Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis

Vedantham, Suresh; Desai, Kush; Weinberg, Ido; Marston, William A.; Winokur, Ronald S.; Patel, Sheena; Kolli, K.; Azene, Ezana M.; Nelson, Kari

doi:10.1016/j.jvir.2022.10.038

Cited by 29 publications

(15 citation statements)

References 111 publications

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“…29 The consensus rejected stent placement for isolated femoral, popliteal, or calf vein involvement, aligning with the European Society of Vascular Surgery and Society of Interventional Radiology guidelines. 28,30 The unanimous agreement against stent placement in children mirrored the existing recommendations. 28 The importance of IVUS for stent assessment reached a consensus.…”

Section: Discussionmentioning

confidence: 84%

“…Limited evidence on stent usage contributes to the challenge of consensus building, aligning with the scarcity of specific recommendations in clinical practice guidelines, except those from the Society of Interventional Radiology. 14,28 In acute DVT with iliac vein compression, severe symptoms, and a preserved functional state, the experts recommended to consider stenting. Similar to the Society of Interventional Radiology guidelines, they suggested stent placement after thrombolysis, emphasizing the need for patient discussion regarding long-term risks.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to the Society of Interventional Radiology guidelines, they suggested stent placement after thrombolysis, emphasizing the need for patient discussion regarding long-term risks. 28 Conversely, some guidelines prioritize anticoagulation therapy over intervention for acute thrombosis. 8 For chronic DVT with iliac vein involvement and moderate-to-severe PTS, our experts aligned with the European Society of Cardiology recommendations.…”

Section: Discussionmentioning

confidence: 99%

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Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis

Trujillo-Santos,

Demelo-Rodríguez,

Bravo de Laguna-Taboada

et al. 2024

Semin Thromb Hemost

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Introduction Deep vein thrombosis (DVT) poses a complex challenge and often leads to postthrombotic syndrome (PTS), a debilitating complication. The emergence of venous stents offers a potential preventive avenue against this complication. This study aimed to provide consensus recommendations on the use of venous stent for DVT. Materials and Methods From June to July 2023, 20 internal medicine, angiology and vascular surgery, and vascular and interventional radiology experts were involved in the Delphi process. Thirty-one recommendations, categorized into three thematic areas, were rigorously evaluated: indications for stent use, stent selection and placement, and monitoring and prevention of complications. Agreement was evaluated using a Likert scale, with consensus defined as agreement by two-thirds of the participants. Results Consensus was reached for 23 (74.2%) of 31 recommendations. The agreement was centered on considerations, such as stent placement in specific acute DVT scenarios, emphasizing pivotal stent characteristics. However, there were divergences in the recommended stent length to prevent migration and stent characteristics based on iliocaval bifurcation morphology. Notably, there was no consensus on whether patients with DVT caused by a major transient risk factor need more than 3 months of anticoagulation therapy or whether aspirin should be added to anticoagulant treatment after venous stenting. Conclusions These consensus recommendations offer practical insights into optimizing venous stent use to prevent PTS in DVT patients. Addressing the critical aspects of stent selection, placement, and postprocedural care, these recommendations contribute to clinical decision-making. The identified divergences underscore the importance of consensus and thus indicate the need for further investigation.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis

Trujillo-Santos,

Demelo-Rodríguez,

Bravo de Laguna-Taboada

et al. 2024

Semin Thromb Hemost

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“…1,17 Based on these analyses, which suggested that at least some outcomes of endovascular intervention may differ between patients with iliofemoral DVT versus isolated femoral-popliteal DVT, this key anatomic distinction has been incorporated into contemporary clinical practice guidelines. [82][83][84][85][86] Investigators of future thrombectomy studies should present the baseline anatomic extent of DVT using these definitions and may be well advised to focus on patients with acute iliofemoral DVT since they are at higher risk for adverse outcomes and have shown greater potential to benefit from endovascular intervention than patients with less extensive DVT. 81,87,88 Fourth, in patients with acute iliofemoral DVT in the ATTRACT trial, endovascular thrombus removal led to greater early (within 1 month) DVT symptom resolution, reduced PTS severity through 6 months, and venous QOL benefits that were most pronounced during the first 6 months of follow-up, compared with standard therapy alone.…”

Section: Mt For Acute Dvtmentioning

confidence: 99%

Section: Mt For Acute Dvtmentioning

confidence: 99%

Delphi Consensus on Reporting Standards in Clinical Studies for Endovascular Treatment of Acute Iliofemoral Venous Thrombosis and Chronic Iliofemoral Venous Obstruction

Vedantham

Gloviczki

Carman

et al. 2023

Circ: Cardiovascular Interventions

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Acute iliofemoral deep vein thrombosis and chronic iliofemoral venous obstruction cause substantial patient harm and are increasingly managed with endovascular venous interventions, including percutaneous mechanical thrombectomy and stent placement. However, studies of these treatment elements have not been designed and reported with sufficient rigor to support confident conclusions about their clinical utility. In this project, the Trustworthy consensus-based statement approach was utilized to develop, via a structured process, consensus-based statements to guide future investigators of venous interventions. Thirty statements were drafted to encompass major topics relevant to venous study description and design, safety outcome assessment, efficacy outcome assessment, and topics specific to evaluating percutaneous venous thrombectomy and stent placement. Using modified Delphi techniques for consensus achievement, a panel of physician experts in vascular disease voted on the statements and succeeded in reaching the predefined threshold of >80% consensus (agreement or strong agreement) on all 30 statements. It is hoped that the guidance from these statements will improve standardization, objectivity, and patient-centered relevance in the reporting of clinical outcomes of endovascular interventions for acute iliofemoral deep venous thrombosis and chronic iliofemoral venous obstruction in clinical studies and thereby enhance venous patient care.

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Selective iliofemoral stent placement for complex pediatric cases: a decade of institutional experience

Karim,

Gayou,

Gross

et al. 2024

Pediatr Radiol

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Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis

Cited by 29 publications

References 111 publications

Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis

Optimizing Venous Stenting: Consensus Recommendations for Enhanced Management of Lower Extremity Deep Vein Thrombosis

Delphi Consensus on Reporting Standards in Clinical Studies for Endovascular Treatment of Acute Iliofemoral Venous Thrombosis and Chronic Iliofemoral Venous Obstruction

Selective iliofemoral stent placement for complex pediatric cases: a decade of institutional experience

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