Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline

Liu, David; Peterson, Erica A.; Dooner, James; Baerlocher, Mark O.; Zypchen, Leslie; Gagnon, Joël; Delorme, M.; Sing, Chad Kim; Wong, Jason; Guzman, Randolph; Greenfield, Gavin; Moodley, Otto; Yenson, Paul R.

doi:10.1503/cmaj.141614

Cited by 46 publications

(35 citation statements)

References 71 publications

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“…In summary, two guidelines were published in 2011 [ 34 , 35 ], nine in 2012 [ 36 – 44 ] and 16 (59%) [ 5 , 45 – 59 ] were published, updated, or re-affirmed between 2013 and 2017, inclusive. Just under half (k = 13 [ 5 , 36 – 38 , 40 – 44 , 53 , 55 , 56 , 58 ]) were developed by groups located in the United States, and an additional 13 CPGs were developed by groups based exclusively in Europe (k = 8 [ 34 , 35 , 39 , 45 , 50 – 52 , 59 ]) and Canada (k = 5 [ 46 – 49 , 57 ]). Additionally, one CPG [ 54 ] was developed by an international group of experts across Europe (Czech Republic, France, and the United Kingdom) and North America.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making

et al. 2018

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BackgroundVenous thromboembolism (VTE) is a major global cause of morbidity and mortality. Low molecular weight heparin (LMWH) and fondaparinux (FDP) are frequently used to treat and prevent VTE and have a variety of safety and practical advantages over other anticoagulants, including use in outpatient settings. These medications are commonly listed on drug formularies, which act as a gateway for health plan prescription coverage by outlining the circumstances under which patients will be covered for specific drugs and drug products. Because patient access to medications is impacted by the nature of their listing on formularies, they must be rigorously reviewed and modernized as new evidence emerges.MethodsAs part of a broader drug class review team, we completed a systematic review of clinical practice guidelines to determine whether the recommendations they reported aligned with the indications listed for the coverage of LMWH and FDP in an outpatient drug formulary. Guideline quality was assessed using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. Recommendation matrices were used to systematically compare, categorize, and summarize included recommendations.ResultsTwenty-seven guidelines were included from which 168 eligible recommendations were identified. Generally, AGREE II domains were adequately addressed; however, domain five (applicability) was poorly addressed. Most recommendations were based on moderate- to low-quality/limited evidence and reported on the use of LMWHs generally; few reported on specific agents.ConclusionsOur findings contributed to the recommendation that the formulary listing for LMWH and FDP be streamlined to include coverage for specific outpatient indications. The paucity of available evidence on the comparative efficacy of specific LMWH agents against each other and FDP limited agent-specific listing recommendations, highlighting the need for high-quality comparative studies on this topic.

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Section: Resultsmentioning

confidence: 99%

A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making

et al. 2018

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“…19e21 The aim of early thrombus removal is to reduce severity of symptoms for the patient and hopefully decrease the rate of post-thrombotic syndrome. 19,20 Presented group of patients consists of more then one hundred consecutive cases where almost everyone who was diagnosed with suspicious obstruction (acute or chronic), and who was willing to have the intervention done, was enrolled. Only a hand full of patients were rejected because of their either severe renal failure, severe heart failure, or mental disability.…”

Section: Discussionmentioning

confidence: 99%

One-Year Results of Iliocaval Stenting

Tosenovsky¹

2019

Annals of Vascular Surgery

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Background: The aim of the study was to assess results of interventions for iliocaval obstruction or compression in patient with acute and chronic venous disease. Methods: Patients with chronic venous insufficiency (CVI) C3-C6 (Clinical, Etiology, Anatomy, Pathology -classification of venous insufficiency) and acute deep venous thrombosis were assessed by ultrasound scan, computed tomography, venography, and/or intravascular ultrasound, and if an obstruction in their iliocaval or iliofemoral segments were confirmed, they underwent venoplasty and stenting. Acute deep venous thrombosis cases were treated with pharmacomechanical and/or catheter-directed thrombolysis and residual obstruction was then stented. Results: One hundred eighteen consecutive limbs were treated between October 2011 and December 2017. Thirty-two limbs had an active ulcer (27%), 27 limbs had healed ulcer or advanced skin changes (23%), 39 limbs had swelling with or without other symptoms of CVI (33%), 15 limbs had acute symptomatic deep venous thrombosis (13%), and the residual 5 iliac vein cases were causing pelvic congestion syndrome (4%). Patency rates of the stents in acute cases were 84.6%, 76.9%, 76.9%, and in chronic cases (combined thrombotic and nonthrombotic) 93.1%, 91%, and 89.9% in 3, 6, and 12 months, respectively. A relief of symptoms was achieved in 81.5 % of limbs at some stage during the first 12 months (most of them within the first 3 months), although at the end of this period only 59.3% remained free of symptoms. There was no limb loss and no mortality within 30 days from the intervention. Conclusions: Iliocaval and iliofemoral venoplasty and stenting in both acute and chronic obstruction cases can be performed safely with good patency rates and reasonable improvement of symptoms of CVI.

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“… 10 , 11 US can have difficulty in detecting proximal DVT in the pelvis because of excess bowel gas, a large body habitus, an in situ inferior vena cava filter, and postsurgical abdomen or acute abdomen. 10 , 12 , 13 Additionally, providing clinicians with 3D anatomical information on concomitant venous diseases is always a challenge with US (eg, proximal vein obstruction). With the advances made in recent years, CTV can provide such information, thus helping in determining treatment strategies for patients with LEDVT.…”

Section: Discussionmentioning

confidence: 99%

Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis

Shi

Wang

et al. 2016

Medicine

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This study aimed to evaluate the diagnostic accuracy of combined direct and indirect CT venography (combined CTV) in the detection of lower extremity deep vein thrombosis (LEDVT).The institutional review board approved the study protocol, and patients or qualifying family members provided informed consent. A total of 96 consecutive patients undergoing combined CTV were prospectively enrolled. A combined examination with digital subtraction angiography (DSA) plus duplex ultrasonography (US) was used as the criterion standard. Three observers were blinded to clinical, DSA, and US results, and they independently analyzed all combined CTV datasets. Interobserver agreement was expressed in terms of the Cohen k value for categorical variables. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined CTV in the detection of LEDVT were determined by using patient- and location-based evaluations.Of the 96 patients, DSA plus US revealed LEDVT in 125 segmental veins in 63 patients. Patient-based evaluation with combined CTV yielded an accuracy of 96.9% to 97.9%, a sensitivity of 95.2% to 96.8%, a specificity of 100% to 100%, a PPV of 100% to 100%, and an NPV of 91.7% to 94.3% in the detection of LEDVT. Location-based evaluation yielded similar results. Through combined direct and indirect CTV, patients obtained a combined CT angiogram on the diseased limb and an indirect CT angiogram on the opposite side. The image quality of combined CTV was superior to an indirect venogram.Combined CTV shows promising diagnostic accuracy in the detection of LEDVT with 3-dimensional modeling of the lower limb venous system.

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Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline

Cited by 46 publications

References 71 publications

A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making

A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making

One-Year Results of Iliocaval Stenting

Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis

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