A Case of Deep Vein Thrombosis Following Ultrasound-Guided Compression of a Pseudoaneurysm

Objectives The aim of sclerotherapy is to induce fibrosclerosis of superficial veins. We postulated that inadvertent entry of sclerosants into deep veins can result in sclerotic occlusion, deep vein sclerosis, a non-thrombotic process distinct from spontaneous deep vein thrombosis. The aim of this study was to assess the role of d-dimer in differentiating between deep vein sclerosis and deep vein thrombosis. Methods Proximal trunks of great and small saphenous veins were treated with endovenous laser ablation. Venous tributaries and perforators were treated with foam ultrasound guided sclerotherapy. Ultrasound studies of lower limb deep veins were performed before and one week after the procedures, to detect deep vein occlusions (DVOs). d-dimer levels were measured for DVOs and long-term ultrasound studies monitored the recanalisation rates. Results In a six-year period, 9143 procedures were performed in 1325 patients for bilateral varicose veins. This included 1124 endovenous laser ablation and 8019 foam ultrasound guided sclerotherapy procedures. A total of 259 DVOs (2.83%) were identified on ultrasound which included 251 deep vein sclerosis (2.74%), seven deep vein thrombosis (0.07%) and one endovenous heat-induced thrombosis (EHIT, 0.08%). d-dimer values <0.5 µg/mL excluded deep vein thrombosis s, 0.5–1.0 µg/mL were more likely to be associated with deep vein sclerosis and >1.0 µg/mL were a more likely to be associated with deep vein thrombosis. Lower sclerosant concentrations and higher foam volumes were associated with increased risk of DVO ( p < .0001). No significant relationship was found between DVO and gender or thrombophilia. Deep vein thrombosis and EHIT cases but not deep vein sclerosis patients were anticoagulated. None had thromboembolic complications. Patients were followed up for a median of 299 days (37–1994 days). Recanalisation rates were 71.1% for deep vein sclerosis (92.3% competent) and 71.4% for deep vein thrombosis (60.0% competent). Conclusions Deep vein sclerosis is a relatively benign clinical entity distinct from deep vein thrombosis and does not require anticoagulation. Majority of affected veins on long-term follow-up regain patency and competence. d-dimer can be used to assist in differentiating deep vein sclerosis from deep vein thrombosis.

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Intravascular ultrasound-guided mechanical thrombectomy using the INARI ClotTriever device of an iatrogenic deep venous thrombosis

BMJ Case Reports ◽

10.1136/bcr-2020-235464 ◽

2020 ◽

Vol 13 (7) ◽

pp. e235464

Author(s):

Osama Abdel-Hafez ◽

Mohammed Salih ◽

Feras Aloka ◽

Kirit Patel

Keyword(s):

Deep Vein Thrombosis ◽

Management Strategy ◽

Mechanical Thrombectomy ◽

Iliac Vein ◽

Interesting Case ◽

Mechanical Obstruction ◽

Significant Morbidity ◽

Ultrasound Guided ◽

Vein Thrombosis ◽

Deep Vein

Deep vein thrombosis (DVT) is a common disorder affecting 1 to 2 per 1000 Americans annually, resulting in significant morbidity and mortality. Anticoagulation is the mainstay management strategy for DVT. However, this could prove insufficient in cases where a mechanical obstruction is responsible for the DVT. We are presenting an interesting case of iatrogenic DVT incurred after Prolene suturing of lacerated iliac vein and the management employed for this challenging case with a successful and significant improvement in the clinical outcome.

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Prevention of Pulmonary Embolism by Inferior Vena Cava Filter in Patients With Proximal Deep Vein Thrombosis

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)85281-3 ◽

1998 ◽

Vol 31 (2) ◽

pp. 362A

Author(s):

R Faivre

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Inferior Vena Cava ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Vena Cava ◽

Vena Cava Filter ◽

Proximal Deep Vein Thrombosis ◽

Vein Thrombosis ◽

Deep Vein

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Incidence of Deep Vein Thrombosis After Varicose Vein Surgery

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70279-3 ◽

2006 ◽

Vol 2006 ◽

pp. 363-364

Author(s):

G.L. Moneta

Keyword(s):

Deep Vein Thrombosis ◽

Varicose Vein ◽

Varicose Vein Surgery ◽

Vein Thrombosis ◽

Deep Vein

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Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614936 ◽

1998 ◽

Vol 79 (03) ◽

pp. 517-519 ◽

Cited By ~ 13

Author(s):

Stephane Heymans ◽

Raymond Verhaeghe ◽

Luc Stockx ◽

Désiré Collen

Keyword(s):

Deep Vein Thrombosis ◽

Continuous Infusion ◽

High Speed ◽

Minor Bleeding ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Long Term Follow Up ◽

Valve Function ◽

Rotating Impeller ◽

Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

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Deep Vein Thrombosis and Fibrinolysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646432 ◽

1991 ◽

Vol 66 (04) ◽

pp. 426-429 ◽

Cited By ~ 16

Author(s):

Marcel Levi ◽

Anthonie W A Lensing ◽

Harry R Büller ◽

Paolo Prandoni ◽

Gerard Dooijewaard ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Plasminogen Activator ◽

Plasminogen Activator Inhibitor ◽

Tissue Type ◽

Controlled Study ◽

First Episode ◽

Control Group ◽

Vein Thrombosis ◽

Type Plasminogen Activator ◽

Deep Vein

SummaryIn the present study 57 consecutive patients with a first episode of venographically proven deep vein thrombosis were investigated to evaluate the release of tissue-type plasminogen activator (t-PA) and of urokinase-type plasminogen activator (u-PA) in response to DDAVP stimulation as well as the resting plasminogen activator inhibitor (PAI) concentration, comparing this to the results obtained in 66 similar patients with a clinical suspicion of thrombosis but with a normal venogram. All assays were performed without knowledge of the patient's status.Four patients in the deep vein thrombosis-group (7%) had an absent u-PA antigen response upon DDAVP infusion, while a normal response was observed in all control subjects. Patients and controls showed similar increases in t-PA antigen level upon DDAVP. High resting PAI antigen levels were encountered in 5 patients in the deep vein thrombosis-group (9%) and in 6 subjects in the control group (9%).The results from this controlled study indicate that a defective release of u-PA may occur in patients with deep vein thrombosis and may have pathogenetic significance. Furthermore it is concluded that elevation of PAI levels cannot be considered as a specific risk factor for venous thrombosis.

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