Endovascular Iliocaval Stent Reconstruction for Inferior Vena Cava Filter-Associated Iliocaval Thrombosis: Approach, Technical Success, Safety, and Two-Year Outcomes in 120 Patients

Jo, Alexandria; Meadows, J. Matthew; Abramowitz, Steven D.; Khaja, Minhajuddin S.; Cooper, Kyle

doi:10.1016/j.jvsv.2017.06.011

Cited by 13 publications

(25 citation statements)

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“…6,7 Endovascular therapy shows promising clinical outcomes to improve PTS-associated symptoms, including leg ulcers. [8][9][10][11] However, the risk of early stent thrombosis (ST) seems to be an important drawback, with a 1-year ST rate of up to 21%. 12 While anticoagulation therapy (AT) remains the corner stone for the management of acute DVT, with extended AT recommended for selected patients at high risk of venous thromboembolism (VTE) recurrence, 13,14 only the quality but not the duration of AT seems to have an impact on the PTS incidence.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome

et al. 2019

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Background Patients with postthrombotic syndrome (PTS) treated with stents are at risk of stent thrombosis (ST). The incidence of ST in the presence and absence of anticoagulation therapy (AT) is unknown. Risk factors are not well understood. Patients and Methods From the prospective Swiss Venous Stent registry, we conducted a subgroup analysis of 136 consecutive patients with PTS. Incidence of ST was estimated from duplex ultrasound or venography, and reported for the time on and off AT. Baseline, procedural, and follow-up data were evaluated to identify factors associated with ST. Results Median follow-up was 20 (interquartile range [IQR] 9–40) months. AT was stopped in 43 (32%) patients after 12 (IQR 6–14) months. Cumulative incidence of ST was 13.7% (95% confidence interval [CI] 7.8–19.6%) and 21.2% (95% CI 13.2–29.2%) during the first 6 and 36 months, respectively. The time-adjusted incidence rate was 11.2 (95% CI 7.7–16.2) events per 100 patient-years, 11.3 (95% CI 7.3–17.3) for the period on, and 11.2 (95% CI 5.3–23.6) for the period off AT. May–Thurner syndrome (MTS) was associated with decreased incidence of ST (hazard ratio [HR] 0.37, 95% CI 0.15–0.91), whereas age < 40 years (HR 2.26, 95% CI 1.03–4.94), stents below the common femoral vein (HR 3.03, 95% CI 1.28–7.19), and postthrombotic inflow veins (HR 2.92, 95% CI 1.36–6.25) were associated with increased incidence. Conclusion The 6-month incidence of ST was considerably high. Beyond 6 months, consecutive annual incidence rates persisted at 4.1 and 3.4% per year thereafter. Patients with higher incidence of ST were younger, had stents below the common femoral vein, postthrombotic leg inflow veins, and less often MTS. Incidence rates for the period on and off AT must be interpreted with caution. Clinical Trial Registration The study is registered on the National Institutes of Health Web site (ClinicalTrials.gov; identifier NCT02433054).

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Section: Introductionmentioning

confidence: 99%

Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome

et al. 2019

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“…Endovascular therapy has been associated with both ulcer healing and amelioration of venous claudication by restoring venous outflow. [87][88][89][90][91] For PTS patients with verified chronic venous occlusion, standard compression therapy and angioplasty with provisional stent placement are recommended for those with chronic occlusion of the inferior vena cava or iliac veins who are at risk for venous leg ulcers. 92 Endovascular therapy has a high technical success and low complication rate.…”

Section: Advanced Treatment Options In Ptsmentioning

confidence: 99%

How to Differentiate Recurrent Deep Vein Thrombosis from Postthrombotic Syndrome

2020

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Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Accuracy of diagnosis is thus of vital importance. Failure to diagnose VTE increases the risk of progression and complications. Conversely, anticoagulation as a result of an incorrect diagnosis exposes patients to the associated hazards of bleeding. The diagnostic management of recurrent deep vein thrombosis (DVT) and postthrombotic syndrome (PTS) is especially challenging due to the lack of well-established diagnostic standards. Particularly, the differentiation between the two is notoriously difficult as symptoms, clinical signs, and diagnostic test findings largely overlap. This review highlights the current diagnostic and management strategies for recurrent DVT and PTS with a focus on clinical findings and imaging modalities. We also discuss current open questions for clinicians in the field, anticipating future directions and predictions for the year 2050.

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“…The indications for endovascular iliocaval recanalization and reconstruction include deep venous occlusion secondary to recurrent DVT, severe PTS, and caval thrombosis leading to significant lifestyle limitations. 11 Acute thrombus is generally defined as those aged less than 2 weeks, while chronic thrombus is defined as being present for more than 4 weeks. Endovascular iliocaval reconstruction may be performed with both acute and chronic thrombosis; however, the indications and techniques for recanalization of acute iliocaval thrombosis differ from those used for chronic thrombosis.…”

Section: Indicationsmentioning

confidence: 99%

“…For this technique, the operator uses a guidewire and catheter to probe through the occlusion until the catheter reaches a patent segment. 11,12,21 Once the occlusion is crossed, through-and-through access may be obtained by capturing an exchange-length wire placed through the catheter with a loop snare device placed from another access site. Throughand-through wire access establishes a rigid rail that may be tightened from both ends to accomplish delivery of catheters, balloons, and stents across the obstructed veins, especially the recalcitrant segments.…”

Section: Recanalizationmentioning

confidence: 99%

“…Some authors opine the use of baby aspirin (81 mg) daily, clopidogrel 75 mg daily, and enoxaparin 1 mg/kg twice daily prior to discharge. 2,5,6,11,22,47 Enoxaparin is preferred for its rapid onset, reliable anticoagulation (unlike warfarin), and potential anti-inflammatory action. Some authors, on the other hand, use anticoagulants only during the acute phase within 6 months of a diagnosed venous thromboembolism or known thrombophilia.…”

Section: Postprocedural Carementioning

confidence: 99%

See 1 more Smart Citation

Endovascular Therapy for Lower Extremity Chronic Deep Venous Occlusive Disease: State of Practice

Wadhwa

Srinivasa

Cooper

et al. 2018

Semin intervent Radiol

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Endovascular Iliocaval Stent Reconstruction for Inferior Vena Cava Filter-Associated Iliocaval Thrombosis: Approach, Technical Success, Safety, and Two-Year Outcomes in 120 Patients

Cited by 13 publications

References 0 publications

Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome

Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome

How to Differentiate Recurrent Deep Vein Thrombosis from Postthrombotic Syndrome

Endovascular Therapy for Lower Extremity Chronic Deep Venous Occlusive Disease: State of Practice

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