Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum

Meissner, Mark H.; Gloviczki, Péter; Comerota, Anthony J.; Dalsing, Michael C.; Eklöf, Bo; Gillespie, David L.; Lohr, Joann M.; McLafferty, Robert B.; Murad, M. Hassan; Padberg, Frank T.; Pappas, Peter J.; Raffetto, Joseph D.; Wakefield, Thomas W.

doi:10.1016/j.jvs.2011.12.081

Cited by 374 publications

(286 citation statements)

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“…Thrombectomy combined with thrombolytics can therefore lead to fewer hemorrhagic complications and reduced morbidity (Table 1). 5,6 Several different thrombectomy devices are available on the market, with a range of different mechanisms of action: simple aspiration of thrombi, hydrodynamic (aspiration by negative pressure of saline jets), fragmentation and combination systems. 7 The device used in this case, the Angiojet  (Possis Medical Inc., Mineapolis, MN), has an action based on the Venturi effect.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism and stroke associated with mechanical thrombectomy

Bastianetto

Pinto

2014

J. vasc. bras.

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Mechanical thrombectomy offers the advantage of rapid removal of venous thrombi. It allows venous obstructions to be removed and requires shorter duration of infusion of thrombolytic agents. However, aspiration of thrombi can lead to complications, particularly pulmonary embolism and hemolysis. The validity of using vena cava filters during thrombectomy in order to avoid embolism has not yet been established. The authors report a case of massive pulmonary embolism associated with ischemic stroke in a patient with a hitherto undiagnosed patent foramen ovale. The patient developed respiratory failure and neurological deficit after thrombectomy. This case raise questions about the value of the thrombectomy for the treatment of proximal vein thrombosis due to the risks of this procedure. The authors also discuss the need for vena cava filters and ruling out a patent foramen ovale in patients undergoing thrombectomy.Keywords: thrombectomy; mechanical thrombolysis; pulmonary embolism; stroke. ResumoA trombectomia mecânica tem a vantagem de levar à rápida remoção dos trombos. Permite a desobstrução venosa e a redução do tempo de infusão de trombolíticos. A aspiração dos trombos pode levar a complicações, principalmente embolia pulmonar e hemólise. Algo que não está definido é a validade do uso de filtros de veia cava durante a trombectomia, com o objetivo de evitar a TEP maciça. Os autores relatam um caso de embolia pulmonar maciça associada a AVC isquêmico, em uma paciente que apresentava forame oval patente. Não havia o diagnóstico prévio da PFO. A paciente evoluiu com insuficiência respiratória e déficit neurológico logo após a trombectomia. Neste caso, questiona-se o valor da trombectomia para o tratamento da trombose venosa proximal, devido aos riscos deste procedimento. Os autores discutem sobre a necessidade de filtro de veia cava e sobre a pesquisa de forame oval nos pacientes que serão submetidos à trombectomia.Palavras-chave: trombectomia; trombólise mecânica; embolia pulmonar; acidente vascular cerebral.

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Section: Discussionmentioning

confidence: 99%

Pulmonary embolism and stroke associated with mechanical thrombectomy

Bastianetto

Pinto

2014

J. vasc. bras.

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“…CDT should be considered for patients with symptomatic iliofemoral DVT who have symptoms of less than 14-day duration, good functional status, a life expectancy of 1 year or more and a low risk of bleeding. Especially, when phlegmasia cerulea dolens or venous gangrene is present, aggressive endovascular thrombus removal should be performed on an emergency basis for limb salvage [147][148][149][150][151].…”

Section: ) Compression Therapymentioning

confidence: 99%

“…The use of prophylactic IVC filter might be restricted in patients at high risk of PE, such as those with a free-floating thrombus extending into the IVC. Therefore, periprocedural retrievable IVC filter placement can be considered in selected patients after assessing the relative risks vs. benefits of filter placement for those with markedly limited cardiopulmonary reserve, free-floating thrombus in IVC, or with mechanical thrombectomy alone without CDT [148,156,175,176]. ⑥ Additional balloon angioplasty and stent Additional endovascular therapy such as balloon angioplasty and stenting can be performed to treat residual stenotic lesions after CDT.…”

Section: Recommendationmentioning

confidence: 99%

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

Kim

Min

Kang

et al. 2016

J Korean Soc Radiol

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“…With a wide variety of presentations ranging from minor leg swelling to severe complications, such venous stasis ulcers, PTS can signifi cantly decrease quality of life [2]. Patients who have extensive DVT, recurrent ipsilateral thrombosis, a history of varicose veins, obesity, or residual thrombus are at an increased risk of developing PTS [1].The best therapeutic approach for the prevention of PTS remains a matter of debate [3,4]. Maintaining a therapeutic international normalized ratio (INR) with warfarin has been associated with lower chances of developing PTS.…”

mentioning

confidence: 99%

“…The best therapeutic approach for the prevention of PTS remains a matter of debate [3,4]. Maintaining a therapeutic international normalized ratio (INR) with warfarin has been associated with lower chances of developing PTS.…”

mentioning

confidence: 99%

Statins for the prevention of post-thrombotic syndrome in patients with deep vein thrombosis Comment on San Norberto et al, p. 133 - 140

Stevenson

Gándara

2016

Vasa

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83Post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT) [1]. With a wide variety of presentations ranging from minor leg swelling to severe complications, such venous stasis ulcers, PTS can signifi cantly decrease quality of life [2]. Patients who have extensive DVT, recurrent ipsilateral thrombosis, a history of varicose veins, obesity, or residual thrombus are at an increased risk of developing PTS [1].The best therapeutic approach for the prevention of PTS remains a matter of debate [3,4]. Maintaining a therapeutic international normalized ratio (INR) with warfarin has been associated with lower chances of developing PTS. In patients with extensive DVT, randomized controlled trials have shown that the use of catheter directed lysis reduces the incidence of PTS [5,6]. Other research has suggested that extended treatment with low molecular weight heparin (LMWH) signifi cantly reduces the incidence of PTS and ulcers. In a systematic review of fi ve randomized trials in patients treated for DVT, LMWH (treatment duration for a minimum of three months) was associated with signifi cant increase in venous re-canalization (relative risk ratio 0.66; 95 % CI, 0.57 -0.77) and decrease in venous ulceration when compared with warfarin [7]. A recently published large randomized controlled trial showed no benefi t of graduated compression stockings for the prevention of PTS [8].Infl ammatory biomarkers such as interleukin-6, C-reactive protein (CRP), and intercellular adhesion molecule-1 may be used to predict the development of PTS [1]. In a recent cohort study, cHDL levels < 35 mg/dL and cLDL levels > than 180 mg/dL were risk factors for the development of recurrent thrombosis and PTS [9].In addition to a reduction in cholesterol and high-sensitivity CRP, current data suggests that statin therapy aff ects the coagulation cascade by inhibiting the activity of tissue factor and platelet activation by reducing the expression of circulating molecules, such as soluble CD40L or P-selectin [10]. In recent randomized controlled trials and metaanalysis, it has been suggested that statins reduce the incidence of fi rst occurrence venous thromboembolism [11,12]. Interestingly, statin therapy did not reduce the incidence of recurrent VTE in patients being treated for acute DVT or pulmonary embolism with oral anticoagulation [13].To date clinicians and researchers are still unclear as to whether or not statins can reduce the incidence of PTS. Recent data from animal models of VTE has suggested that statin therapy reduced the incidence of deep vein thrombosis induced vein wall scarring by 50 % [14]. In this issue of VASA-European Journal of Vascular Medicine, San Norberto and colleagues present the fi rst trial evaluating the use of statin therapy (rosuvastatin 10 mg (or 5 mg for patients > 70 years) for the prevention of PTS in patients treated for DVT [15]. In this trial, patients diagnosed with DVT were treated with three months of LMWH therapy and were randomized to receive rosuvastat...

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Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum

Abstract: Most data regarding early thrombus removal strategies are of low quality but do suggest patient-important benefits with respect to reducing postthrombotic morbidity. We anticipate revision of these guidelines as additional evidence becomes available.

Cited by 374 publications

References 100 publications

Pulmonary embolism and stroke associated with mechanical thrombectomy

Pulmonary embolism and stroke associated with mechanical thrombectomy

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

Statins for the prevention of post-thrombotic syndrome in patients with deep vein thrombosis Comment on San Norberto et al, p. 133 - 140

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