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iliofemoral thrombosis

Courtney L Furlough, Ashish K Jain, Karen J Ho, Heron E Rodriguez, Tadaki M Tomita, Mark K Eskandari
OBJECTIVE: Cryopreserved human arterial allografts are a recognized acceptable alternative for vascular reconstruction when other traditional conduits are either unavailable or contraindicated. We reviewed our experience using cryopreserved arterial allografts for peripheral artery reconstructions in contaminated and infected surgical fields. METHODS: A single-center, retrospective review was conducted of 57 patients who underwent a peripheral vascular reconstruction using a cryopreserved arterial allograft from January 2002 through July 2017...
February 5, 2019: Journal of Vascular Surgery
Cesar Cuen-Ojeda, Luis O Bobadilla-Rosado, Ramon Garcia-Alva, Luis H Arzola, Javier E Anaya-Ayala, Carlos A Hinojosa
The endovascular recanalization of the iliocaval system has replaced venous surgical reconstructions as the primary treatment option in severe post-thrombotic syndrome (PTS). We herein present a 51-year-old female with previous deep venous thrombosis, complicated with PTS with a large and complex circumferential calf ulcer measuring 25 cm of length in the left lower extremity. Venogram revealed a complete and extensive occlusion in the left iliofemoral system. A surgical bypass from the left common femoral vein to the right common iliac vein was performed...
December 2018: Vascular Specialist International
Tim Sebastian, Rolf P Engelberger, David Spirk, Lawrence O Hakki, Frederic A Baumann, Rebecca S Spescha, Nils Kucher
BACKGROUND: The optimal duration of anticoagulation therapy (AT) following catheter-based therapy of acute iliofemoral deep vein thrombosis (IFDVT) with stent placement is unknown. Theoretically, resolving the underlying obstructive iliac vein lesion by a stent may eliminate the main trigger for recurrence, the post-thrombotic syndrome (PTS), and the need for extended-duration AT. PATIENTS AND METHODS: From 113 patients with acute IFDVT who underwent endovascular thrombus removal and stent placement, we compared patency rates and clinical outcomes between 58 patients on limited-duration AT (3-12 month) and 55 patients on extended-duration AT (> 12 months)...
January 22, 2019: VASA. Zeitschrift Für Gefässkrankheiten
Efthymios D Avgerinos, Zein Saadeddin, Adham N Abou Ali, Yash Pandya, Eric Hager, Michael Singh, George Al-Khoury, Michel S Makaroun, Rabih A Chaer
OBJECTIVE: Iliac vein stenting is recommended to treat venous outflow obstruction after catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis (DVT). Data on the outcome of proximal and distal stent extension are limited. Proximal stent extension to the vena cava may obstruct the contralateral iliac vein, whereas distal extension below the inguinal ligament contradicts common practice for arterial stents. The aim of this retrospective study was to assess outcomes and predictors of failure of iliac vein stents and contralateral iliac vein thrombosis, taking into consideration stent positioning...
January 16, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Leslie J Padrnos, David Garcia
Background: May-Thurner Syndrome (MTS) is caused by compression of the left common iliac vein between the right common iliac artery and the pelvis. It likely predisposes an individual to lower extremity deep vein thrombosis (DVT) as well as symptoms of unilateral lower extremity swelling and discomfort in the absence of a known history of thrombosis. In the case of MTS-associated acute thrombosis, there is low-quality evidence to suggest that endovascular intervention including thrombolysis and endovascular stent placement reduces the risk of recurrent thrombosis...
January 2019: Research and Practice in Thrombosis and Haemostasis
P C Wong, Y C Chan, Y Law, S Wk Cheng
BACKGROUND: Conventional treatment of deep vein thrombosis (DVT) of the lower extremities by anticoagulation alone has been proven to be insufficient to prevent recurrence and post-thrombotic syndrome (PTS). Early restoration of venous patency and preservation of valvular function by endovascular surgery has been advocated. The aim of this study was to review the efficacy and safety of percutaneous mechanical thrombectomy (PMT) against catheter-directed thrombolysis (CDT) in the treatment of acute iliofemoral DVT...
January 11, 2019: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Ricardo Lopez, Randall DeMartino, Mark Fleming, Haraldur Bjarnason, Melissa Neisen
OBJECTIVE: The use of catheter-directed thrombolysis (CDT) may provide clinical benefit in patients with acute deep venous thrombosis (DVT), but significant doubt remains about its indications and risks. We assessed technical success in resolution of acute iliofemoral or central DVT after single-session treatment with a novel mechanical aspiration thrombectomy device as an alternative to initiation of CDT. METHODS: This was a single-center retrospective review of patients with acute iliofemoral or central DVT treated with the Indigo continuous aspiration mechanical thrombectomy 8 system (Penumbra, Inc, Alameda, Calif) from 2016 to 2017...
January 10, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Andreia Coelho, Gerard O'Sullivan
PURPOSE: The purpose of this paper is to assess the applicability of direct computed tomography venography (DCTV) in assessing dominant inflow vein in the femoral confluence in extensive chronic iliofemoral venous obstruction, using venography as the gold standard. METHODS: All DCTVs performed in symptomatic patients with previous iliofemoral deep vein thrombosis subsequently submitted to venography in the period from January 2014 to August 2018 were retrospectively reviewed...
January 9, 2019: Cardiovascular and Interventional Radiology
Mukesh Kumar Garg, Ambarish Satwik, Varinder S Bedi, Gurunandan Uppinakudru, Sandeep Agarwal, Ajay Yadav
Duplication of the inferior vena cava (IVC) with coagulation mutations in the form of factor V Leiden and MTHFR mutations represents an unusual subset of patients. We are reporting a case of a 43-year-old man who presented with left iliofemoral deep venous thrombosis diagnosed on duplex ultrasound scan. At the time of catheter-directed thrombolysis with prophylactic IVC filter placement, a duplicated IVC system was observed. After thrombolysis, a stenotic lesion in the left common iliac vein and IVC was stented...
March 2019: Journal of Vascular Surgery Cases and Innovative Techniques
Ali Khalifeh, Michaella Reif, Besher Tolayamat, Janet Karanja, Rajabrata Sarkar, Shahab Toursavadkohi
We present a series of kidney transplant dysfunction secondary to lower extremity deep venous thrombosis (DVT). A 70-year-old man underwent living unrelated kidney transplantation and presented 2 months postoperatively with acute kidney injury (AKI) secondary to external iliac vein thrombosis. Graft function improved after endovascular intervention. A 43-year-old man underwent living unrelated kidney transplantation and presented 3 years postoperatively with AKI secondary to external iliac vein thrombosis...
March 2019: Journal of vascular surgery cases and innovative techniques
Kush R Desai, Nicholas Xiao, Jennifer Karp, Riad Salem, Heron Rodriguez, Mark Eskandari, Omar M Uddin, Robert J Lewandowski
OBJECTIVE: The objective of this study was to demonstrate the safety and efficacy of treatment of inferior vena cava filter (IVCF)-related chronic iliocaval thrombosis with single-session IVCF retrieval and iliocaval recanalization, thereby optimizing stent deployment and avoiding adverse events (AEs) related to stent placement across an obstructed filter. METHODS: From January 2015 to April 2018, a cohort of 25 consecutive patients presented for treatment of IVCF-related chronic iliocaval thrombosis with filter retrieval, followed by recanalization with stent placement and adjunctive iliofemoral thrombectomy as needed...
January 3, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Christoph Hehrlein, Björn Schorch, Nadia Kress, Amina Arab, Constantin von Zur Mühlen, Christoph Bode, Thomas Epting, Jörg Haberstroh, Lilly Mey, Hans Schwarzbach, Ralf Kinscherf, Vitus Stachniss, Stefanie Schiestel, Adalbert Kovacs, Harald Fischer, Ernst Nennig
Metallic Zn alloys have recently gained interest as potential candidates for developing platforms of bioresorbable vascular stents (BVS). Previous studies revealed that Mg alloys used for BVS can degrade too early, whereas PLLA materials may fail to provide effective scaffolding properties. Here we report on results of a new bioresorbable, metallic stent made from a Zn-Ag alloy studied in a porcine animal model of thrombosis and restenosis. While the tensile strength (MPa) of Zn-3Ag was higher than that of PLLA and resembled Mg's (WE43), fracture elongation (%) of Zn-3Ag was much greater (18-fold) than the PLLA's or Mg alloy's (WE43)...
2019: PloS One
Anthony J Comerota, Clive Kearon, Chu-Shu Gu, Jim A Julian, Samuel Z Goldhaber, Susan R Kahn, Michael R Jaff, Mahmood K Razavi, Andrei L Kindzelski, Riyaz Bashir, Parag Patel, Mel Sharafuddin, Michael J Sichlau, Wael E Saad, Zakaria Assi, Lawrence V Hofmann, Margaret Kennedy, Suresh Vedantham
BACKGROUND: The ATTRACT Trial previously reported that pharmacomechanical catheter-directed thrombolysis (PCDT) did not prevent the post-thrombotic syndrome (PTS) in patients with acute proximal deep vein thrombosis (DVT). In the current analysis, we examine the effect of PCDT in ATTRACT patients with iliofemoral DVT. METHODS: Within a large multicenter randomized trial, 391 patients with acute DVT involving the iliac and/or common femoral veins were randomized to PCDT with anticoagulation versus anticoagulation alone (No-PCDT) and were followed for 24 months to compare short-term and long-term outcomes...
December 4, 2018: Circulation
Anja B Drebes, Neil H Davies
In recent years there has been an increasing interest in endovascular iliofemoral vein stenting to prevent/alleviate symptoms relating to proximal venous outflow obstruction. Maintaining long-term stent patency is one of the main challenges, and risk factors for the development of re-thrombosis are not well understood. Published data on safety and efficacy of the procedure predominantly comes from cohort studies mainly focusing on mechanical aspects relating to stent placement and flow. Aetiology of thrombus formation and thrombotic tendencies of patients due to underlying medical conditions are not captured well or linked to clinical outcomes, and impact of choice and length of antithrombotic therapy have not been specifically investigated...
December 26, 2018: Current Pharmaceutical Design
Anastasia Plotkin, Matthew G Bartley, Kathryn E Bowser, Jeniann A Yi, Omid Jazaeri, Gregory A Magee
BACKGROUND: Iliofemoral vein thrombosis can lead to debilitating edema and venous claudication that significantly worsens quality of life, especially in young active individuals. Venous reconstruction becomes increasingly complex and has worsening patency with subsequent revisions so preoperative planning is critical to success. METHODS: We report a case of a 54-year-old man in active military service with profoundly symptomatic leg swelling after failure of 3 previous common femoral vein (CFV) reconstructions...
November 23, 2018: Annals of Vascular Surgery
Wei Wei, Xuemei Jiang, Bo Xu, Yikuan Chen
Stents have been widely used to restore the patency of the iliac vein in the treatment of its obstruction. However, various complications related to those stents have been reported. This case report covers a 67-year-old male who was diagnosed with left iliofemoral venous post-thrombotic syndrome with recurrent acute deep venous thrombosis. Thrombosis of the inferior vena cava was induced by pronounced extension of left iliac vein stents. Extending stents in this way covers the outlet of the contralateral common iliac vein and may induce thrombosis in the inferior vena cava...
January 2018: Thoracic and Cardiovascular Surgeon Reports
Yang Shen, Xiang Wang, Sha-Sha Jin, Rui-Li Zhang, Wen-Jun Zhao, Guang Chen
OBJECTIVE: The objective of this study was to investigate the risk of postoperative acute kidney injury (AKI) in patients with acute iliofemoral deep venous thrombosis (IFDVT) who underwent percutaneous pharmacomechanical thrombectomy (PMT) using AngioJet (Boston Scientific, Marlborough, Mass) or catheter-directed thrombolysis. METHODS: Electronic medical records of patients with acute IFDVT from January 2014 to September 2017 were reviewed. Those who received PMT with AngioJet (AJ-PMT group) or catheter-directed thrombolysis (CDT group) were included in this study...
November 12, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Dalibor Musil
The treatment of deep vein thrombosis (DVT) is based on anticoagulation with heparin, warfarin and direct oral anti-coagulants. According to the 9th ACCP Recommendation, for patients with DVT of the lower limbs, where the clinical state and home conditions permit, preference is given to home treatment over hospitalization. Despite that, the majority of patients with acute DVT still tend to be hospitalized, in particular when proximal thrombosis from the popliteal vein upward is involved. Furthermore, the recommendations do not describe proximal (iliofemoral) DVT as exceptional and more serious...
2018: Vnitr̆ní Lékar̆ství
Tim Sebastian, Lawrence O Hakki, David Spirk, Frederic A Baumann, Daniel Périard, Martin Banyai, Rebecca S Spescha, Nils Kucher, Rolf P Engelberger
BACKGROUND: The optimal anticoagulant following catheter-based therapy of acute iliofemoral deep vein thrombosis (IFDVT) is unknown. METHODS: From the Swiss Venous Stent registry, an ongoing prospective cohort study, we performed a subgroup analysis of patients with acute IFDVT who underwent catheter-based early thrombus removal followed by nitinol stent placement. Duplex ultrasound and Villalta scores were used to determine patency rates and incidence of the post-thrombotic syndrome (PTS) in patients treated with either rivaroxaban (n = 73) or a vitamin K-antagonist (VKA; n = 38) for a minimum duration of 3 months...
December 2018: Thrombosis Research
Ulrike Huegel, Daniel Surbek, Beatrice Mosimann, Nils Kucher
Catheter-directed thrombolysis for iliofemoral deep venous thrombosis (DVT) aims to reduce acute leg symptoms and to prevent the post-thrombotic syndrome. There are no data from controlled trials in pregnant patients. Reports of thrombolysis for treatment of DVT during pregnancy are scarce. Pregnancy is considered a relative contraindication to thrombolytic therapy because of the risk of bleeding and concerns about the effects of radiation exposure on the fetus. We report on a catheter-directed thrombolysis procedure without radiation and contrast medium exposure in a first-trimester pregnant patient with massive iliofemoral DVT and free-floating thrombus extending to the suprarenal inferior vena cava...
October 29, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
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