The feasibility of catheter-directed thrombolysis for acute deep vein                thrombosis: a regional perspective

Background Deep vein thromboses (DVTs) are a significant cause of morbidity and mortality. Valvular destruction leads to the spectrum of disease called the post-thrombotic syndrome (PTS) with the sequelae of chronic venous ulceration and a reduced quality of life. Catheter-directed thrombolysis (CDT) may reduce the incidence of PTS following an acute proximal DVT and increases quality of life thereafter, but it is uncertain what proportion of patients diagnosed with a DVT would be suitable for CDT. Methods This study quantified the proportion of patients investigated for DVT that would have been suitable for CDT. A retrospective review was performed of all upper and lower limb duplex ultrasound scans for suspected DVTs in a contemporary one-year period in a major regional vascular institute. All positive scans for acute proximal lower limb DVTs were compared against strict inclusion and exclusion criteria for CDT, based on national guidelines and international randomized trials. Results A total of 2368 duplex ultrasound venous investigations were performed in a one-year period and 252 scans demonstrated DVT. Of these, 158 were acute proximal lower limb DVTs. Application of the inclusion and exclusion criteria for CDT suggested that 47/158 (30%) were potentially suitable for CDT using current criteria. The median age of the 158 patients was 58 years, meaning that more than half were of working age and 54% were men. Conclusion Using current eligibility criteria, only about 30% of patients with DVT appear to be suitable for CDT.

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Comparison of Pharmacomechanical Catheter-Directed Thrombolysis versus Catheter-Directed Thrombolysis for the Treatment of Acute Iliofemoral Deep Vein Thrombosis: Measures of Long-Term Clinical Outcome and Quality of Life

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2021.10.004 ◽

2022 ◽

Vol 10 (1) ◽

pp. 283

Author(s):

T. Huang ◽

W. Ding ◽

Z. Chen ◽

Y. Yin ◽

J. Yu ◽

...

Keyword(s):

Quality Of Life ◽

Deep Vein Thrombosis ◽

Clinical Outcome ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

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Comparison of Pharmacomechanical Catheter-Directed Thrombolysis versus Catheter-Directed Thrombolysis for the treatment of acute iliofemoral deep vein thrombosis: Measures of long term clinical outcome and quality of life

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.03.040 ◽

2021 ◽

Author(s):

Tianan Huang ◽

Wenbin Ding ◽

Zhuo Chen ◽

Yu Yin ◽

Jingfan Yu ◽

...

Keyword(s):

Quality Of Life ◽

Deep Vein Thrombosis ◽

Clinical Outcome ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

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Percutaneous pharmacomechanical thrombectomy for acute iliofemoral deep vein thrombosis: A suitability study

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514521607 ◽

2014 ◽

Vol 30 (4) ◽

pp. 235-241 ◽

Cited By ~ 3

Author(s):

AZ Nghiem ◽

N Rudarakanchana ◽

HM Moore ◽

AH Davies

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Randomised Trial ◽

Duplex Ultrasound ◽

Exclusion Criteria ◽

Vein Thrombosis ◽

Acute Deep Vein Thrombosis ◽

Deep Vein ◽

Limb Deep Vein Thrombosis

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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Treatment of Acute Iliofemoral Deep Vein Thrombosis; Does Catheter Directed Thrombolytic Therapy Change Outcomes?

Cardiology Open Access ◽

10.33140/coa.04.03.01 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Quality Of Life ◽

Deep Vein Thrombosis ◽

Iliac Vein ◽

P Value ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Group A ◽

Deep Vein

Background: Iliofemoral deep vein thrombosis (DVT) is associated with severe post-thrombotic morbidity when treated with anticoagulation alone. Catheter- directed thrombolysis (CDT) allows early removal of thrombus and reduces valvular reflux and Post-thrombotic Syndrome (PTS). Patients and methods: This prospective randomized multi-center controlled two- arm blind study was conducted in 6 centers on 252 patients with iliofemoral DVT. Patients were randomly allocated by using simple random allocation cards method into two groups; Group (A): CDT followed by oral anticoagulation (N=126 (50%)), Group (B): Standard DVT therapy (N=126 (50%)). Follow-up was for 24 months. Results: Patients of group (A) significantly complained less pain at 10 & 30 days (P-Value: 0.02 & 0.04 respectively). Also there was significant decrease in leg circumference in group (A) at 10 & 30 days (P-Value: 0.001 & 0.03 respectively). Patency of iliac vein segment was significantly higher in group (A) during the 24 months follow up (P-Value <0.001 (HS)). Patients in group (A) developed less PTS at six months, at one year and at two years (P-Value: 0.024, 0.017 and 0.035 respectively). Better Quality of life was observed in group (A) (P-Value: 0.003). Conclusion: Addition of catheter-directed thrombolysis in the treatment of acute iliofemoral DVT; was safe and tolerated by most of the patients with better effect to reduce leg pain & circumference. It was considered a protecting weapon to prevent post-thrombotic syndrome and so improve quality of life and was related to achievement of higher iliac vein patency and less reflux.

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Endovascular management of proximal lower limb deep venous thrombosis – A prospective study with six-month follow-up

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514538423 ◽

2014 ◽

Vol 30 (7) ◽

pp. 441-448 ◽

Cited By ~ 4

Author(s):

S Patra ◽

BC Srinivas ◽

CM Nagesh ◽

B Reddy ◽

CN Manjunath

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Catheter Directed Thrombolysis ◽

Grade Ii ◽

Deep Vein ◽

Limb Deep Vein Thrombosis ◽

Proximal Lower Limb

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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Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial

Vascular Medicine ◽

10.1177/1358863x19862043 ◽

2019 ◽

Vol 24 (5) ◽

pp. 442-451 ◽

Cited By ~ 7

Author(s):

Ido Weinberg ◽

Suresh Vedantham ◽

Amber Salter ◽

Gail Hadley ◽

Noor Al-Hammadi ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Outcomes ◽

Femoral Vein ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Thrombus Removal ◽

Residual Thrombus ◽

Deep Vein ◽

To Receive

Few studies have documented relationships between endovascular therapy, duplex ultrasonography (DUS), post-thrombotic syndrome (PTS), and quality of life (QOL). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial randomized 692 patients with acute proximal deep vein thrombosis (DVT) to receive anticoagulation or anticoagulation plus pharmacomechanical catheter-directed thrombolysis (PCDT). Compression DUS was obtained at baseline, 1 month and 12 months. Reflux DUS was obtained at 12 months in a subset of 126 patients. Clinical outcomes were collected over 24 months. At 1 month, patients who received PCDT had less residual thrombus compared to Control patients, evidenced by non-compressible common femoral vein (CFV) (21% vs 35%, p < 0.0001), femoral vein (51% vs 70%, p < 0.0001), and popliteal vein (61% vs 74%, p < 0.0001). At 12 months, in the ultrasound substudy, valvular reflux prevalence was similar between groups (85% vs 91%, p = 0.35). CFV non-compressibility at 1 month was associated with higher rates of any PTS (61% vs 46%, p < 0.001), a higher incidence of moderate-or-severe PTS (30% vs 19%, p = 0.003), and worse QOL (difference 8.2 VEINES-QOL (VEnous INsufficiency Epidemiological and Economic Study on Quality of Life) points; p = 0.004) at 24 months. Valvular reflux at 12 months was associated with moderate-or-severe PTS at 24 months (30% vs 0%, p = 0.01). In summary, PCDT results in less residual thrombus but does not reduce venous valvular reflux. CFV non-compressibility at 1 month is associated with more PTS, more severe PTS, and worse QOL at 24 months. Valvular reflux may predispose to moderate-or-severe PTS. ClinicalTrials.gov Identifier NCT00790335.

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Endothermal Heat Induced Thrombosis

Phlebologie ◽

10.1055/a-1518-0551 ◽

2021 ◽

Author(s):

Mikel Sadek ◽

Lowell S. Kabnick

Keyword(s):

Quality Of Life ◽

Additional Data ◽

Duplex Ultrasound ◽

Classification Systems ◽

Clinical Behavior ◽

Vein Thrombosis ◽

Treatment And Prevention ◽

The Cost ◽

Deep Vein

AbstractEndothermal heat induced thrombosis (EHIT) is a post-procedural entity following endothermal superficial venous ablation that refers to the propagation of thrombus into the adjacent deep vein lumen. It is identified most commonly during the post-procedural surveillance venous duplex ultrasound. EHIT is recognized as a unique post-procedural entity, distinct in clinical behavior from a deep vein thrombosis. The definition, classification systems, pathophysiology, risk factors, treatment, and prevention are all discussed. The understanding of EHIT has advanced considerably, but additional data are required to understand its impact on quality of life and the cost-effectiveness of surveillance.

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Ilio-Femoral Deep Vein Thrombosis Secondary to May-Thurner Syndrome With Ipsilateral Lower Limb Arterio-Venous Graft In-Situ

Vascular and Endovascular Surgery ◽

10.1177/1538574421994782 ◽

2021 ◽

pp. 153857442199478

Author(s):

Brjan Kaiji Betzler ◽

Li zhang ◽

Kai Siang Chan ◽

Enming Yong ◽

Ivan Kuang Hsin Huang ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Duplex Ultrasound ◽

Iliac Vein ◽

Common Iliac Vein ◽

Arteriovenous Graft ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

Ilio-femoral deep vein thrombosis (DVT) is rare in patients with lower limb arterio-venous grafts due to a state of high blood flow. May-Thurner syndrome (MTS) is an anomaly where the left common iliac vein is compressed by the right common iliac artery. We present a rare case of ilio-femoral deep vein thrombosis in a patient with May-Thurner Syndrome and an underlying arteriovenous graft in-situ who presented with acute lower limb swelling. The patient underwent catheter-directed thrombolysis, pharmaco-mechanical thrombectomy, venoplasty and iliac vein stenting. Follow-up surveillance duplex ultrasound showed patency of the iliac vein stent and arteriovenous graft at 1-year postoperatively.

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