scholarly journals Iliofemoral deep vein thrombosis and the problem of post-thrombotic syndrome

2018 ◽  
Vol 17 (2) ◽  
pp. 99-103
Author(s):  
Nicholas Denny ◽  
◽  
Shreshta Musale ◽  
Helena Edlin ◽  
Jecko Thachil ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Compression Stockings ◽  
Short Term ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Catheter Directed Thrombolysis ◽  
Short Term Mortality ◽  
Considerable Morbidity ◽  
Deep Vein

Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Among the different presentations of DVT, thrombus in the iliofemoral veins may be considered the severest form. Although anticoagulation is the mainstay of the management of iliofemoral thrombosis, despite adequate anticoagulant treatment, complications including post-thrombotic syndrome is not uncommon. The latter is often overlooked but can cause considerable morbidity to the affected individuals. Preventing this condition remains a challenge but recent clinical trials of catheter directed thrombolysis and elasticated compression stockings provide some advance in this context. In this article, with the aid of a clinical case, we review the particular considerations to take into account when managing patients with an iliofemoral DVT.

Chronic deep vein thrombosis

2018 ◽  
Vol 17 (3) ◽  
pp. 144-147
Author(s):  
Nicholas Denny ◽  
◽  
Shreshta Musale ◽  
Helena Edlin ◽  
Ferdinando Serracino-Inglott ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Accurate Diagnosis ◽  
Short Term ◽  
Vein Thrombosis ◽  
Short Term Mortality ◽  
Deep Vein

Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Although acute DVT is often well managed, there is uncertainty in the management of chronic DVT which is increasingly being noted among patients presenting with similar symptoms to their initial DVT. The presence of a residual venous clot can be a problem for both physicians and patients fearing the risk of emboli to the same extent as the acute DVT. There are also issues in the accurate diagnosis and appropriate management of chronic DVT, which is the focus of the second part of this review.

scholarly journals Advances in Deep Vein Thrombosis Management with Thrombolysis

2009 ◽  
Vol 8 (2) ◽  
pp. 63-69
Author(s):  
Ali Akhtar Cheema ◽  
◽  
Robert H Mallinson ◽  
Nicola Trepte ◽  
Keyword(s):  
Deep Vein Thrombosis ◽  
Current Status ◽  
Common Disease ◽  
Short Term ◽  
Systemic Thrombolysis ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Deep Vein ◽  
Over 40 Years

Lower extremity deep vein thrombosis (DVT) is a common disease associated with serious short term and long term complications. Its conventional treatment has been anticoagulation. Thrombolytic treatment has been used for DVT for over 40 years. More recently catheter directed thrombolysis has taken over systemic thrombolysis. This technique is useful to prevent post thrombotic syndrome (PTS) after DVT. In this review article we present a case of DVT thrombolysis in our hospital, look at the pathophysiology of PTS, the mechanism of thrombolysis and the current status of thrombolysis in DVT.

scholarly journals Predictors of long-term post-thrombotic syndrome following high proximal deep vein thrombosis: a cross-sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Marit Engeseth ◽  
Tone Enden ◽  
Per Morten Sandset ◽  
Hilde Skuterud Wik
Keyword(s):  
Deep Vein Thrombosis ◽  
Proximal Deep Vein Thrombosis ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Younger Age ◽  
Deep Vein

Abstract Background Post-thrombotic syndrome (PTS) is a frequent chronic complication of proximal deep vein thrombosis (DVT) of the lower limb, but predictors of PTS are not well established. We aimed to examine predictors of PTS in patients with long-term PTS following proximal DVT. Methods During 2006–09, 209 patients with a first time acute upper femoral or iliofemoral DVT were randomized to receive either additional catheter-directed thrombolysis or conventional therapy alone. In 2017, the 170 still-living participants were invited to participate in a cross-sectional follow-up study. In the absence of a gold standard diagnostic test, PTS was defined in line with clinical practice by four mandatory, predefined clinical criteria: 1. An objectively verified DVT; 2. Chronic complaints (> 1 month) in the DVT leg; 3. Complaints appeared after the DVT; and 4. An alternative diagnosis was unlikely. Possible predictors of PTS were identified with multivariate logistic regression. Results Eighty-eight patients (52%) were included 8–10 years following the index DVT, and 44 patients (50%) were diagnosed with PTS by the predefined clinical criteria. Younger age and higher baseline Villalta score were found to be independent predictors of PTS, i.e., OR 0.96 (95% CI, 0.93–0.99), and 1.23 (95% CI, 1.02–1.49), respectively. Lack of iliofemoral patency at six months follow-up was significant in the bivariate analysis, but did not prove to be significant after the multivariate adjustments. Conclusions In long-term follow up after high proximal DVT, younger age and higher Villalta score at DVT diagnosis were independent predictors of PTS.

Catheter-directed thrombolysis in deep vein thrombosis: Which procedural measurement predicts outcome?

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 135-139 ◽  
Author(s):  
J Grommes ◽  
KT von Trotha ◽  
MA de Wolf ◽  
H Jalaie ◽  
CHA Wittens
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Obstruction ◽  
Deep Venous System ◽  
Vein Thrombosis ◽  
Risk Of Bleeding ◽  
Catheter Directed Thrombolysis ◽  
Increased Risk ◽  
Deep Vein ◽  
Procedural Outcome

The post-thrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by a venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies enable early recanalization of the deep veins aiming reduced incidence and severity of PTS. Extended CDT is associated with an increased risk of bleeding and stenting of residual venous obstruction is indispensable to avoid early rethrombosis. Therefore, this article focuses on measurements during or after thrombolysis indicating post procedural outcome.

scholarly journals Prevention and Management of the Post-Thrombotic Syndrome

2020 ◽  
Vol 9 (4) ◽  
pp. 923 ◽  
Author(s):  
Ilia Makedonov ◽  
Susan R. Kahn ◽  
Jean-Philippe Galanaud
Keyword(s):  
Venous Insufficiency ◽  
Current Evidence ◽  
Low Molecular Weight ◽  
Compression Stockings ◽  
Low Molecular Weight Heparins ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Lifestyle Measures ◽  
Deep Vein

The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency secondary to prior deep vein thrombosis (DVT). It affects up to 50% of patients after proximal DVT. There is no effective treatment of established PTS and its management lies in its prevention after DVT. Optimal anticoagulation is key for PTS prevention. Among anticoagulants, low-molecular-weight heparins have anti-inflammatory properties, and have a particularly attractive profile. Elastic compression stockings (ECS) may be helpful for treating acute DVT symptoms but their benefits for PTS prevention are debated. Catheter-directed techniques reduce acute DVT symptoms and might reduce the risk of moderate–severe PTS in the long term in patients with ilio-femoral DVT at low risk of bleeding. Statins may decrease the risk of PTS, but current evidence is lacking. Treatment of PTS is based on the use of ECS and lifestyle measures such as leg elevation, weight loss and exercise. Venoactive medications may be helpful and research is ongoing. Interventional techniques to treat PTS should be reserved for highly selected patients with chronic iliac obstruction or greater saphenous vein reflux, but have not yet been assessed by robust clinical trials.

scholarly journals Catheter-Based Therapies and Other Management Strategies for Deep Vein Thrombosis and Post-Thrombotic Syndrome

2020 ◽  
Vol 9 (5) ◽  
pp. 1439 ◽  
Author(s):  
Siddhant Thukral ◽  
Suresh Vedantham
Keyword(s):  
Deep Vein Thrombosis ◽  
Management Strategies ◽  
Patient Centered ◽  
Specific Patient ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Patient Morbidity ◽  
Patient Groups ◽  
Deep Vein

Acute deep vein thrombosis (DVT) causes substantial short-term and long-term patient morbidity. Medical, lifestyle, and compressive therapies have been investigated for the prevention of pulmonary embolism (PE) and recurrence of venous thromboembolism (VTE). However, patient-centered outcomes such as resolution of presenting DVT symptoms and late occurrence of post-thrombotic syndrome (PTS) have not been prioritized to the same degree. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups.

scholarly journals Long-term recurrence of venous thromboembolism after short-term treatment of symptomatic isolated distal deep vein thrombosis: A cohort study

2017 ◽  
Vol 22 (6) ◽  
pp. 518-524 ◽  
Author(s):  
Marco P Donadini ◽  
Francesco Dentali ◽  
Samuela Pegoraro ◽  
Fulvio Pomero ◽  
Chiara Brignone ◽  
...  
Keyword(s):  
Cohort Study ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Term Treatment ◽  
Short Term ◽  
Short Term Treatment ◽  
Vein Thrombosis ◽  
Recurrent Vte ◽  
Deep Vein

Isolated distal deep vein thrombosis (IDDVT) is a common clinical manifestation of venous thromboembolism (VTE). However, there are only scant and heterogeneous data available on the long-term risk of recurrent VTE after IDDVT, and the optimal therapeutic management remains uncertain. We carried out a retrospective cohort study of consecutive patients diagnosed with symptomatic IDDVT between 2004 and 2011, according to a predefined short-term treatment protocol (low molecular weight heparin (LMWH) for 4–6 weeks). The primary outcome was the occurrence of recurrent VTE. A total of 321 patients were enrolled. IDDVT was associated with a transient risk factor or cancer in 165 (51.4%) and 56 (17.4%) patients, respectively. LMWH was administered for 4–6 weeks to 280 patients (87.2%), who were included in the primary analysis. Overall, during a mean follow-up of 42.3 months, 42 patients (15%) developed recurrent VTE, which occurred as proximal DVT or PE in 21 cases. The recurrence rate of VTE per 100 patient-years was 3.5 in patients with transient risk factors, 7.2 in patients with unprovoked IDDVT, and 5.9 in patients with cancer ( p=0.018). At multivariable analysis, unprovoked IDDVT and previous VTE were significantly associated with recurrent VTE (HR 2.16, 95% CI 1.12–4.16 and HR 1.97, 95% CI 1.01–3.86, respectively). In conclusion, the long-term risk of recurrent VTE after IDDVT treated for 4–6 weeks is not negligible, in particular in patients with unprovoked IDDVT or cancer. Further studies are needed to clarify whether a longer, but definite treatment duration effectively prevents these recurrences.

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