Author(s):  
Samuel Goldhaber ◽  
Victor Tapson ◽  
Michael Jaff
Keyword(s):  
Deep Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Duplex Ultrasound ◽  
Physician Education ◽  
Utilization Rate ◽  
Thromboembolism Prophylaxis ◽  
Vein Thrombosis ◽  
Vena Cava Filters ◽  
Deep Vein

SummaryThe objective was to investigate newly diagnosed patients with deep vein thrombosis (DVT) who received inferior vena cava filters (IVCFs). A prospective registry enrolled 5451 patients from 183 US study sites. In all patients, examination by venous duplex ultrasound confirmed the diagnosis of DVT. We collected and analyzed data on 781 patients who received an IVCF . The most frequently prescribed treatments were low–molecular-weight heparin and unfractionated heparin, which were used as a bridge to warfarin in 39% (n=2143) and 35% (n=1926) of patients, respectively. Of the total population, 781 (14%) (235 outpatients, 546 inpatients) underwent IVCF placement. The most common reasons for IVCF placement were contraindication to anticoagulation (n = 271), prophylaxis (n = 259), major bleeding related to anticoagulation therapy (n = 92), and anticoagulation failure (n = 73). Multivariate analysis revealed that patients were more likely to undergo IVCF insertion with multiple system organ failure (odds ratio [OR], 3.6; 95% CI, 1.48–8.60), previous stroke (OR, 3.2; 95% CI, 2.11–4.74), or history of pulmonary embolism (OR, 2.4; 95% CI, 1.95–2.91). In conclusion, a surprisingly high 14% (781) of patients with confirmed DVT received an IVCF. Many of these patients may have warranted less invasive methods of venous thromboembolism prophylaxis. Improved physician education regarding mechanical and pharmacologic prophylaxis alternatives might reduce the use of IVCFs.

Bilateral Iliac Vein Thrombosis After Seat Belt-Related Trauma Revealing Hypoplasia of the Inferior Vena Cava

Angiology ◽  
2002 ◽  
Vol 53 (3) ◽  
pp. 359-362 ◽  
Author(s):  
Brigitte Granel ◽  
Jacques Serratrice ◽  
Jean Michel Bartoli ◽  
Patrick Disdier ◽  
Philippe Piquet ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Seat Belt ◽  
Vena Cava ◽  
Iliac Vein ◽  
Vein Thrombosis ◽  
Iliac Vein Thrombosis

Deep Vein Thrombosis and Venous Thromboembolism in the Critically Ill

2017 ◽  
Author(s):  
Kathryn L. Butler ◽  
George Velmahos
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Vena Cava Filters ◽  
Deep Vein

Venous thromboembolism (VTE) poses unique diagnostic and therapeutic dilemmas in the intensive care unit (ICU). Immobility, inflammatory states, and trauma uniquely predispose surgical ICU patients to deep vein thrombosis and pulmonary embolism. Concurrently, the risks of perioperative and traumatic bleeding complicate management of VTE, with anticoagulation contraindicated in many scenarios. This review surveys the latest evidence in the diagnosis and management of VTE among critically ill surgical patients. It discusses evidence-based guidelines regarding diagnostic imaging, anticoagulation, prophylaxis, inferior vena cava filters, non–vitamin K oral anticoagulants, and surgical and catheter-based therapies. The review also examines the special challenges encountered when treating multisystem trauma patients.  Key words: anticoagulation therapy, deep vein thrombosis, pharmacoprophylaxis, pulmonary embolism, venous thromboembolism  

Clinical recurrence of palpitations following slow pathway ablation in patients with suspected paroxysmal supraventricular tachycardias but non-documented, non-inducible tachycardias

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Ramos Jimenez ◽  
A Marco Del Castillo ◽  
VC Lozano Granero ◽  
C Lazaro Rivera ◽  
R Salgado ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Clinical Suspicion ◽  
Therapeutic Modality ◽  
P Value ◽  
Slow Pathway ◽  
Clinical Recurrence ◽  
Slow Pathway Ablation ◽  
Supraventricular Tachycardias

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation is recommended as first-line treatment in patients with atrioventricular nodal reentry tachycardias (AVNRT). However, the best therapeutic modality in patients with dual AV nodal physiology but non-inducible tachycardias in electrophysiological study (EPS) remains controversial, especially when no tachycardias have been documented. Our objective was to evaluate the results of empirical slow pathway ablation in patients showing dual AV nodal physiology but non-inducible AVNRT. Methods Multicenter, retrospective, observational registry of consecutive patients undergoing EPS due to clinical suspicion of paroxysmal supraventricular tachycardias (PSVT), but with no prior ECG documentation. Clinical, EPS and ablation (when performed) data were collected and andalyzed.  Results 427 patients of 12 centers were included. Mean age was 46.3 ±16.1 and 297 (69.6%) were females. AVNRT was induced in 188 patients (typical in 181 cases, atypical in 7). Dual AV nodal physiology with or without single nodal echo beats, but with no sustained tachycardia and without evidence of accessory pathway was present in 68 patients. Ablation of the slow pathway was performed in 187/188 patients with AVNRT and in 30/68 patients with dual physiology. Among subjects with non-inducible tachycardia, ablation reduced significantly recurrences (39.5% in non-ablated vs. 16.7%; p = 0.04), with a level equivalent to those with ablated AVNRT(14.4% vs. 16.7%; p = 0.75). Procedure-related complications were similar in both groups: empirical ablation n = 1; 3.3% vs. induced tachycardia n = 6; 3.2% (p = 0.98). Conclusions In patients with high clinical suspicion of PSVT but non-documented and non-inducible arrhythmias, the presence of dual AV nodal physiology makes AVNRT a likely mechanism of the clinical tachycardia. Catheter ablation of slow pathway reduces the risk of recurrence to a level equivalent to those with inducible and ablated AVNRT. AVNRT (n = 188) Dual nodal physiology (n = 68) p value Age (years) 48.6 ± 16.3 41.9 ± 14.0 <0.01 Female 71.8% 67.7% 0.52 Years symptomatic 9.3 ± 11.3 3.6 ± 8.1 <0.01 Sudden onset 83.9% 88.0% 0.54 Abrupt end 73.4% 74.6% 0.96 Previous rate-slowing drugs 30.9% 25.0% 0.36 Previous antiarrhythmic drugs 5.9% 2.9% 0.35 Isoproterenol in EPS 70.0% 89.7% <0.01

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