Endovascular Treatment in Postthrombotic Syndrome

Wahlgren, Carl‐Magnus; Wahlberg, Eric; Olofsson, Pär

doi:10.1177/1538574410369710

Cited by 46 publications

(30 citation statements)

References 8 publications

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“…Technical success rates of venous stenting are very high with approximately 84-93 % in chronic postthrombotic iliac vein obstruction [29,45]. Technical success rates decrease to 66 % in postthrombotic lesions with total occlusion of the IVC [46].…”

Section: Effectivenessmentioning

confidence: 99%

CIRSE Standards of Practice Guidelines on Iliocaval Stenting

Mahnken

Thomson

Haan

et al. 2014

Cardiovasc Intervent Radiol

109

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Chronic venous insufficiency (CVI) as an advanced stage of chronic venous disease is a common problem that occurs in approximately 1-5 % of the adult population. CVI has either a nonthrombotic (primary) or postthrombotic (secondary) cause involving reflux, obstruction, or a combination of both. The role of venous obstruction is increasingly recognized as a major cause of CVI, with obstructive lesions in the iliocaval segment being markedly more relevant than lesions at the levels of the crural and femoral veins. Approximately 70-80 % of iliac veins develop a variable degree of obstruction fol-

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Section: Effectivenessmentioning

confidence: 99%

CIRSE Standards of Practice Guidelines on Iliocaval Stenting

Mahnken

Thomson

Haan

et al. 2014

Cardiovasc Intervent Radiol

109

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“…After screening 793 studies for eligibility, 37 studies reporting 45 treatment effects (nonthrombotic, [12][13][14][15][16][17][18][19] AT, 13,18,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and CPT 12,14,17,30,33,34,[37][38][39][40][41][42][43][44][45][46][47][48] ) from 2869 unique patients (nonthrombotic, 1122; AT, 629; and CPT, 1118) were included in the meta-analysis. The most common reasons for study exclusion were lack of relevant stent placement outcomes (19 studies), kin relationships (18 studies), sample size <10 (16 studies), combined outcome reporting in nonthrombotic and thrombotic patients (8 studies), and combined outcome reporting in AT and CPT patients (6 studies).…”

Section: Study Selectionmentioning

confidence: 99%

Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction

Razavi

Jaff

Miller

2015

Circ: Cardiovascular Interventions

221

117

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Background-Endovenous recanalization of iliofemoral stenosis or occlusion with angioplasty and stent placement has been increasingly used to maintain long-term venous patency in patients with iliofemoral venous outflow obstruction. The purpose of this systematic review and meta-analysis was to determine safety and effectiveness of venous stent placement in patients with iliofemoral venous outflow obstruction. Methods and Results-We searched MEDLINE and EMBASE for studies evaluating safety or effectiveness of stent placement in patients with iliofemoral venous outflow obstruction. Data were extracted by disease pathogenesis: nonthrombotic, acute thrombotic, or chronic post-thrombotic. Main outcomes included technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years. A total of 37 studies reporting 45 treatment effects (nonthrombotic, 8; acute thrombotic, 19; and chronic post-thrombotic, 18) from 2869 patients (nonthrombotic, 1122; acute thrombotic, 629; and chronic post-thrombotic, 1118) were included. Technical success rates were comparable among groups, ranging from 94% to 96%. Complication rates ranged from 0.3% to 1.1% among groups for major bleeding, from 0.2% to 0.9% for pulmonary embolism, from 0.1% to 0.7% for periprocedural mortality, and from 1.0% to 6.8% for early thrombosis. Patient symptom relief data were reported inconsistently. At 1 year, primary and secondary patency were 96% and 99% for nonthrombotic, 87% and 89% for acute thrombotic, and 79% and 94% for chronic post-thrombotic. Conclusions-Stent Methods Literature SearchThis study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. 9 We searched MEDLINE and EMBASE for randomized or nonrandomized controlled studies and prospective or retrospective case series of stent placement for treatment of iliofemoral venous outflow obstruction by using a combination of relevant keywords. The details of the MEDLINE search strategy are listed in Table I in the Data Supplement. The syntax for EMBASE was similar, but adapted as necessary. In addition, manual searches were conducted using the Directory of Open Access Journals, Google Scholar, and the reference lists of included papers and relevant meta-analyses. No date restrictions were applied to the searches. The final search was conducted March 15, 2015. Study SelectionTwo researchers independently selected studies for inclusion in the review. Disagreements were resolved by consensus. Titles and abstracts were initially screened to exclude review articles, commentaries, letters, case reports, and obviously irrelevant studies. Full texts of the remaining articles were retrieved and reviewed. Main inclusion criteria included studies with (1) primary diagnosis of obstructive lesions of the common femoral vein, external iliac vein, and the common iliac vein, (2) stent placement in the common femoral vein, external iliac vein, common iliac vein, and the inferior vena cava, (3) outcomes reporte...

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“…Furthermore, it is important to point out that the performers' degree of experience is elementary for a successful recanalization and a long-term patency rate, especially when treating complex cases such as these, requiring stenting of the iliocaval confl uence as in our second case [15,16]. Beside possible re-stenosis and persistence of symptoms, invasive treatment harbours a low risk of major bleeding from 0.3 -1.1 %, vessel perforation, compartment syndrome, pulmonary embolism from 0.2 % -0.9 %, periprocedural mortality from 0.1 % -0.7 %, stent fracture, and stent dislocation as well as early thrombosis from 1.0 % -6.8 % [3,11,14,17,18]. In addition, it is important to note that the radiation exposure increases with the complexity of the intervention, particularly in young patients undergoing interventions of the inferior vena cava plus both iliac veins, radiation exposures needs to be considered.…”

Section: Discussionmentioning

confidence: 69%

Complex interventional iliocaval recanalization due to plasmacytoma and cystic echinococcosis

Stoll

Kucher

Vogel

et al. 2017

Vasa

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Summary: Post-thrombotic syndrome is common after iliofemoral vein thrombosis. Conservative therapy, mainly limited to compression and anticoagulation therapy, might not be suffi cient in controlling symptoms. Interventional recanalization of the chronically occluded iliac veins is an evolving method, promising rapid relief of symptoms. Here, we present two cases of complex interventions in one patient with preceding pelvic radiotherapy due to a plasmacytoma and in another patient in whom a cava wedge resection had been performed because of cystic echinococcosis in the liver.

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Endovascular Treatment in Postthrombotic Syndrome

Abstract: Endovascular treatment of chronic postthrombotic femoroiliocaval venous disease is a safe technique that can be performed with acceptable patency rates in this challenging patient population.

Cited by 46 publications

References 8 publications

CIRSE Standards of Practice Guidelines on Iliocaval Stenting

CIRSE Standards of Practice Guidelines on Iliocaval Stenting

Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction

Complex interventional iliocaval recanalization due to plasmacytoma and cystic echinococcosis

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