scholarly journals Percutaneous thrombectomy in the management of early rethrombosis in venous thoracic outlet syndrome: two case reports

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ján Sýkora ◽  
Kamil Zeleňák ◽  
Martin Vorčák ◽  
Adam Krkoška ◽  
Štefánia Vetešková ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Treatment Algorithm ◽  
Limited Data ◽  
Case Presentation ◽  
Percutaneous Mechanical Thrombectomy ◽  
Catheter Directed Thrombolysis ◽  
Effort Thrombosis ◽  
First Rib Resection

Abstract Background Venous thoracic outlet syndrome resulting in the upper limb deep venous thrombosis is known as Paget–Schroetter syndrome or effort thrombosis. A general treatment algorithm includes catheter-directed thrombolysis followed by surgical thoracic outlet decompression. There are limited data regarding endovascular treatment of rethrombosis presenting early after the surgery. Case presentation Two cases of early rethrombosis successfully treated with percutaneous mechanical thrombectomy by two different techniques are described. In both cases, rethrombosis was diagnosed soon after thrombolysis and first rib resection with scalenectomy. After 12 months, both patients remain symptom-free, with patent subclavian veins confirmed by duplex ultrasonography. Conclusion Percutaneous mechanical thrombectomy devices may offer a safe treatment option for patients with recurrent thrombosis after thoracic outlet surgery, even when thrombolytic therapy is contraindicated.

scholarly journals Percutaneous Thrombectomy in the Management of Early Rethrombosis in Venous Thoracic Outlet Syndrome: Two Case Reports

2021 ◽  
Author(s):  
Ján Sýkora ◽  
Kamil Zeleňák ◽  
Martin Vorčák ◽  
Adam Krkoška ◽  
Štefánia Vetešková ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Treatment Algorithm ◽  
Limited Data ◽  
Case Presentation ◽  
Percutaneous Mechanical Thrombectomy ◽  
Catheter Directed Thrombolysis ◽  
Effort Thrombosis ◽  
First Rib Resection

Abstract BackgroundVenous thoracic outlet syndrome resulting in the upper limb deep venous thrombosis is known as Paget–Schroetter syndrome or effort thrombosis. A general treatment algorithm includes catheter-directed thrombolysis followed by surgical thoracic outlet decompression. There are limited data regarding endovascular treatment of rethrombosis presenting early after the surgery.Case presentationTwo cases of early rethrombosis successfully treated with percutaneous mechanical thrombectomy by two different techniques are described. In both cases, rethrombosis was diagnosed soon after thrombolysis and first rib resection with scalenectomy. After 6 months, both patients remain symptom-free, with patent subclavian veins confirmed by duplex ultrasonography. ConclusionPercutaneous mechanical thrombectomy devices may offer a safe treatment option for patients with recurrent thrombosis after thoracic outlet surgery, even when thrombolytic therapy is contraindicated.

Thoracic Outlet Syndrome

2016 ◽  
Author(s):  
Mark W Fugate ◽  
Julie A Freischlag
Keyword(s):  
Multimodal Treatment ◽  
Thoracic Outlet Syndrome ◽  
Venous Flow ◽  
Treatment Algorithms ◽  
Effort Thrombosis ◽  
First Rib Resection ◽  
Neurovascular Structures ◽  
Arterial Thoracic Outlet Syndrome ◽  
Cervical Ribs ◽  
Neurogenic Tos

Thoracic outlet syndrome (TOS) is a condition caused by compression of the neurovascular structures leading to the arm passing through the thoracic outlet. The incidence of TOS is reported as 0.3 to 2% in the general population. There are three distinct types of TOS: neurogenic (95%), venous (4%), and arterial (1%). Treatment algorithms depend on the type of TOS. Arterial and venous TOS often present urgently with arterial or venous thrombosis, which is fairly easily identified by thorough history taking and a physical examination. Diagnosis is also aided by duplex ultrasonography. Restoration of arterial or venous flow can often be readily accomplished by thrombolysis. More important, however, is the diagnosis of the underlying structural component involved in the development of symptoms. Although statistically the most common, neurogenic TOS is often the most difficult to diagnose and treat. There are good data indicating that appropriately selected patients benefit from surgical therapy for neurogenic TOS as well. To prevent recurrence of symptoms, patients must undergo first rib resection and anterior scalenectomy, as well as resection of any rudimentary or cervical ribs. Regardless of the type of TOS encountered, proper therapy requires a thorough diagnostic evaluation and multimodal treatment. Keywords: thoracic outlet syndrome, arterial thoracic outlet syndrome, neurogenic thoracic outlet syndrome, venous thoracic outlet syndrome, TOS, effort thrombosis, thoracic outlet decompression

scholarly journals Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of acute pulmonary embolism and lower extremity deep venous thrombosis: A novel one-stop endovascular strategy

2017 ◽  
Vol 46 (2) ◽  
pp. 836-851 ◽  
Author(s):  
Bing Liu ◽  
MingYuan Liu ◽  
LiHong Yan ◽  
JunWei Yan ◽  
Jiang Wu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Success Rate ◽  
Acute Pulmonary Embolism ◽  
Mechanical Thrombectomy ◽  
Iliac Vein ◽  
Percutaneous Mechanical Thrombectomy ◽  
Catheter Directed Thrombolysis

Objective This study was performed to evaluate the efficacy and feasibility of percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) in patients with acute pulmonary embolism (APE) and lower extremity deep venous thrombosis (LEDVT). Methods In total, 20 consecutive patients with APE and LEDVT were prospectively selected for PMT combined with CDT. Mechanical thrombus fragmentation and aspiration using a pigtail rotation catheter followed by CDT was performed in each patient. Details regarding the patients’ clinical presentation and outcome, pulmonary status parameters (pulmonary arterial pressure, partial pressure of oxygen in arterial blood, Miller score, thigh and calf circumference, and shock index), and lower extremity parameters (thrombus-lysis grade and Villalta scale score) were recorded. Results All 20 patients’ clinical manifestations significantly improved. Both the clinical success rate and technical success rate were 100%. No major adverse events occurred during hospitalization. Four patients developed iliac vein compression syndrome and underwent stent implantation in the iliac vein. No pulmonary embolism recurred within 16.5±6.8 months of follow-up. Conclusions The combination of PMT and CDT is a safe and effective treatment for APE and LEDVT with good short- and intermediate-term clinical outcomes.

scholarly journals Catheter-directed thrombolysis versus percutaneous mechanical thrombectomy in the management of acute limb ischemia: a single center review

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Ravi Kumar Muli Jogi ◽  
Karthikeyan Damodharan ◽  
Hing Lun leong ◽  
Allison Chek Swee Tan ◽  
Sivanathan Chandramohan ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Single Center ◽  
Percutaneous Mechanical Thrombectomy ◽  
Catheter Directed Thrombolysis

Percutaneous Mechanical Thrombectomy for the Management of Venous Thoracic Outlet Syndrome

2003 ◽  
Vol 10 (2) ◽  
pp. 336-340 ◽  
Author(s):  
Darren B. Schneider ◽  
Thomas K. Curry ◽  
Charles M. Eichler ◽  
Louis M. Messina ◽  
Roy L. Gordon ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Mechanical Thrombectomy ◽  
Percutaneous Mechanical Thrombectomy

Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for subacute iliofemoral deep vein thrombosis

2020 ◽  
Vol 35 (8) ◽  
pp. 589-596
Author(s):  
Yi-Ding Xu ◽  
Bin-Yan Zhong ◽  
Chao Yang ◽  
Xu-Sheng Cai ◽  
Bo Hu ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Mechanical Thrombectomy ◽  
Primary Patency ◽  
Efficacy Rate ◽  
Percutaneous Mechanical Thrombectomy ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Catheter Directed Thrombolysis ◽  
Primary Endpoints ◽  
Deep Vein

Objective To evaluate and compare the treatment efficacy and safety between catheter-directed thrombolysis monotherapy and catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy for patients with subacute iliofemoral deep vein thrombosis. Methods We conducted a retrospective analysis of a total of 74 subacute iliofemoral deep vein thrombosis patients who underwent catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy. Patients treated with catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy (percutaneous mechanical thrombectomy group, n = 30) or catheter-directed thrombolysis monotherapy (catheter-directed thrombolysis group, n = 44) were included. The primary endpoints were the clinical efficacy rate of thrombolysis, primary patency, and the incidence of post-thrombotic syndrome (at 12 months diagnosed according to the original Villalta score criteria. Secondary endpoints were the total urokinase dose, the thrombolysis time, the detumescence rate and complications. Results The percentage of successful thrombolysis for percutaneous mechanical thrombectomy group was higher than that for catheter-directed thrombolysis group ( P = 0.045). At the 12-month follow-up, there was no difference in the primary patency ( P > 0.05) or the incidence of post-thrombotic syndrome ( P = 0.36). Percutaneous mechanical thrombectomy group had significant advantages in reducing urokinase doses and thrombolysis times compared with catheter-directed thrombolysis group for patients with thrombus clearance levels II and III ( P < 0.05). Conclusion Catheter-directed thrombolysis combined with percutaneous mechanical thrombectomy performs better in removing vein thrombi, reducing urokinase doses, and shortening thrombolysis times.

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