scholarly journals Role of venous stenting for venous thromboembolism

Hematology ◽  
2020 ◽  
Vol 2020 (1) ◽  
pp. 606-611
Author(s):  
Karen Breen
Keyword(s):  
Best Practice ◽  
Assessment Tools ◽  
Postthrombotic Syndrome ◽  
Venous Stenting ◽  
Vein Thrombosis ◽  
Venous Circulation ◽  
Potential Benefits ◽  
Venous Outflow Obstruction ◽  
Deep Vein

Abstract Endovenous stenting has emerged as the method of choice to treat iliofemoral venous outflow obstruction. It is used in patients with established postthrombotic syndrome (PTS) after previous deep vein thrombosis (DVT) to reduce symptoms of chronic pain and swelling and to aid ulcer healing in severe cases. Venous stenting is used to alleviate symptoms of obstruction in patients presenting with acute DVT, with the aim of preventing development of PTS. There is a low risk of morbidity and mortality associated with the use of endovenous stenting, and although significant advances have been made, particularly improvements in stent design for use in the venous circulation, data are lacking on beneficial long-term outcomes. Unmet research needs include optimal patient selection, anticoagulant choice and duration, best practice for postoperative surveillance, and use of validated assessment tools to measure outcomes. In this article, I address the potential benefits, as well as the challenges, of endovenous stenting.

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.

Asymptomatic postoperative deep vein thrombosis and the development of postthrombotic syndrome

2005 ◽  
Vol 93 (02) ◽  
pp. 236-241. ◽  
Author(s):  
Lars Jorgensen ◽  
Michael Crawford ◽  
Peer Wille-Jørgensen
Keyword(s):  
Screening Method ◽  
Postthrombotic Syndrome ◽  
Long Term Effects ◽  
Vein Thrombosis ◽  
Treatment Regimens ◽  
Increased Risk ◽  
Reference Databases ◽  
Deep Vein

SummaryPerioperative antithrombotic clinical regimens have reduced the incidence of postoperative deep venous thrombosis (DVT). Long-term effects of asymptomatic postoperative DVT have been studied in a number of clinical trials and the present review describes the clinical significance of asymptomatic postoperative DVT regarding the possible development of postthrombotic syndrome (PTS).We performed a systematic review of reference databases focusing upon studies including patients suspected of having postoperative DVT and reporting subsequent cases of PTS at the end of a well-defined follow-up period. The included studies were stratified according to type of screening method and applied statistics. Over-all evaluation included metaanalyses based upon the Cochrane software package. The overall relative risk of developing PTS was 1.58 (95% confidence intervals: 1.24 – 2.02) in patients suffering from asymptomatic DVT as compared to patients without DVT ( p < 0.0005).In conclusion, asymptomatic postoperative DVT is associated with an increased risk of late development of PTS. The finding emphasizes that postoperative DVT, diagnosed by means of well-defined objective measures, remains the correct scientific endpoint in trials evaluating the efficacy of preoperative antithrombotic treatment regimens.

scholarly journals Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

2020 ◽  
Vol 18 (4) ◽  
pp. 857-864 ◽  
Author(s):  
Jean‐Philippe Galanaud ◽  
Marc Righini ◽  
Lorris Le Collen ◽  
Aymeric Douillard ◽  
Helia Robert‐Ebadi ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Postthrombotic Syndrome ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

Catheter-based treatment of ilio-femoral deep vein thrombosis - an update on current evidence

VASA ◽  
2013 ◽  
Vol 42 (3) ◽  
pp. 161-167 ◽  
Author(s):  
Jennifer Fahrni ◽  
Rolf P. Engelberger ◽  
Nils Kucher ◽  
Torsten Willenberg ◽  
Iris Baumgartner
Keyword(s):  
Deep Vein Thrombosis ◽  
High Rate ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Postthrombotic Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vein Thrombosis ◽  
Deep Vein

Ilio-femoral deep vein thrombosis (DVT) has a high rate of long-term morbidity in the form of the postthrombotic syndrome (PTS). Therefore, management of acute thrombosis should not only focus on the prevention of acute complications such as propagation or embolisation of the initial clot but also on preventing PTS and recurrent thrombosis. Contemporary catheter-based treatments of deep vein thrombosis have proven to be safe and effective in selected patients. Current guidelines recommend medical therapy with anticoagulation alone for all but the most severe, limb-threatening thrombosis. They additionally allow for consideration of catheter-based treatment in patients with acute DVT and low risk of bleeding complications to prevent PTS. Recent studies favoring interventional therapy have not been included in these guidelines. Data on long-term outcome is expected to be published soon, clarifying and very likely strengthening the role of catheter-based treatments in the management of acute ilio-femoral DVT.

Midterm Outcomes of Pharmacomechanical Thrombectomy in the Treatment of Lower Extremity Deep Vein Thrombosis With a Rotational Thrombectomy Device

2017 ◽  
Vol 51 (5) ◽  
pp. 301-306 ◽  
Author(s):  
Ahmet Yuksel ◽  
Oktay Tuydes
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Postthrombotic Syndrome ◽  
Technical Success Rate ◽  
Vein Thrombosis ◽  
Rotational Thrombectomy ◽  
Thrombectomy Device ◽  
Deep Vein

Background: The purpose of this study was to assess the safety and efficacy with midterm outcomes of pharmacomechanical thrombectomy (PMT) performed by using a relatively new thrombectomy device in the treatment of lower extremity deep vein thrombosis (DVT). Methods: Between February 2014 and February 2016, a total of 46 patients with lower extremity DVT were treated with PMT by using Cleaner rotational thrombectomy system. Preprocedural, intraprocedural, postprocedural, and follow-up records of patients were collected and retrospectively analyzed. Results: Mean age of patients was 50.5 (14.8) years, and 58.7% of them were female. Technical success rate of procedure was 91.3%. Mean procedure time was 81.8 (40.3) minutes. Early clinical improvement was observed in all patients with successful treatment. No serious adverse event related to procedure and mortality was observed. Mean follow-up time was 16.0 (7.9) months. Reocclusion was observed in 7 (17.5%) patients during the follow-up period. Venous patency rates of patients at 1-, 3-, 6-, and 12-month follow-up visits were 95%, 92.5%, 89.7%, and 79.5%, respectively. Mild, moderate, and severe postthrombotic syndrome were observed in 8 (20%) patients, 4 (10%) patients, and 1 (2.5%) patient, respectively. Postthrombotic syndrome–free survival rate was 67.5%. Conclusion: Cleaner rotational thrombectomy system appears to be safe and effective in the treatment of lower extremity DVT. Further larger randomized studies are needed to determine the long-term outcomes of this treatment modality.

Pharmacomechanical Thrombolysis for Deep Vein Thrombosis in May-Thurner Syndrome

2017 ◽  
Vol 12 (6) ◽  
pp. 466-471
Author(s):  
Mayank Roy ◽  
Morris Sasson ◽  
Armando Rosales-Velderrain ◽  
Savannah Moon ◽  
Mark Grove ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Stent Placement ◽  
Patency Rate ◽  
Iliac Vein ◽  
Postthrombotic Syndrome ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Objective Patients with May-Thurner syndrome presenting with acute deep vein thrombosis benefit from early lysis of clot and endovascular treatment. We evaluated the outcome of patients with May-Thurner syndrome who presented with deep vein thrombosis, managed with pharmacomechanical thrombolysis as the primary mode of intervention, in combination with angioplasty and stent placement. Methods We reviewed all patients with May-Thurner syndrome managed in our institution between January 2009 to December 2015. Patency rate and postthrombotic syndrome were evaluated as primary end points. Results A total of seven patients (6 females, 1 male) with a mean ± SD age of 48 ± 17 years and mean ± SD body mass index of 29.64 ± 7.25 kg/m2 were identified. Six patients presented with acute deep vein thrombosis and one presented with chronic venous insufficiency. Five patients underwent pharmacomechanical thrombolysis (TRELLIS and altepase) with concomitant stenting of the common iliac vein, one had only angioplasty with stent placement, and one had only pharmacomechanical thrombolysis. Median time from presentation to pharmacomechanical thrombolysis was 4 days (range = 1–9). Patency rate and postthrombotic syndrome at 12 months were 100% and 0%, respectively. No patient experienced major bleeding or pulmonary embolism. The median length of stay was 3 days (range = 0–4). There was no mortality associated with the procedure. The mean ± SD follow-up was 26 ± 15 months. Conclusions In patients with May-Thurner syndrome, pharmacomechanical thrombolysis is an effective approach for the management of acute deep vein thrombosis, decreasing thrombus burden, and long-term postthrombotic syndrome when used in conjunction with stenting.

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