Caval Thrombus Management: The Data, Where We Are, and How It Is Done

Harrison, Brittany; Hao, Frank; Koney, Nii Koney-Kwaku; McWilliams, J.; Moriarty, John M.

doi:10.1053/j.tvir.2018.03.002

Cited by 10 publications

(7 citation statements)

References 63 publications

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“…Also, indefinite anticoagulant therapy as well as wearing of medical compression stockings is advocated [12, 16, 20]. In selected cases of acute DVT in the presence of IVCA, endovascular approaches such as catheter-directed thrombolysis and stenting have been successfully applied [16, 30–32]. Surgery is reserved for cases with severe symptoms [32–36].…”

Section: Discussionmentioning

confidence: 99%

“…In selected cases of acute DVT in the presence of IVCA, endovascular approaches such as catheter-directed thrombolysis and stenting have been successfully applied [16, 30–32]. Surgery is reserved for cases with severe symptoms [32–36]. Finally, in case of a correct and uninterrupted anticoagulation, the long-term prognosis concerning life expectancy is good [16].…”

Section: Discussionmentioning

confidence: 99%

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Thrombophlebitis hiding under a KILT – case report on 40 years long-term follow-up of neonatal renal vein thrombosis

et al. 2019

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Background Neonatal renal vein thrombosis is a recognised cause of renal and inferior caval vein atresia (IVCA). However, the long-term impact of the condition is underrecognized with a high burden of morbidity for the patient, especially in adulthood. IVCA has been shown to be an independent risk factor for deep venous thrombosis (DVT) with a high risk of recurrence. The acronym KILT for kidney and inferior vena cava anomaly with leg thrombosis summarizes the pathological situation. Case presentation We present the case of a 40-year-old patient with pain in the right lower limb resulting from acute thrombophlebitis. No risk factors could be identified. His history was remarkable with two episodes of deep venous thrombosis first of the left, then the right leg 22 years earlier; at that time also, no risk factor was identified. Because of the idiopathic character of that thrombosis, the patient remained on long-term anticoagulation with phenprocoumon. The present thrombophlebitis occurred while the INR was not therapeutic in the preceding weeks. A CT with contrast showed atresia of the inferior vena cava and of the right kidney, and presence of numerous collaterals. A thorough medical history revealed a renal vein thrombosis as a neonate. Anticoagulation was intensified, and stent placement became necessary after a further 2 years. Discussion and conclusions KILT syndrome is a rare but underrecognized condition. Complications may arise in young adulthood only, and it is of prime importance to instruct parents of the pediatric patient of the possible consequences of renal vein thrombosis and to assure guidance from the treating physicians throughout adulthood. Diagnosis of IVCA is by CT with contrast or by MRI, and lifelong anticoagulation may be necessary. Since the KILT syndrome is widely underdiagnosed, we challenge the clinicians to keep it in mind when confronted with thrombophlebitis or thrombosis of the young, male and with no other identifiable risk factors for deep vein thrombosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thrombophlebitis hiding under a KILT – case report on 40 years long-term follow-up of neonatal renal vein thrombosis

et al. 2019

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“…4 However, it involves prolonged infusion of thrombolytic agents which can lead to a high rate of hemorrhage. 5,6 Also, rates of re-thrombosis can be significant and long-term patency compromised. 7 Another possibility is catheter directed thrombectomy (CDTc) allowing single session treatment.…”

Section: Discussionmentioning

confidence: 99%

“… 4 However, it involves prolonged infusion of thrombolytic agents, which can lead to a high rate of hemorrhage. 5 , 6 Also, the rates of rethrombosis can be significant and long-term patency compromised. 7 …”

Section: Discussionmentioning

confidence: 99%

Catheter-directed thrombectomy with the JETi8 in the treatment of acute superior vena cava syndrome

Emsley¹,

Haller²,

Arts³

2022

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…Thrombi in the vena cava and in the right atrium (RA) present a risk factor for increased morbidity and mortality, and are associated with the potential risk of pulmonary embolism (PE). 1 Foreign bodies such as previously placed cardiac leads may cause thrombotic material to form. 2 The removal of thrombi or lead vegetations from the above mentioned sites is commonly associated with open heart surgery including sternotomy and the use of a heart-lung machine (HLM).…”

Section: Introductionmentioning

confidence: 99%

Technical implementation of percutaneous thrombus aspiration using the AngioVac system

et al. 2020

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Objectives: The AngioVac system (AngioDynamics, Latham, NY, USA) provides a method for the minimally invasive, percutaneous aspiration of thrombus formations originating from the central venous system as well as solid matter such as lead vegetations and right atrial thrombi. Methods: This retrospective, observational study describes the initial experience in 52 adult patients with the AngioVac system, focusing mainly on the development of the extracorporeal circuit to improve usability and safety. Results: The mean patient age was 62.9 years (range 23-86 years). 22 patients were female and 30 were male. Indications for percutaneous aspiration were lead vegetations (n = 36; 69.2%), right atrial thrombi (n = 9; 17.3%), central venous thrombi (n = 5; 9.6%) and pulmonary embolisms (n = 2; 3.8%). Successful aspiration was performed in 44 cases (84.6%) and partial success was achieved in five patients (9.6%), while failure to remove thrombi or vegetations occurred in three cases (5.8%). Our practical experience led to the installation of a shunt line for recirculation and the implementation of safety features concerning air handling, which are also employed in minimally invasive extracorporeal bypass circuits. Initial tests monitored the level of negative pressure according to differences in flow and access sites but these still have to be validated on a larger scale. Conclusion: In this initial experience, the AngioVac system appeared to be safe regarding the extracorporeal circulation and the elimination of thrombi and lead vegetations.

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Caval Thrombus Management: The Data, Where We Are, and How It Is Done

Cited by 10 publications

References 63 publications

Thrombophlebitis hiding under a KILT – case report on 40 years long-term follow-up of neonatal renal vein thrombosis

Thrombophlebitis hiding under a KILT – case report on 40 years long-term follow-up of neonatal renal vein thrombosis

Catheter-directed thrombectomy with the JETi8 in the treatment of acute superior vena cava syndrome

Technical implementation of percutaneous thrombus aspiration using the AngioVac system

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