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Phlebology Mar 2015Invasive management of postthrombotic syndrome encompasses the two ends of the deep vein thrombosis spectrum, patients with acute iliofemoral deep vein thrombosis and... (Review)
Review
Invasive management of postthrombotic syndrome encompasses the two ends of the deep vein thrombosis spectrum, patients with acute iliofemoral deep vein thrombosis and those with chronic postthrombotic iliofemoral venous obstruction. Of all patients with acute deep vein thrombosis, those with involvement of the iliofemoral segments have the most severe chronic postthrombotic morbidity. Catheter-based techniques now permit percutaneous treatment to eliminate thrombus, restore patency, potentially maintain valvular function, and improve quality of life. Randomized trial data support an initial treatment strategy of thrombus removal. Failure to eliminate acute thrombus from the iliofemoral system leads to chronic postthrombotic obstruction of venous outflow. Debilitating chronic postthrombotic symptoms of the long-standing obstruction of venous outflow can be reduced by restoring unobstructed venous drainage from the profunda femoris vein to the vena cava.
Topics: Acute Disease; Blood Flow Velocity; Endovascular Procedures; Humans; Mechanical Thrombolysis; Postthrombotic Syndrome; Venous Thrombosis; Venous Valves
PubMed: 25729069
DOI: 10.1177/0268355514568846 -
Journal of Vascular Surgery. Venous and... Jan 2017Duplex ultrasound (DUS) is performed by the majority of physicians after endovenous ablation (EVA) of the great saphenous vein to screen for endovenous heat-induced... (Review)
Review
BACKGROUND
Duplex ultrasound (DUS) is performed by the majority of physicians after endovenous ablation (EVA) of the great saphenous vein to screen for endovenous heat-induced thrombosis (EHIT) at the saphenofemoral junction extending into the femoral vein. Several factors should be considered in assessing the value and cost of routine DUS after EVA: the natural history of EHIT is poorly defined, the incidence appears low, and the majority are both asymptomatic and Kabnick type 2 (projecting only slightly into the femoral vein). Moreover, routine postoperative DUS screening is not recommended for procedures with higher thromboembolic complication rates, such as joint replacement or bariatric surgery.
METHODS
Data on the incidence of death, EHIT, and deep venous thrombosis (DVT) were derived from a systematic review after either radiofrequency or laser ablation of the saphenous vein from two sources: (1) EVA randomized controlled trials (N = 1482) and a (2) large (>150 patients) EVA case series (N = 12,363). The number of tests required to detect one case of EHIT/DVT was calculated from the incidence in the EVA and case series data bases; the cost to detect a case was estimated using the 2013 Medicare global fee schedule for the cost of a unilateral venous DUS study.
RESULTS
This analysis included 13,845 EVA-treated limbs. There were no reported deaths. The incidence of DUS-detected venous thromboembolism after EVA is 0.7%. The cost of unilateral DUS according to the Medicare global reimbursement fee for office-based studies is $106.71. The total cost of performing DUS in this study population is estimated to be at least $1,477,399, and the amount of dollars expended per venous thromboembolism detected is $14,667.
CONCLUSIONS
The current Society for Vascular Surgery/American Venous Forum recommendation is to perform screening DUS after EVA within 72 hours postoperatively with a weak level of recommendation (grade 2C). The current analysis demonstrates a low incidence of EHIT/DVT with a corresponding high cost to detect each case with routine DUS screening. These data combined with the unclear clinical significance of EHIT suggest that the policy of universal post-EVA screening should be revised in the near future.
Topics: Catheter Ablation; Costs and Cost Analysis; Health Care Costs; Humans; Postoperative Care; Ultrasonography, Doppler, Duplex; Venous Thrombosis
PubMed: 27987602
DOI: 10.1016/j.jvsv.2016.07.001 -
Orthopaedic Surgery Jul 2022Isolated calf deep venous thrombosis (ICDVT) includes thrombosis located at the far end of the popliteal vein, such as the anterior tibial vein, posterior tibial vein,... (Review)
Review
Isolated calf deep venous thrombosis (ICDVT) includes thrombosis located at the far end of the popliteal vein, such as the anterior tibial vein, posterior tibial vein, fibular vein, and intramuscular vein of the soleus and gastrocnemius. This type of thrombosis has the highest incidence, accounting for approximately half of all deep vein thrombosis (DVT) cases; however, there is no consistent recommendation for ICDVT treatment across countries, and there is also no optimal management strategy. In recent years, increasing evidence has shown that ICDVT can develop into proximal DVT, even causing pulmonary embolism (PE). Therefore, some experts suggest anticoagulant therapy for this type of DVT, while others hold an opposing attitude. Therefore, the treatment strategy for this type of DVT has become a hot and difficult research topic. The purpose of this review is to summarize the characteristics of ICDVT and the effects of different treatment strategies by analyzing recent and important classical works in the literature in an attempt to provide recommendations for the treatment of this most common type of DVT in orthopaedic clinics.
Topics: Anticoagulants; Humans; Leg; Pulmonary Embolism; Risk Factors; Thrombosis; Venous Thrombosis
PubMed: 35478486
DOI: 10.1111/os.13292 -
Catheterization and Cardiovascular... Oct 2021Over the last years, the endovascular approach to the management of the acute and chronic deep vein thrombosis (DVT) has gained more and more attention from the...
Over the last years, the endovascular approach to the management of the acute and chronic deep vein thrombosis (DVT) has gained more and more attention from the scientific community. DVT is the third most common cardiovascular disease after coronary heart disease and stroke, with classic treatment based on anticoagulation. Recent evidences have highlighted the risk of postthrombotic syndrome as high as 30%-50% in proximal ilio-femoral lesions, with irreversible clinical symptoms and impact on the quality of life of the population. Since 2000s, the new concept of thrombus removal in the acute phase has been supported by the introduction of different techniques based on the endovascular ablation of the clot by in-situ fibrinolysis and, more recently, fragmentation and aspiration. In the chronic phase, recanalization of the thrombosed segment is recommended by stent placement to remove the obstruction and eventually reduce the congestion. Immediate technical success of these procedures is widely satisfying, whereas the long-term clinical benefits are still debated. This paper presents an overview of the modern management of the DVT by endovascular approach with regard to the clinical contexts, interventional strategies and clinical outcomes. Endovascular specialist needs to be aware of this incoming challenge, as local expertise is demanded for the modern management of these patients in multidisciplinary theaters.
Topics: Endovascular Procedures; Humans; Iliac Vein; Postthrombotic Syndrome; Quality of Life; Thrombolytic Therapy; Treatment Outcome; Venous Thrombosis
PubMed: 33185318
DOI: 10.1002/ccd.29375 -
The American Journal of Medicine May 2017Little is known about the in-hospital mortality of deep venous thrombosis in recent years. This investigation was undertaken to determine trends in in-hospital mortality...
BACKGROUND
Little is known about the in-hospital mortality of deep venous thrombosis in recent years. This investigation was undertaken to determine trends in in-hospital mortality in patients with deep venous thrombosis and mortality according to age.
METHODS
Administrative data were analyzed from the National (Nationwide) Inpatient Sample, 2003-2012. We determined in-hospital all-cause mortality according to year and age among patients with a primary (first-listed) diagnosis of deep venous thrombosis. We analyzed all such patients and we analyzed those who had none of the comorbid conditions listed in the Charlson Comorbidity Index.
RESULTS
From 2003-2012, 1,603,690 hospitalized patients had a primary diagnosis of deep venous thrombosis. All-cause in-hospital mortality decreased from 1.3% in 2003 to 0.6% in 2012. Mortality increased with age from 0.1% in those aged 18-20 years to 1.5% in those over age 80 years. All-cause in-hospital mortality in those with no comorbid conditions according to the Charlson Comorbidity Index (1,094,184 patients) decreased from 1.1% in 2003 to 0.5% in 2012. Presumably, these deaths were from pulmonary embolism. All-cause mortality in those with no comorbid conditions increased with age from 0.1% in those aged 18-20 years to 1.4% in those over aged 80 years.
CONCLUSION
All-cause death and death due to pulmonary embolism in patients hospitalized with a primary diagnosis of deep venous thrombosis decreased from 2003-2012. The death rate increased with age. The decreased mortality over the period of investigation may have resulted from a shift toward use of low-molecular-weight heparins and newer anticoagulants.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Cause of Death; Comorbidity; Female; Hospital Mortality; Humans; Male; Middle Aged; Venous Thrombosis; Young Adult
PubMed: 27894736
DOI: 10.1016/j.amjmed.2016.10.030 -
Scientific Reports Jan 2023Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous...
Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous studies on enhancing efficiency of computer-aided diagnosis, but clinical diagnostic approaches have never been considered. In this study, we evaluated the performance of an artificial intelligence (AI) algorithm in the detection of iliofemoral deep venous thrombosis on computed tomography angiography of the lower extremities to investigate the effectiveness of using the clinical approach during the feature extraction process of the AI algorithm. To investigate the effectiveness of the proposed method, we created synthesized images to consider practical diagnostic procedures and applied them to the convolutional neural network-based RetinaNet model. We compared and analyzed the performances based on the model's backbone and data. The performance of the model was as follows: ResNet50: sensitivity = 0.843 (± 0.037), false positives per image = 0.608 (± 0.139); ResNet152 backbone: sensitivity = 0.839 (± 0.031), false positives per image = 0.503 (± 0.079). The results demonstrated the effectiveness of the suggested method in using computed tomography angiography of the lower extremities, and improving the reporting efficiency of the critical iliofemoral deep venous thrombosis cases.
Topics: Humans; Artificial Intelligence; Venous Thrombosis; Pulmonary Embolism; Angiography; Lower Extremity
PubMed: 36653367
DOI: 10.1038/s41598-022-25849-0 -
The American Journal of Medicine Jul 2021Whether deep venous thrombosis involving the pelvic veins or inferior vena cava is associated with higher in-hospital mortality or higher prevalence of in-hospital...
BACKGROUND
Whether deep venous thrombosis involving the pelvic veins or inferior vena cava is associated with higher in-hospital mortality or higher prevalence of in-hospital pulmonary embolism than proximal or distal lower extremity deep venous thrombosis is not known.
METHODS
This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016, 2017. Patients hospitalized with a primary diagnosis of deep venous thrombosis at known locations were identified by International Classification of Diseases-10-Clinical Modification codes.
RESULTS
In-hospital all-cause mortality with deep venous thrombosis involving the inferior vena cava in patients treated only with anticoagulants was 2.2% versus 0.8% with pelvic vein deep venous thrombosis (p<0.0001), 0.7% with proximal deep venous thrombosis (p<0.0001) and 0.2% with distal deep venous thrombosis (p<0.0001). Mortality with anticoagulants was similar with pelvic vein deep venous thrombosis compared with proximal lower extremity deep venous thrombosis, 0.8% versus 0.7% (p=0.39). Lower mortality was shown with pelvic vein deep venous thrombosis treated with thrombolytics than with anticoagulants, 0% versus 0.8% (p<0.0001). In-hospital pulmonary embolism occurred in 11% to 23%, irrespective of the site of deep venous thrombosis.
CONCLUSION
Patients with deep venous thrombosis involving the inferior vena cava had higher in-hospital mortality than patients with deep venous thrombosis at other locations. Pelvic vein deep venous thrombosis did not result in higher mortality or more in-hospital pulmonary embolism than proximal lower extremity deep venous thrombosis. The incidence of in-hospital pulmonary embolism was considerable with deep venous thrombosis at all sites.
Topics: Aged; Aged, 80 and over; Cohort Studies; Disease Management; Female; Hospital Mortality; Hospitalization; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Thrombolytic Therapy; United States; Venous Thrombosis
PubMed: 33316253
DOI: 10.1016/j.amjmed.2020.11.013 -
Journal of Vascular Surgery. Venous and... Jan 2019Anticoagulation is the cornerstone for the treatment of deep venous thrombosis and pulmonary embolism. On occasion, this is not possible because of bleeding... (Review)
Review
Anticoagulation is the cornerstone for the treatment of deep venous thrombosis and pulmonary embolism. On occasion, this is not possible because of bleeding complications or, rarely, breakthrough pulmonary embolism associated with this treatment method. The development of vena cava interruption in the 1970s was a critical advance in the treatment of these patients. Placement of inferior vena cava (IVC) filters has been steadily increasing since their introduction. Nonetheless, the incidence of complications associated with placement of these devices is largely unknown. Most of the evidence regarding IVC filter complications relies on case reports, with scarce data coming from larger randomized controlled trials. We aimed to present a summary addressing long-term complications of IVC filters as published in recent articles addressing problems such as IVC thrombosis and IVC filter migration, perforation, fracture, embolization, and tilting. We performed a PubMed search and Google Scholar search using different combinations of "long term," "complications," "IVC filter," and "vena cava filter." We reviewed the available English publications and reported the findings in this summary.
Topics: Device Removal; Evidence-Based Medicine; Foreign-Body Migration; Humans; Prosthesis Design; Prosthesis Failure; Prosthesis Implantation; Risk Factors; Time Factors; Treatment Outcome; Vena Cava Filters; Venous Thrombosis
PubMed: 30126794
DOI: 10.1016/j.jvsv.2018.01.022 -
Circulation Feb 2019
Topics: Humans; Postthrombotic Syndrome; Veins; Venous Thrombosis
PubMed: 30802168
DOI: 10.1161/CIRCULATIONAHA.118.037903 -
Progress in Cardiovascular Diseases 2018Patients with a history of deep vein thrombosis and pulmonary embolism are at risk for a recurrent event. This is particularly true of patients with idiopathic events or... (Review)
Review
Patients with a history of deep vein thrombosis and pulmonary embolism are at risk for a recurrent event. This is particularly true of patients with idiopathic events or events related to low risk triggers. In these patients extending anticoagulation beyond 3 to 6months may be warranted. Using clinical risk, biomarker analysis and risk stratification protocols we can make the best recommendations to patients with respect to the risks and benefits of ongoing therapy. Trials demonstrating benefit from low-dose aspirin for secondary prophylaxis may provide an option for patients in whom ongoing anticoagulation is deemed unsafe. In addition, recent introduction of the direct oral anticoagulants have expanded options for secondary prophylaxis for preventing venous thromboembolism recurrence.
Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Long-Term Care; Male; Middle Aged; Pulmonary Embolism; Recurrence; Risk Assessment; Time Factors; Venous Thrombosis
PubMed: 29634958
DOI: 10.1016/j.pcad.2018.04.002