Acute Venous Iliofemoral Thrombosis: Early Surgical Thrombectomy Is Effective and Durable

Ockert, S.; Allmen, Matthias von; Heidemann, Michaela; Brusa, J.; Duwe, Jan; Seelos, Robert

doi:10.1016/j.avsg.2017.07.003

Cited by 9 publications

(4 citation statements)

References 29 publications

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“…Therefore we are unable to make use of a statistical compensation for the lost to follow-up patients. Nevertheless, comparable studies in the last years had a smaller number of patients [1,13,15,17]. Nearly the half of our treated patients had reflux in the deep venous system.…”

Section: Discussionmentioning

confidence: 83%

“…Thus, a subgroup analysis of this study shows a benefit in the reduction of severe PTS for the use of pharmacomechanical catheter-directed thrombolysis, limited to patients with an iliofemoral DVT [11]. However, there have been demonstrated good results for surgical thrombectomy of iliofemoral DVT in terms of prevention of PTS as well [1,8,[12][13][14][15][16][17]. Even though duplex ultrasound mapping is the gold standard in the diagnosis of venous diseases including PTS [18], other noninvasive diagnostic methods e.g.…”

Section: Introductionmentioning

confidence: 99%

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Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

et al. 2020

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Introduction Deep vein thrombosis (DVT) is a frequent burden and a post-thrombotic syndrome (PTS) can be a serious long-term consequence. Iliofemoral DVT should be associated with severe forms of PTS. Therefore an early thrombus removal has been recommended in specific conditions. The aim of this study was to find out both, the long-term results after surgical thrombectomy of iliofemoral DVT in respect of the development of PTS as well as the venous hemodynamics after surgery concerning venous reflux and venous obstruction. Methods Sixty-seven patients who underwent surgical thrombectomy between the years 2000 and 2014 were included in this study; iliofemoral DVT was present in 52 of these patients. 35 patients could be reinvestigated after a mean follow-up of 8.5 years. CEAP (Clinical-Etiological-Anatomical-Pathophysiological) and Villalta scores were recorded in order to describe and assess PTS. Follow-up examinations included a detailed duplex mapping. Venous hemodynamics were measured by digital photoplethysmography and venous occlusion plethysmography. Results The primary patency rate of the iliofemoral segment was 88% after 8.5 years. 48% of all patients showed reflux in deep vein segments. Mild or moderate PTS occurred in 57% of all patients. Notably, there was no patient with an active ulcer or severe PTS. The mean venous outflow volume of all patients in the treated legs was 66.1 ml/100ml/min and significantly less than in the controlled contralateral non-treated legs (p<0.05). The mean venous

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

et al. 2020

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“…Among them are endovascular or surgical thrombectomy or catheter-directed thrombolysis. 2,3…”

Section: Introductionmentioning

confidence: 99%

Inferior vena cava filters utilization in patients with venous thromboembolism: Analysis of a database of a tertiary hospital

et al. 2020

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Purpose The aim of the study was to assess the inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE) in tertiary care. Methods We performed a retrospective analysis of database of a tertiary hospital in 2016–2017. All the records of patients admitted for VTE or diagnosed with VTE being hospitalized for other reasons were extracted. The data collected were number of patients, who received IVCF, indications to filter insertion, PE and death rate after procedure, frequency of IVCF occlusion. Results 2399 patients with VTE were admitted to hospital. 442 (18,4%) of them received IVCF (239 in 2016 and 203 in 2017). Retrievable models were used in most cases (98,8%). In 119 (5,0%) patients cava filters were used due to contraindications for anticoagulation, while in 184 (7,7%) patients’ anticoagulation was not effective and thrombosis progression was registered. 101 (4,2%) patients received IVCF due to high PE risk (length of floating thrombus ≥7 cm, in proximal location), high pulmonary hypertension was indication to IVCF insertion in 38 (1,6%) patients with deep vein thrombosis (DVT) in combination with pulmonary embolism (PE). Overall mortality rate after IVCF insertion was 5 (0,2%). No fatal PE was registered. IVCF occlusion during hospitalization occurred in 116 (4,8%) cases. Only 29 (1,2%) of patients were admitted back for IVCF removal. Conclusions Every one in five patients with proximal DVT and/or PE receives IVCF in a routine practice in tertiary hospital. The most common indications for IVCF implantation were inability for anticoagulation or anticoagulation failure. Removal rate of retrievable cava filters is low.

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“…Vedantham and colleagues 4 revealed that the clotremoval rate with PMT was 82%, compared with 26% for surgical thrombectomy alone. Ockert and associates 10 reported a primary technical success rate of 100% with surgical thrombectomy and concluded that cardiovascular surgeons should include it in their repertoire. Pharmacomechanical thrombectomy is most beneficial in young, functionally active patients who have extensive and proximal thrombus and who present with acute DVT (<14 d) or with PCD.…”

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confidence: 99%

Surgical Intervention for Phlegmasia Cerulea Dolens in a 61-Year-Old Cancer Patient

Ruben-Castillo

Cuen-Ojeda

López-Peña

et al. 2022

Texas Heart Institute Journal

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Phlegmasia cerulea dolens, a rare and potentially fatal complication of acute deep vein thrombosis, is characterized by substantial edema, intense pain, and cyanosis. Phlegmasia cerulea dolens may compromise limb perfusion and lead to acute ischemia, gangrene, amputation, and death. We present the case of a 61-year-old woman with a history of breast cancer who had signs and symptoms of phlegmasia cerulea dolens in her left leg. She was treated promptly with open surgical thrombectomy and sequential distal compression with use of an Esmarch bandage to ensure complete thrombus extraction. These techniques restored venous flow and saved her leg. Open surgical thrombectomy should be considered in the presence of limb-threatening acute deep vein thrombosis presenting as phlegmasia cerulea dolens.

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Acute Venous Iliofemoral Thrombosis: Early Surgical Thrombectomy Is Effective and Durable

Cited by 9 publications

References 29 publications

Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years

Inferior vena cava filters utilization in patients with venous thromboembolism: Analysis of a database of a tertiary hospital

Surgical Intervention for Phlegmasia Cerulea Dolens in a 61-Year-Old Cancer Patient

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