PP89. Treatment of Acute Iliofemoral Deep Vein Thrombosis: A Systematic Review and Meta-analysis

Abstract

Background: Intravenous Leiomyomatosis(IVL)is a rare, histological benign but biological behavior malignant tumor. Literature reports on IVL are less than 200 cases, and most majority of them are individual reports.Methods: Six patients with intravenous leiomyomatosis involved in the cava inferior vena were analyzed.Results: Three patients received one-stage operation and two received two-stage operation. All the operations were successful. No perioperative death or other complications were observed. Among the six patients, primary tumor and intravenous tumor embolus were completely resected from four patients. Residual tumor was remained in one patient who had serious adherence due to multiple operations. However, with the anti-estrogen therapy, the residual tumor had significantly regressed. All the patients had tumor relapse after the operation.Conclusion: We believe that IVL is group of disease and not a single disease entity. Although IVL is extremely rare, vascular surgeon must pay more attention to this disease. There are many therapeutic methods to choose from when uterine leiomyomatosis involves the cava inferior vena, among which operation is the best choice. Anti-estrogen therapy seems to be justified in patients with ER(ϩ) and PR(ϩ).

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

“…Overall, the quality of evidence supporting early thrombus removal strategies is very low (Grade C) because of the methodologic limitations of the relevant studies (lack of randomization, incomparability of study groups, loss to follow-up), imprecise estimates of effects, and indirectness of the evidence. 19 However, the available evidence does suggest that early thrombus removal strategies for iliofemoral venous thrombosis are associated with significant reductions in manifestations of the postthrombotic syndrome as well as improvements in the surrogate markers of valvular incompetence (reflux) and persistent venous obstruction. 19 Competing risks include those associated with surgery (surgical thrombectomy) and bleeding (thrombolytic strategies).…”

“…19 However, the available evidence does suggest that early thrombus removal strategies for iliofemoral venous thrombosis are associated with significant reductions in manifestations of the postthrombotic syndrome as well as improvements in the surrogate markers of valvular incompetence (reflux) and persistent venous obstruction. 19 Competing risks include those associated with surgery (surgical thrombectomy) and bleeding (thrombolytic strategies). Systematic review of comparative studies suggests that adverse events are poorly reported overall 19 and that caution is warranted in ensuring patients are appropriately selected.…”

“…Nevertheless, recent data suggest that strategies of early thrombus removal do indeed have a role in the management of acute DVT. 18,19 The Society for Vascular Surgery (SVS) and American Venous Forum (AVF) formed a committee of experts in venous disease to develop evidence-based clinical practice guidelines regarding strategies of early thrombus removal for acute DVT. The committee commissioned the conduct of a systematic review and meta-analysis of the relevant literature to inform their recommendations.…”

“…In contrast to previously published systematic reviews, 20 this review was confined to patients with iliofemoral DVT and excluded systemic and locoregional thrombolytic infusion (eg, pedal vein infusion 14 ) while including surgical thrombectomy. The results of this systematic review, 19 published separately in this issue of the Journal of Vascular Surgery, forms the basis of these practice guidelines. When necessary, as for pharmacomechanical thrombolysis and inferior vena cava (IVC) filtration, this review was supplemented by less rigorous data, including those from pooled analyses and case series.…”

“…A systematic process 25 was followed whereby initial guidelines were drafted and submitted, together with the systematic review, 19 to each panel member for comment. Comments were incorporated into the guidelines and resubmitted to the panel members for further revision or acceptance.…”