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Iliofemoral venous obstruction

Tzu-Ting Kuo, Chun-Yang Huang, Chiao-Po Hsu, Chiu-Yang Lee
BACKGROUND: Aggressive and early thrombus removal strategy has been widely used as a treatment for iliofemoral deep vein thrombosis (DVT). We compared the long-tem venous outcome, including postthrombotic syndrome (PTS), in patients undergoing catheter-directed thrombolysis (CDT) and pharmacomechanical thrombectomy (PMT). METHODS: From January 2009 to December 2013, 61 patients with acute proximal DVT were enrolled in this prospective study. Thirty-one patients underwent CDT and 30 patients underwent PMT, and each patient was followed for at least 2 years after treatment...
February 2017: Journal of the Chinese Medical Association: JCMA
Tzu-Yao Liao, Hui-Ching Hsu, Min-Sheng Wen, Yu-Hsiang Juan, Yu-Hsin Hung, Chuang-Chi Liaw
BACKGROUND: To study iliofemoral venous thrombosis related to iliofemoral venous obstruction in cancer patients. METHODS: In this case series study, 829 cancer patients were surveyed for iliofemoral obstruction/thrombosis within 10 years. The criteria for inclusion were: (1) presence of unilateral lower-extremity swelling; (2) computed tomography (CT) scans showing a tumor with external compression of the iliac or femoral vein, and (3) duplex ultrasound scans showing venous thrombosis or venous flow insufficiency over a femoral vein or saphenous vein...
September 2016: Case Reports in Oncology
Himanshu Verma, Ramesh K Tripathi
Post-thrombotic syndrome secondary to iliofemoral deep venous thrombosis is a significant contributor to advanced chronic venous insufficiency. Iliac vein stenting is a standard procedure to treat iliocaval obstruction. In cases with obstruction extending across the groin, venous inflow for an iliac vein stent may be poor and compromise results of iliac vein stenting. Treatment options include extension of stents across the inguinal ligament that may have limitations in improving inflow only from only one vessel...
January 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Michael K W Lichtenberg, Houman Jalaie
Deep vein thrombosis (DVT) is associated with a high cost burden for health care systems because of secondary cost intensive complications like pulmonary embolism and especially the post thrombotic syndrome (PTS). The current standard therapy of anticoagulation for DVT therapy has not changed through the years leaving patients especially with iliofemoral vein thrombus on a high-risk situation for developing PTS. Current study situation for endovascular treatment of iliofemoral DVT treatment gives a rationale for active thrombus removal using catheter directed therapy (CDT) or pharmacomechanical thrombectomy (PMT) which improves valvular vein function and luminal patency reducing the potential complication of PTS...
November 2016: Deutsche Medizinische Wochenschrift
C R Lattimer, E Mendoza
OBJECTIVES: Without gravity opposing drainage, most venous diseases would not exist. Therefore, manoeuvres that assess venous function should include gravity. The aim was to "dose" gravity in subjects using static positions and dynamic angulations on a tilt-table and to assess its effects with air plethysmography (APG) and duplex ultrasound over the femoral vein. METHODS: Three groups (providing n = 11 legs each) were compared. (a) A control group, without clinical or duplex evidence of venous disease...
December 2016: European Journal of Vascular and Endovascular Surgery
Vladimir Y I G Tichelaar, Ellen E Brodin, Anders Vik, Trond Isaksen, Finn Egil Skjeldestad, Satish Kumar, Nora C Trasti, Kulbir Singh, John-Bjarne Hansen
BACKGROUND: Recent studies have suggested that catheter-directed thrombolysis (CDT) reduces development of post-thrombotic syndrome (PTS). Ultrasound-assisted CDT (USCDT) might enhance the efficiency of thrombolysis. We aimed to compare USCDT with CDT on efficacy, safety, development of PTS, and quality of life after long-term follow-up. METHODS: We describe a retrospective case series of 94 consecutive patients admitted with iliofemoral or more proximal deep vein thrombosis (DVT) to the University Hospital from 2002 to 2011, treated either with CDT or USCDT...
August 2016: Cardiovascular and Interventional Radiology
Nadeem A Siddiqui, Ziad Sophie, Farhan Zafar, Delvene Soares, Iram Naz
Introduction Post-thrombotic syndrome is a common and debilitating sequelae of lower limb deep venous thrombosis. Very little awareness is present about the risk factors and about the diagnosis, prevention, and treatment of this condition. Objective The objective of this study is to identify the predictors of post-thrombotic syndrome after lower limb deep venous thrombosis. Materials and methods A case-control study was conducted on all adult patients who were admitted with lower limb deep venous thrombosis at our institution from January 2005 to June 2012...
February 2017: Vascular
R L M Kurstjens, M A F de Wolf, H W Konijn, I M Toonder, P J Nelemans, R de Graaf, C H A Wittens
UNLABELLED: Essentials Little is known about the hemodynamic consequences of deep venous obstructive disease. We investigated pressure changes in 22 patients with unilateral postthrombotic obstruction. Common femoral vein pressure significantly increased after walking, compared to control limbs. Common femoral vein hypertension could explain the debilitating effect of venous claudication. Click to hear Dr Ten Cate's perspective on postthrombotic syndrome SUMMARY: Background Little is known about the hemodynamic consequences of deep venous obstructive disease...
June 2016: Journal of Thrombosis and Haemostasis: JTH
Andrew J Meltzer, Peter H Connolly, Nii Kabu Kabutey, Doug W Jones, Darren B Schneider
Inferior vena cava filter (IVCF) placement is associated with increased risk of deep venous thrombosis. This may result from filter obstruction by trapped emboli or in situ thrombosis of the IVCF, followed by caval thrombus propagation, and may be associated with significant morbidity. Here, we describe a technique and early results of endovascular recanalization of IVCF chronic total occlusions in five patients with complete chronic total occlusions of a previously implanted IVCF, the inferior vena cava, and the bilateral iliofemoral venous systems...
January 2015: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Christopher R Lattimer, George Geroulakos, Evi Kalodiki
BACKGROUND: This is an analysis of the hemodynamic response of post-thrombotic legs to a sustained thigh compression and quick-release maneuver. This is an integral part of the investigation of venous occlusion plethysmography that has been promoted as a way of assessing the venous return. The aim was to quantify the venous volume changes in patients after deep venous thrombosis (DVT) and to determine whether refluxing legs differed from obstructed legs. METHODS: The inflow and outflow air plethysmography tracings of 332 of 519 legs were examined retrospectively...
October 2014: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Christophe Seinturier, Frédéric Thony, Sophie Blaise, Gilles Pernod, Patrick Henri Carpentier
Vascular lesions are frequent in Behçet's disease, and among them, deep venous thrombosis may occur in up to one-third of patients. Treatment is based on immunosuppressive drugs in addition to anticoagulants. We report the case of a young woman who presented with an acute iliofemoral venous thrombosis. Acute treatment with endovascular thrombectomy and catheter-directed fibrinolysis failed, probably because of the inflammatory status of the vessel wall. Recanalization with stenting of the obstructed common femoral and iliac veins 1 year later was successful under immunosuppressive therapy...
July 2014: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Xzabia A Caliste, Amanda L Clark, Adam J Doyle, John P Cullen, David L Gillespie
OBJECTIVE: Percutaneous transluminal angioplasty with stenting of the iliac veins is the method of choice to treat patients with symptomatic lower extremity venous outflow obstruction. The optimal method of performing this technique remains to be solved, however. One question in particular is that when braided stainless steel stents (Wallstents; Boston Scientific, Natick, Mass) are used, should these venous stents extend into the vena cava or should they stop short of this for fear of causing thrombosis of the patient's normal contralateral iliofemoral vein? It has been our practice to extend our venous stents significantly into the vena cava to coapt with the inferior vena cava (IVC) wall in the majority of patients with disease of the common iliac vein at the iliocaval junction...
July 2014: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Ylva Haig, Tone Enden, Carl-Erik Slagsvold, Leiv Sandvik, Per Morten Sandset, Nils Einar Kløw
BACKGROUND: Deep vein thrombosis (DVT) often results in venous valvular incompetence and incomplete recanalization, followed by post-thrombotic syndrome (PTS). Treatment with additional catheter-directed thrombolysis (CDT) in patients with an iliofemoral DVT has been shown to reduce the frequency of PTS. The objective of this study was to assess the effect of CDT on venous reflux and patency and to identify possible predictors for the development of PTS. METHODS: Open, multicenter, randomized, controlled clinical trial...
April 2014: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Montserrat Blanch Alerany, Luis Miguel Izquierdo Lamoca, Marta Ramirez Ortega, Isabel Lago Rivas, Romina Zotta Desboeufs, Stefan Stefanov Kiuri
INTRODUCTION: Patients with deep vein thrombosis affecting the iliac and vena cava veins develop a more severe post-thrombotic syndrome than those with femoropopliteal disease. It has been traditionally treated only with medical therapy. During the last decade, endovascular repair has become the treatment of choice. The aim of this study is to report our midterm results using this technique. METHODS: From 2009 to 2012, 41 limbs in 36 patients with post-thrombotic chronic flow obstruction of iliofemoral vein secondary to stenotic or occlusive lesions and with a clinical CEAP class 3 or higher or venous pain underwent percutaneous treatment...
January 2014: Journal of Vascular Surgery. Venous and Lymphatic Disorders
John J Lee, Mustafa Al-Jubouri, Robin Acino, Anthony J Comerota, Fedor Lurie
BACKGROUND: It has been reported that early clot removal benefits patients with iliofemoral deep venous thrombosis (DVT) by removing obstruction and preserving valve function. However, a substantial number of patients who had successful clot removal develop post-thrombotic syndrome (PTS). Residual thrombus and rethrombosis play a part in this phenomenon, but the role of coexisting primary chronic venous disease (PCVD) in these patients has not been studied. METHODS: All patients who underwent catheter-based techniques of thrombus removal for symptomatic acute iliofemoral DVT during a 5-year period compose the study group...
October 2015: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Niels Bækgaard, Lotte Klitfod, Maja Jørgensen
Catheter-directed thrombolysis for deep venous thrombosis is considered the basic treatment modality for intrathrombus removal. This method is preferably used in patients with iliofemoral deep venous thrombosis due to poor spontaneous recanalization in this segment, especially on the left side. The method was published almost 25 years ago and has gained ground in the treatment because of poor results from systemic thrombolysis and because of the possibility of stenting any underlying iliac obstruction during the procedure...
March 2016: Phlebology
Lotte Klitfod, Sven Just, Pia Foegh, Niels Baekgaard
BACKGROUND: Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired quality of life in more than 50%. Endovascular treatment for iliac vein obstruction using stents is known to alleviate PTS symptoms in selected patients. PURPOSE: To report the Danish long-term results of endovascular treatment with iliac stenting...
September 2015: Acta Radiologica Open
Mahmood K Razavi, Michael R Jaff, Larry E Miller
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...
October 2015: Circulation. Cardiovascular Interventions
Angela A Kokkosis, Nicos Labropoulos, Antonios P Gasparis
The evaluation of patients with venous ulceration primarily includes noninvasive methods to elucidate the distribution and extent of pathology. Duplex ultrasound is the first line of investigation, as it provides assessment of both reflux and obstruction conditions. In patients with iliofemoral pathology, axial imaging with computed tomography scan or magnetic resonance imaging should be performed. If the treatment of iliofemoral vein obstruction is warranted, then invasive assessment using venography and/or intravascular ultrasound should be used to guide the interventional procedure...
March 2015: Seminars in Vascular Surgery
Nicolas Langwieser, Isabell Bernlochner, Isabel Wustrow, Ralf J Dirschinger, Juliane Jaitner, Michael Dommasch, Christian Bradaric, Karl-Ludwig Laugwitz, Tareq Ibrahim
OBJECTIVES: Studies addressing optimal postprocedural pharmacological management after endovascular stenting of iliofemoral post-thrombotic venous obstruction are lacking. We report our early clinical experience with a combination of rivaroxaban and clopidogrel in patients after iliofemoral post-thrombotic venous obstruction stenting. METHODS: Demographic, procedural, and follow-up data of nine patients (seven women; mean age of 32 ± 11 years) undergoing 10 procedures for iliofemoral post-thrombotic venous obstruction performed between August 2012 and January 2014 were retrospectively reviewed...
July 2016: Phlebology
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