Management of Cavoatrial Deep Venous Thrombosis: Incorporating New Strategies

Zayed, Mohamed A.; Silva, Gayan S. De; Ramaswamy, R.; Sánchez, Luis A.

doi:10.1055/s-0036-1597761

Cited by 7 publications

(5 citation statements)

References 56 publications

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“…20 Treatment of catheterassociated cavo-atrial thrombus also carries a high mortality of approximately 16% and 13% when treated with anticoagulation and surgical management, respectively. 7 Our operative mortality for these patients was significantly lower at 1.7%. The next largest series reported a 0%…”

Section: Preoperative Characteristicsmentioning

confidence: 63%

“…6 Cavo-atrial thrombus is also a major public health problem with a complicated patient population. 7 However, treatment for both of these entities is not well-defined. American Heart Association guidelines currently have a class IIB level of evidence to operate on right-sided endocarditis in their outline in the management of valvular heart disease.…”

Section: Introductionmentioning

confidence: 99%

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Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Newman¹,

Patel

Keeling

et al. 2020

J Card Surg

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Purpose Despite paucity of data, there exists growing popularity of catheter‐based extraction methods for intravascular thrombi and vegetations. We describe a large single center experience with vacuum‐assisted extraction techniques (VAET) for right‐sided intravascular and cardiac masses. Methods We retrospectively reviewed the perioperative course of patients undergoing VAET between 2014 and 2019. Primary outcomes were survival and freedom from recurrent bacteremia. Procedural success was a composite definition of survival, majority of mass extraction, absence of recurrent bacteremia, and valve function not requiring further intervention during index hospitalization. Results Of the entire cohort (n = 58), 48% and 52% underwent VAET for vegetations and sterile thrombi, respectively. Of those with positive cultures, the most common organism isolated was Staphylococcus aureus (48%). Preoperative active bacteremia was present in 36% (21/58) and of these patients, 76% (16/21) had neither recurrent nor persistent bacteremia post‐op. The majority of masses (67%, 38/58) were debulked with an average reduction in size of 42%. Conversion to open surgery occurred in 3.5% (2/58). Intraoperative and 30‐day survival were 98% (57/58) and 90% (28/31), respectively. Overall success was 86% (50/58). The prevalence of moderate/severe tricuspid regurgitation was 37% pre‐op and 61% post‐op. Average length of intensive care unit and overall hospital stay was 5.6 and 16 days, respectively. Conclusions In this single center experience, VAET was conducted safely with a high degree of success and freedom from short‐term recurrent bacteremia. This minimally invasive procedure is an attractive alternative to traditional open techniques for removal of right‐sided intravascular and cardiac masses.

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Section: Preoperative Characteristicsmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Newman¹,

Patel

Keeling

et al. 2020

J Card Surg

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show abstract

“…At present, the methods to prevent deep venous thrombosis mostly take drugs or physical methods to reduce the viscosity of blood and promote the blood circulation of lower limbs. However, it is difficult to control the dosage of drug prevention, which is easy to cause postoperative bleeding [ 4 , 5 ]. Various physical prevention methods, including postoperative massage and electrical stimulation of calf muscles, are sometimes difficult to achieve the expected effect due to difficult control and large individual differences.…”

Section: Introductionmentioning

confidence: 99%

Influences of Antithrombotic Elastic Socks Combined with Air Pressure in Reducing Lower Extremity Deep Venous Thrombosis for Patients Undergoing Cardiothoracic Surgery

Zhang

Sun

et al. 2022

Computational and Mathematical Methods in Medicine

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This study was designed to investigate the application and therapeutic effect of antithrombotic elastic socks combined with air pressure in the prevention of lower extremity deep venous thrombosis in patients undergoing cardiothoracic surgery. Sixty patients in cardiothoracic surgery of our hospital from January 2019 to December 2020 were randomly divided into a study group and control group. The control group was treated with routine treatment intervention. Based on routine treatment intervention, the study group was treated with antithrombotic elastic socks combined with pneumatic treatment intervention. The activated partial thromboplastin time (APTT), thrombin time (TT), femoral venous blood flow velocity of both lower limbs, and the incidence of lower extremity deep venous thrombosis (LEDVT), postoperative lower extremity swelling, inflammatory factors, and satisfaction were measured. After intervention, APTT ( 31.74 ± 1.15 s) and TT ( 14.58 ± 0.24 s) in the study group were higher than those in the control group APTT ( 25.13 ± 1.14 s) and TT ( 12.14 ± 0.23 s) ( P < 0.05 ). The left lower limb femoral vein blood flow velocity and the right lower limb femoral vein blood flow velocity in the study group were better than those in the control group ( P < 0.05 ). The incidence of postoperative lower limb swelling and deep vein in the study group was lower than that in the control group ( P < 0.05 ). Serum tumor necrosis factor alpha and interleukin-6 concentrations in the study group were lower than those in the control group ( P < 0.05 ). The satisfaction rate of patients in the study group (93.33%) was significantly higher than that in the control group (70.00%) ( P < 0.05 ). In conclusion, after cardiothoracic surgery, antithrombotic elastic socks combined with air pressure can significantly reduce the incidence of LEDVT by improving patients’ coagulation function, reducing inflammatory reaction. It is worthy of popularization and application in relevant surgery.

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“…Over the longer term, patients who sustain large-volume DVT are at high risk of developing post thrombotic syndrome (PTS), which is a condition characterized by chronic leg pain, edema, discoloration, and skin ulceration [10]. PTS results from valvular incompetence or residual chronic venous out ow obstructions, and is associated with signi cant morbidity and disability [11]. As such, DVT can be life-threatening in the acute setting, and debilitating in the chronic setting.…”

Section: Introductionmentioning

confidence: 99%

In Vivo Porcine Model of Acute Iliocaval Deep Vein Thrombosis

Roberts,

Zaghloul,

Ismail

et al. 2024

J Endovasc Ther

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Acute deep vein thrombosis (DVT) is a potentially life-threatening condition in which blood clots form in the venous system. Recently, a number of endovascular thrombectomy devices have been introduced to treat acute DVT. Given their varied efficacy and safety profiles, a clear need exists for further device innovation and enhancement. However, a major limitation in the testing, verification, and validation of new thrombectomy devices is a clinically representative large animal model of acute DVT. Unfortunately, existing approaches to creating DVT in porcine models are time-consuming, technically challenging, and yield inconsistent results. We therefore developed a rapid, technically straightforward, and reproducible protocol for induction of large-volume iliocaval DVTs in a living porcine host. This approach involves sequestering the iliocaval venous segment with standard balloon occlusion catheters, and a controlled limited infusion of a 25% ethanol solution within the sequestered static segment. We observed that this method was safe, technically straightforward, and reproducible in producing large-volume acute DVTs. We believe that this technique can be utilized as a standardized DVT model in the testing of future endovascular venous thrombectomy devices. Clinical Impact The study establishes a rapid, technically straightforward, and reproducible porcine large animal model for acute iliocaval deep vein thrombosis (DVT). The procedure can be performed with basic endovascular skillsets. With its procedural efficiency and consistency, the platform is promising for comparative in vivo testing of venous thrombectomy devices in a living host, and for future verification and validation studies to determine efficacy of novel thrombectomy devices relative to predicates.

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Management of Cavoatrial Deep Venous Thrombosis: Incorporating New Strategies

Cited by 7 publications

References 56 publications

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Influences of Antithrombotic Elastic Socks Combined with Air Pressure in Reducing Lower Extremity Deep Venous Thrombosis for Patients Undergoing Cardiothoracic Surgery

In Vivo Porcine Model of Acute Iliocaval Deep Vein Thrombosis

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