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Outcomes of catheter-directed treatment of lower extremity deep vein thrombosis of patients presenting to a tertiary care hospital.

ABSTRACT: Lower extremity deep vein thrombosis (DVT) is a common illness with an annual incidence of 1 per 1000 adults. The major long-term complication of DVT is post-thrombotic syndrome (PTS) which occurs in up to 60% of patients within 2 years of an episode of DVT.We aim to evaluate the outcomes of catheter-directed treatment (CDT) for symptomatic acute or subacute lower extremity DVT.A retrospective 12-year study was conducted on the outcomes of CDT on 54 consecutive patients who presented with acute or subacute lower extremity DVT to our hospital.Descriptive summary statistics and the Chi-square test were used to measure the outcomes of CDT.Grade 3 thrombolysis was achieved in 25 (46.3%) patients, grade 2 thrombolysis in 25 (46.3%) patients, and grade 1 thrombolysis in 4 (7.4%) patients. Significant recanalization (grade 2 or 3 thrombolysis) was possible in 50 (92.6%) patients. There was no statistically significant difference in the percentage of significant recanalization that could be achieved between patients who underwent CDT before and after 10 days. There was no significant difference between the thrombolysis achieved between urokinase and r-tPA. PTS was seen in 33% of the patients. Major complications were seen in 5.5% of the patients.CDT is a safe and effective therapeutic technique in patients with acute and subacute lower extremity DVT, if appropriate patient selection is made.

SUBMITTER: Sundar G

PROVIDER: S-EPMC4813079 | biostudies-other | 2016 Jan-Mar

REPOSITORIES: biostudies-other

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Outcomes of catheter-directed treatment of lower extremity deep vein thrombosis of patients presenting to a tertiary care hospital.

Sundar Gaurav G Keshava Shyamkumar N SN Moses Vinu V Chiramel George K GK Ahmed Munawwar M Mammen Suraj S Aggarwal Sunil S Stephen Edwin E

The Indian journal of radiology & imaging 20160101 1

<h4>Background</h4>Lower extremity deep vein thrombosis (DVT) is a common illness with an annual incidence of 1 per 1000 adults. The major long-term complication of DVT is post-thrombotic syndrome (PTS) which occurs in up to 60% of patients within 2 years of an episode of DVT.<h4>Aims</h4>We aim to evaluate the outcomes of catheter-directed treatment (CDT) for symptomatic acute or subacute lower extremity DVT.<h4>Materials and methods</h4>A retrospective 12-year study was conducted on the outcom ...[more]

PMID: 27081228

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Project description:BackgroundThis study aimed to assess the short-term effect of residual thrombus of the lower extremity after pharmacomechanical catheter-directed thrombolysis (PCDT) on the incidence of post-thrombotic syndrome (PTS) and iliofemoral vein patency rate in patients who underwent PCDT.MethodsThere were 94 continuous patients with severe deep vein thrombosis (DVT) of the lower extremities admitted to our hospital between March 2016 and June 2018; 73 cases receiving PCDT and verified with iliac vein compression syndrome (IVCS) were assigned into two groups. Thirty-nine patients without thrombus of the popliteal and infrapopliteal veins were assigned to the proximal DVT group. The remaining 34 cases were placed in the extensive DVT group. The thrombus scores, including venous registry index (VRI) score, Marder score, and Society for Vascular Surgery (SVS) score before and after PCDT, the primary two years' cumulative rate of iliofemoral patency, and the rate of PTS, and complications were analyzed retrospectively.ResultsUltimately, 27 patients in the proximal DVT group and 26 cases in the extensive DVT group completed the study. The two groups had no significant differences in terms of basic characteristics, complication and the rate of PTS (P>0.05). However, there were significant differences in terms of postoperative mean thrombus score and the mean degree of thrombosis removal score by Marder and SVS scores, residual thrombus by lower thrombosis classification (LET) and the two years' cumulative iliofemoral vein patency rate (P<0.05). And the logistic regression analysis demonstrated the residual thrombus of LET class II [odds ratio (OR), 4.619, 95% confidence interval (CI), 1.090-19.567, P=0.038] was an independent risk factor for iliofemoral vein occlusion.ConclusionsThe residual thrombus of LET class II is an independent risk factor for iliofemoral vein occlusion. It is very important to keep the patency of the popliteal vein when deciding to use a stent to maintain iliofemoral vein patency. Furthermore, the anterior tibial vein approach and crisscross technique may be two important alternative methods that can be used to address the thrombus of popliteal vein for patients with extensive DVT.

Project description:BACKGROUND:The post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter "pharmacomechanical thrombolysis") rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome. METHODS:We randomly assigned 692 patients with acute proximal deep-vein thrombosis to receive either anticoagulation alone (control group) or anticoagulation plus pharmacomechanical thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tissue plasminogen activator and thrombus aspiration or maceration, with or without stenting). The primary outcome was development of the post-thrombotic syndrome between 6 and 24 months of follow-up. RESULTS:Between 6 and 24 months, there was no significant between-group difference in the percentage of patients with the post-thrombotic syndrome (47% in the pharmacomechanical-thrombolysis group and 48% in the control group; risk ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.11; P=0.56). Pharmacomechanical thrombolysis led to more major bleeding events within 10 days (1.7% vs. 0.3% of patients, P=0.049), but no significant difference in recurrent venous thromboembolism was seen over the 24-month follow-up period (12% in the pharmacomechanical-thrombolysis group and 8% in the control group, P=0.09). Moderate-to-severe post-thrombotic syndrome occurred in 18% of patients in the pharmacomechanical-thrombolysis group versus 24% of those in the control group (risk ratio, 0.73; 95% CI, 0.54 to 0.98; P=0.04). Severity scores for the post-thrombotic syndrome were lower in the pharmacomechanical-thrombolysis group than in the control group at 6, 12, 18, and 24 months of follow-up (P<0.01 for the comparison of the Villalta scores at each time point), but the improvement in quality of life from baseline to 24 months did not differ significantly between the treatment groups. CONCLUSIONS:Among patients with acute proximal deep-vein thrombosis, the addition of pharmacomechanical catheter-directed thrombolysis to anticoagulation did not result in a lower risk of the post-thrombotic syndrome but did result in a higher risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute and others; ATTRACT ClinicalTrials.gov number, NCT00790335 .).

Project description:BackgroundEffective treatment of upper extremity deep vein thrombosis (UEDVT) is crucial to prevent further complications. Various treatments, including percutaneous mechanical thrombectomy (PMT), catheter-directed thrombolysis (CDT), decompression surgery, and venoplasty are suggested for UEDVT. However, no prospective study has yet favored any of these treatments. This study presents a review of our experience with CDT followed by balloon venoplasty in patients with acute primary UEDVT.MethodsWe enrolled all patients diagnosed with acute UEDVT from January 2020 to June 2021. Subjects with UEDVT due to secondary causes like malignancies, indwelling catheters, or leads were excluded. CDT was performed through brachial vein access, using a perfusion catheter, and rt-PA administration. Balloon venoplasty was performed if the treated segment had remaining stenosis after CDT. Patients were followed up at the vein clinic for any signs and symptoms in the upper extremity and lifestyle changes. Follow-up ultrasonography was done 12 months after discharge.ResultsTwelve patients with a mean age of 41.08 ± 14.0 years were included in the study. The mean duration of CDT was 25.00 ± 10.56 h. After CDT, all patients had remaining occlusions, with seven having more than 50% remaining stenosis. However, after balloon venoplasty, no patient had significant (more than 50%) stenosis. There was no serious complication after both procedures. Patients were followed up for a mean duration of twelve months after their admission, with a mean time of maintenance anticoagulation was 10.73 ± 5.77 months. Only one patient had recurrent symptoms in his target limb which required a decompression surgery, while the rest were free of symptoms in their treated extremity. No subject developed pulmonary emboli (PE) during admission or the follow-up period. There was no evidence of hospital readmission for any reason. Upper extremity color-doppler sonography of the patients at twelve months after their procedure showed normal venous flow without any significant stenosis in 8 (66.7%), and partially normal flow with patent target vein in 4 (33.3%) patients.ConclusionsCDT followed by balloon venoplasty may be an effective treatment for selected patients with acute primary UEDVT, providing desirable long-term results and potentially avoiding the need for decompression surgery in the short or long term.

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Outcomes of catheter-directed treatment of lower extremity deep vein thrombosis of patients presenting to a tertiary care hospital.

Publications

Outcomes of catheter-directed treatment of lower extremity deep vein thrombosis of patients presenting to a tertiary care hospital.

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