Acute Lower Extremity Deep Vein Research Articles

Downregulation of interleukin-6 and C-reactive protein underlies a novel inhibitory role of microRNA-136-5p in acute lower extremity deep vein thrombosis.

Deep vein thrombosis (DVT) comprises a critical and common health condition with high incidence, mortality, and long-term adverse sequelae. Several differentially expressed microRNAs (miRNAs) have emerged as promising prognostic markers in DVT. The present study intended to explore the functional relevance of miR-136-5p in acute lower extremity DVT (LEDVT). Rat models of acute LEDVT were established and miR-136-5p expression was altered by agomir or antagomir to assess its effects. In addition, in vitro gain- and loss-experiments, prior to exposure to CoCl2, were performed to investigate effects of miR-136-5p on human umbilical vein endothelial cell (HUVEC) apoptosis and levels of interleukin-6 (IL-6) and C-reactive protein (CRP). miR-136-5p was downregulated, whereas IL-6 and CRP were elevated in acute LEDVT patients. Notably, miR-136-5p was confirmed to target both IL-6 and CRP. Overexpression of miR-136-5p led to reduced length, weight, and ratio of weight to length of the venous thrombus. Furthermore, overexpressed miR-136-5p downregulated the expression of IL-6 and CRP, consequently inhibiting HUVEC apoptosis. Conjointly, our data indicate that the overexpression of miR-136-5p has the potential to bind to the 3’-UTR in the mRNAs for IL-6 and CRP and mitigate acute LEDVT, which provides a basis for new therapeutic targets in acute LEDVT treatment.

Modified one-session endovascular treatment for deep venous thrombosis with high risk of pulmonary embolism: Short-term outcomes.

To evaluate the safety and short-term outcomes of the modified one-session endovascular treatment with inferior vena cava filter placement and retrieval in one stage for the treatment of acute lower extremity deep vein thrombosis. Twenty-three patients with unilateral acute lower extremity deep vein thrombosis underwent modified one-session endovascular treatments, which were performed in one stage. Inferior vena cava filter placement without detachment, thrombectomy, and inferior vena cava filter retrieval were performed in one stage. Angioplasty and stent implantation were performed for patients with iliac vein stenosis. Venography was performed to identify the clearance of the thrombus. Color Doppler ultrasound and/or venography were conducted during the follow-up. A total of 20/23 (87%) patients with thrombus removal rate >90% successfully underwent modified one-session endovascular treatment. inferior vena cava filters were detached in 3/23 (13%) patients achieving 50%-90% thrombus removal rate. Twenty-one iliac vein stents were implanted in 21/23 (91%) patients with iliac vein stenosis. After treatment, the differences in the circumferences of the affected limb and the healthy limb both significantly decreased. No procedure-related death, symptomatic pulmonary embolism, or major bleeding occurred. During the 12-25months of follow-up, iliac vein stents and lower extremity veins maintained patent. The modified one-session endovascular treatment with one-stage inferior vena cava filter placement and retrieval might be safe for the treatment of acute lower extremity deep vein thrombosis, and the early clinical outcomes are satisfactory. Placing and retrieving an inferior vena cava filter in one session could safeguard the endovascular interventions as well as reduce the filter-related complications associated with long dwelling times.

Upregulation of microRNA-136-5p Alleviates Acute Lower Extremity Deep Vein Thrombosis Through Negatively Regulating Interleukin-6 and C-Reactive

Background: Deep vein thrombosis (DVT) is known as a critical common health issue with high incidence, mortality, and long-term sequelae. Many differentially expressed microRNAs (microRNAs) have been proven to be promising prognostic markers for DVT patients. Herein, this study intended to explore the functional relevance of miR-136-5p on acute lower extremity DVT (LEDVT). Methods: Following the establishment of acute LEDVT rat model, the expression of miR-136-5p was altered by agomir or antagomir to assess its effects on regulating venous thrombus. Moreover, the gain- and loss-experiments, prior to the exposure to CoCl2, were performed in vitro to clarify the effects of miR-136-5p on human umbilical vein endothelial cell (HUVEC) apoptosis and levels of interleukin-6 (IL-6) and C-reactive protein (CRP). Results: Accordingly, miR-136-5p was found to be downregulated, while IL-6 and CRP were elevated in acute LEDVT patients. Conclusion: Notably, miR-136-5p was confirmed to target both IL-6 and CRP. Overexpression miR-136-5p led to reduced length, weight, and the ratio of weight to length of venous thrombus. Additionally, overexpressed miR-136-5p regulated both IL-6 and CRP to inhibit HUVECs apoptosis. Taken conjointly, the overexpression of miR-136-5p has the potential to bind to IL-6 and CRP to mitigate acute LEDVT, which provided new therapeutic targets for acute LEDVT treatment. Funding Statement: This study was supported by the General Projects of National Natural Science Foundation of China — the Function and Regulation Mechanism of ETBR in Aortic Endothelium and Smooth Muscle Cells in Pregnancy Induced Hypertension (No. 81871187), the Regional Projects of the National Natural Science Foundation of China — Correlation Analysis Between Endothelin Receptor and Pregnancy Induced Hypertension and Abnormal Blood Pressure Regulation (No. 81460239), and the Natural Science Foundation Project of Ningxia Province — Correlation Analysis Between Anastomotic Regional Blood Flow Velocity and Intimal Hyperplasia after Revascularization (No. NZ17195). Declaration of Interests: The authors have declared that no competing interests exist. Ethics Approval Statement: This study protocol was approved by the Ethics Committee and Experimental Animal Ethics Committee of Qingdao Municipal Hospital. In addition, written informed consent was obtained from all participants or their relatives that were involved in the study. The animal experiment strictly adhered to the principles of the Guide for the Care and Use of Laboratory Animals published by the National Institutes of Health to minimize the pain, suffering and discomfort to experimental animals.

A case-controlled study on AngioJet rheolytic thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis.

Objective This study aims to compare the efficacy and safety of AngioJet rheolytic thrombectomy vs. catheter-directed thrombolysis in patients with acute lower extremity deep vein thrombosis. Methods Between the period of February 2015 and October 2016, 65 patients with documented acute lower extremity deep vein thrombosis were treated with catheter-directed intervention. These patients were divided into two groups: AngioJet group and catheter-directed thrombolysis group. Comparisons were made with regard to efficacy and safety between these two groups. Results In the AngioJet group, complete or partial thrombus removal was accomplished in 23 (72%) and 3 (9%) patients, respectively. In the catheter-directed thrombolysis group, complete or partial thrombus removal was accomplished in 27 (82%) patients and 1 (3%) patient, respectively. In the AngioJet group, the perimeter difference between the suffered limb and healthy one declined from 5.1 ± 2.3 cm to 1.4 ± 1.2 cm ( P < 0.05). In the catheter-directed thrombolysis group, the perimeter difference declined from 4.7 ± 1.6 cm to 1.5 ± 0.9 cm ( P < 0.05). The mean urokinase dose was 0.264 ± 0.135 million units in the AngioJet group and 1.869 ± 0.528 million units in the catheter-directed thrombolysis group ( P < 0.05). The duration of thrombolysis was 4.2 ± 1.7 h in the AngioJet group and 73.6 ± 18.3 h in the catheter-directed thrombolysis group ( P < 0.05). The occurrence of complications in these two groups was 19% and 18%, respectively (not significant). Conclusion AngioJet rheolytic thrombectomy is a new, safe and effective approach for treating acute lower extremity deep vein thrombosis. When compared to catheter-directed thrombolysis, this treatment provides similar success with lower urokinase dosage and shorter duration of thrombolysis.

Comparison of Treatment Result Between Anticoagulation Alone and Catheter-Directed Thrombolysis Plus Anticoagulation in Acute Lower Extremity Deep Vein Thrombosis.

PurposeDeep vein thrombosis (DVT) is the third most common cause of cardiovascular morbidity and mortality. Anticoagulation has been the primary treatment modality for acute DVT. However, catheter-directed thrombolysis (CDT) has recently become widely accepted as an additional therapy to anticoagulation. We assessed comparative outcomes in patients with acute DVT who underwent anticoagulation therapy alone (ACA) group and those treated with CDT group.Materials and MethodsWe retrospectively reviewed medical records of 149 patients with DVT from January 2011 to December 2015. We compared patients who received ACA group (n=120) and those who received CDT plus anticoagulation (CDT group, n=29). We analyzed the prevalence of lesions, thrombus removal rate in each lesion, and recurrence-free rate between the two groups.ResultsWe found thrombus involvement in a total of 281 lesions in the ACA group and 85 lesions in the CDT group. For the distribution of lesions in each group, those in the femoral vein accounted for 34.2% of all lesions and those in the popliteal vein accounted for 31.7%. During follow-up, the overall thrombus removal rate was 91.1% in the ACA group and 87.0% in the CDT group (P=0.273). The recurrence-free rate was higher in the CDT group in a log-rank test; however, there was no statistically significant difference between the two groups (P=0.594).ConclusionAccording to our results, there was no significant difference in thrombus removal and recurrence-free rates between the CDT and ACA groups. ACA still has an important role in the treatment of DVT.

Long-term results of additional thrombolytic therapy in patients with acute deep vein thrombosis treated with pharmacomechanical thromboaspiration: A comparative study.

This study aims to evaluate the clinical and ultrasonographic long-term results of additional thrombolytic therapy to pharmacomechanical thromboaspiration in patients with acute and subacute lower extremity deep vein thrombosis. Medical data of a total of 68 patients ( 41 males, 27 females; mean age 38 years; range, 25 to 56 years) who were admitted to our department with the diagnosis of hyperacute or acute deep vein thrombosis between January 2013 and January 2015 were retrospectively analyzed. The patients were divided into two groups: thrombectomy without thrombolytic therapy (Group 1, n=33) and thrombectomy with thrombolytic therapy (Group 2, n=35). All patients were administered Clinical Symptom Scoring and Doppler ultrasonography at one, six, and 12 months. Clinical symptom scores were higher in Group 1 at one month (p<0.001), while there was no significant difference between the groups at six months (p=0.102). Group 1 had higher scores at 12 months (p=0.043). The complete patency rates for both groups were similar at one month (p=0.181); however, the rates were higher in Group 2 at six and 12 months (p=0.019 and p=0.002, respectively). There was no significant difference in the complete patency rates between the groups at one and six months (p=0.563 and p=0.064, respectively), while these rates were higher in Group 2 at 12 months (p=0.013). In patients with acute deep vein thrombosis, the complete patency rates were found to be higher in all control Doppler ultrasonography examinations. In the treatment of both hyperacute and acute deep vein thrombosis, the addition of thrombolytic therapy to pharmacomechanical thromboaspiration improves the clinical symptoms and venous patency rates.

INTRA-CARDIAC EMBOLIZATION OF AN INFERIOR VENA CAVA FILTER RESULTING IN CARDIAC ARREST

SESSION TITLE: Cardiovascular Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Inferior vena cava (IVC) filters are commonly used to prevent pulmonary emboli (PE) in patients with high thromboembolic risk and an absolute contraindication to anticoagulation. These devices can offer life-saving protection but are not without risk. The overall complication rate associated with IVC filters is low, but several known device-related complications are associated with significant morbidity and mortality, including in-situ IVC thrombus, filter perforation, filter fracture, and/or filter embolization. Rates of filter embolization are exceptionally low, with an incidence of less than 1 percent, and most often occur at the time of device deployment. Here, we present a case of delayed, intra-cardiac IVC filter embolization leading to cardiac arrest. CASE PRESENTATION: A 49-year-old man with a past medical history significant for recurrent thromboembolic disease with known acute right lower extremity deep vein thrombosis and chronic superior mesenteric vein thrombus was admitted to the intensive care unit for a massive upper gastrointestinal bleed secondary to duodenal varices identified on esophagogastroduodenoscopy (EGD). His duodenal varices were not amenable to endoscopic intervention. Given his elevated risk for recurrent gastrointestinal bleeding and recurrent thromboembolic disease, an IVC filter was placed without complication. Two days later, following a repeat EGD for attempted histoacryl variceal gluing, the patient experienced sudden cardiac arrest, characterized by pulseless monomorphic ventricular tachycardia. He was resuscitated for approximately 70 minutes with intermittent return of spontaneous circulation and ability to follow commands. Bedside cardiac ultrasound during the resuscitation revealed a multi-lobulated, mobile mass intertwined within the tricuspid valve. After stabilization, computed tomography of the chest with angiography showed a saddle pulmonary embolism with migration of the IVC filter into the right ventricle. He underwent emergent sternotomy with thromboembolectomy and retrieval of the embolized IVC filter. He made a complete recovery after surgery and was discharged to independent living from the hospital with a new IVC filter in place. DISCUSSION: IVC filter embolization is a rare but potentially fatal complication, and sudden cardiac arrest is a common presentation. Bedside ultrasound is useful for early diagnosis. As evidenced by the patient presented here, prompt identification and removal of the embolized filter can lead to positive patient outcomes. CONCLUSIONS: Intra-cardiac embolization of IVC filters can occur days after device deployment and lead to life-threatening cardiac arrhythmias. Reference #1: Grewal S, Chamarthy MR, Kalva SP. Complications of inferior vena cava filters. Cardiovascular Diagnosis and Therapy. 2016;6(6):632-641. Reference #2: Athanasoulis CA, Kaufman JA, Halpern EF, et al. Inferior vena caval filters: review of 26-year single-center clinical experience. Radiology. 2000;216(1):54-66. Reference #3: Owens CA, Bui JT, Knuttinen MG, et. Al. Intracardiac migration of inferior vena cava filters: review of published data. Chest. 2009;136(3):877-887. DISCLOSURES: No relevant relationships by Max Martin, source=Web Response No relevant relationships by Kelly Pennington, source=Web Response No relevant relationships by Michael Wilson, source=Web Response

DVT Intervention in the Post-ATTRACT Era.

Patients suffering from acute lower extremity deep vein thrombosis (DVT) are at risk for developing chronic limb pain, heaviness, and fatigue, known as the post-thrombotic syndrome (PTS). Although several studies have shown that catheter-directed therapy reduces clot burden and may improve clinical outcomes, the multicenter randomized controlled ATTRACT trial showed no difference in PTS or quality of life at 2years between patients treated with pharmacomechanical catheter-directed thrombolysis (PCDT) and those treated with anticoagulation alone, and a higher major bleeding rate in the PCDT group. PCDT is not indicated for most patients diagnosed with lower extremity DVT. Since PCDT may benefit patients with iliofemoral DVT, intervention can be considered in this subset of patients if they are at low risk of bleeding.

Presence and degree of residual venous obstruction on serial duplex imaging is associated with increased risk of recurrence and progression of infrainguinal lower extremity deep venous thrombosis

ObjectiveThe role of follow-up venous duplex ultrasound (DUS) after acute lower extremity deep vein thrombosis (DVT) remains unclear, yet it is commonly performed. We aimed to clarify the role of follow-up DUS. Our primary objective was to determine the association between the presence of residual venous obstruction (RVO) on DUS and DVT recurrence or propagation (rDVT). Secondary objectives included finding risk factors associated with RVO and rDVT. MethodsWe conducted a retrospective study of patients diagnosed with DVT on DUS from January 1, 2011, to December 31, 2013, that received a follow-up DUS. Patient demographics, risk factors, medications, and DUS findings were recorded. Ten segments from the common femoral to distal calf veins were checked for the presence of RVO, DVT propagation, and recurrence. RVO was defined as any nonacute venous obstruction with more than 40% of luminal diameter remaining during compression or the presence of chronic post-thrombotic occlusive disease. rDVT was measured as either a new acute DVT in the previously involved segment, or involvement of a new segment in the same extremity. ResultsA total of 185 lower extremities representing 156 patients met the inclusion criteria. RVO was noted in 61.1% of limbs. The 3-year rDVT rate was 10.3%. Patients with recurrent venous thromboembolism or thrombophilia had a higher risk of developing RVO (odds ratio [OR], 2.89, P < .01; OR, 4.39, P = .04, respectively). Extremities with larger clot burden had an increased risk of RVO on follow-up DUS (OR, 1.25 per segment; P < .01). The presence and degree of RVO on follow-up DUS had an increased risk of rDVT on subsequent DUS (OR, 3.90, P = .04; OR, 1.21 per segment, P = .04, respectively). Limbs with complete resolution of DVT by DUS had a significantly decreased risk of rDVT (OR, 0.26; P = .04). ConclusionsExtremities with larger initial clot burden exhibited an increased risk of subsequent RVO. The presence of RVO and, interestingly, the number of involved segments on follow-up DUS increased the risk of rDVT. Our results suggest that the presence of residual disease and increased RVO burden on follow-up DUS after an acute DVT may identify those patients who are at an increased risk for rDVT and may help guide the duration of anticoagulation therapy.

Diagnosis and endovascular treatment of iliac venous compression syndrome.

To report *The first two authors contributed equally to this work. our clinical experience on diagnostic criteria and endovascular management in patients with iliac venous compression syndrome. Between July 2013 and May 2015, 85 consecutive patients with suspected iliac venous compression syndrome were evaluated by transfemoral venography and intravascular ultrasonography. Venographic evidence of iliac venous occlusion, stenosis, or pelvic collateral vessels, and the degree of stenosis as examined with intravascular ultrasonography were recorded. The endovascular procedure, complications, clinical outcome, and the Venous Clinical Severity Score were evaluated before and after the intervention. Of the 85 limbs, 66 cases of iliac venous compression syndrome were confirmed and 19 cases were excluded. In all of the 66 patients, we successfully performed endovascular intervention (22 balloon dilations, 44 balloon dilations + stenting). Two patients with stent implantation developed acute lower extremity deep vein thrombosis, resulted in successful lysis of the thrombus with catheter-directed thrombolysis. The presence of intraluminal spurs and pelvic collateral vessels represents not only pathological and anatomical changes by long-term mechanical compression, but also indicators of the severity of iliac venous compression syndrome. The degree of stenosis cannot accurately represent the severity and treatment of iliac venous compression syndrome, especially in the right iliac vein. Endovascular intervention is a safe and effective treatment that reduces lower extremity symptoms. Full and intentional dilation of the intraluminal spurs is an important technical aspect, which is often ignored.

Catheter-Directed Thrombolysis Versus Standard Anticoagulation for Acute Lower Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials.

Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis. Compared with anticoagulant alone, CDT was shown to significantly increase the percentage patency of the iliofemoral vein (P < .00001; I 2 = 44%) and reduce the risk of PTS (P = .0002; I 2 = 79%). In subgroup analysis of randomized controlled trials, CDT was not shown to prevent PTS (P = .2; I 2 = 59%). A reduced PTS risk was shown, however, in nonrandomized trials (P < .00001; I 2 = 47%). Meta-analysis showed that CDT can reduce severe PTS risk (P = .002; I 2 = 0%). However, CDT was not indicated to prevent mild PTS (P = .91; I 2 = 79%). A significant increase in bleeding events (P < .00001; I 2 = 33%) and pulmonary embolism (PE) (P < .00001; I 2 = 14%) were also demonstrated. However, for the CDT group, the duration of stay in the hospital was significantly prolonged compared to the anticoagulant group (P < .00001; I 2 = 0%). There was no significant difference in death (P = .09; I 2 = 0%) or recurrent venous thromboembolism events (P = .52; I 2 = 58%). This meta-analysis showed that CDT may improve patency of the iliofemoral vein or severe PTS compared with anticoagulation therapy alone, but measuring PTS risk remains controversial. However, CDT could increase the risk of bleeding events, PE events, and duration of hospital stay.

Therapeutic effect of AngioJet mechanical thrombus aspiration system combined with catheter directed thrombolysis on acute deep vein thrombosis

Objective: To analyze the curative effect of AngioJet mechanical thrombus aspiration combined with catheter directed thrombolysis (CDT) on acute lower extremity deep vein thrombosis (LEDVT). Methods: The clinical data of 20 cases of acute LEDVT treated by AngioJet combined with CDT were analyzed. The inferior vena cava filter was implanted preoperatively, and then the thrombolysis was performed by using AngioJet. The thrombolytic catheter was placed for CDT treatment, and the thrombolysis was evaluated by review angiography. Results: All cases were successfully punctured and catheterized. The suction time was (235±75) seconds. The usage of urokinase was (180±90)*10(4) U. The differences before and after thrombolysis of ipsilateral and contralateral thigh circumference were (8.3±1.5) cm and (2.5±1.0) cm, respectively. The differences before and after thrombolysis of the ipsilateral and contralateral calf circumference were (2.4±1.0)cm and (1.5±0.7) cm, respectively. All of which had statistical significant (P<0.01). Conclusion: AngioJet mechanical thrombus aspiration system is a novel and safe method for the treatment of acute LEDVT. When used in conjunction with CDT, its advantages was more significant.

Safety of catheter-directed thrombolysis for the treatment of acute lower extremity deep vein thrombosis: A systematic review and meta-analysis.

Background:Despite established guidelines, catheter-directed thrombolysis (CDT) for the management of acute lower extremity deep vein thrombosis (DVT) should not be overstated because the risks of CDT are uncertain. We performed a meta-analysis to comprehensively and quantitatively evaluate the safety of CDT for patients with acute lower extremity DVT.Methods:Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE, and Scopus, were searched up to January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated by CDT or compared CDT with anticoagulation. In case series studies, the pooled estimates of safety outcomes for complications, pulmonary embolism (PE), and mortality were calculated across studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated.Results:Of the 1696 citations identified, 24 studies (6 comparing CDT with anticoagulation and 18 case series) including 9157 patients met the eligibility criteria. In the case series studies, the pooled risks of major, minor, and total complications were 0.03 (95% confidence interval [CI]: 0.02–0.04), 0.07 (95% CI: 0.05–0.08), and 0.09 (95% CI: 0.08–0.11), respectively; other pooled risk results were 0.00 for PE (95% CI: 0.00–0.01) and 0.07 for mortality (95% CI: 0.03–0.11). Our meta-analysis of 6 studies comparing the risk of complications and PE related to CDT with those related to anticoagulation showed that CDT was associated with an increased risk of complications (OR = 4.36; 95% CI: 2.94–6.47) and PE (OR = 1.57; 95% CI: 1.37–1.79).Conclusion:Acute lower extremity DVT patients receiving CDT are associated with a low risk of complications. However, compared with anticoagulation, CDT is associated with a higher risk of complications and PE. Rare mortality related to thrombolytic therapy was reported. More evidence should be accumulated to prove the safety of CDT.

VKORC1 -1639 G>A Polymorphism in Romanian Patients With Deep Vein Thrombosis.

The purpose of the research was to study the influence of several genetic factors, especially the -1693 G>A polymorphism of the VKORC1 gene, on the risk of acute unprovoked lower extremity deep vein thrombosis (DVT). The study included 127 patients (median age 63 [53.2; 72] years; 61 [48%] women and 66 [52%] men) who were diagnosed with acute lower extremity DVT and 114 controls (median age 62 [53; 73] years; 64 [56.1%] women and 50 [43.9%] men) without DVT. We recorded data regarding the history of DVT and the presence of varicose veins. We determined the genotypes for factor V Leiden (FVL) mutation, prothrombin G20210A mutation, VKORC1 -1639 G>A mutation, and PAI-1 -675 4G/5G polymorphism. Varicose veins were found in 67 (52.8%) patients and 29 (25.4%) controls (P < .001). FVL was present in 29 (22.8%) patients and 10 (8.8%) controls (P = .005). The VKORC1 (-1693 G>A) GG genotype was found in 42 (33.1%) patients and 41 (36%) controls, the GA genotype in 71 (55.9%) patients and 47 (41.2%) controls, and AA genotype in 14 (11%) patients and 26 (22.8%) controls (P = .020). Multivariate analysis showed that the presence of varicose veins, FVL, and VKORC1 -1639 G>A was independently associated with the risk of DVT. The VKORC1 (-1693 G>A) AA genotype was associated with fewer cases of DVT (odds ratio = 0.435; 95% confidence interval 0.205-0.991; P = .031).

Clinical effects and safety of catheter- directed thrombolysis for acute lower extremity deep vein thrombosis in patients aged 70 years and over

Objective To analyze the efficacy and safety of catheter-directed thrombolysis (CDT) for acute lower extremity deep venous thrombosis (DVT) in patients aged 70 years and over . Methods Clinical data of 109 cases who had acute lower extremity DVT and had been treated with CDT from March 2011 to September 2014 were retrospectively analyzed. Results Inferior vena cava filters (IVCF) were implanted in 109 patients. A thrombolytic catheter was inserted from the contralateral femoral vein (21 cases), ipsilateral popliteal vein (44 cases), posterior tibial vein (28 cases) or small saphenous vein (16 cases). The duration of thrombolysis was (5.47±2.13) d. The dosage of urokinase was (3.80±0.56)million units. Forty-two cases underwent balloon dilatation alone, and 67 cases combined balloon dilatation with stent implantation. Gingival bleeding occurred in 7 patients and gross hematuria occurred in 4 patients during thrombolysis, which disappeared after medication adjustment. No symptomatic pulmonary embolism (PE) or other serious complications were found in any patients. There were significant differences in the venous patency score and lower limb circumferences at 10 cm above and below the knee one week after treatment (t=3.874, P=0.031). Ninety-seven cases were followed up for a mean period of (20.7±6.5) months, and the vein patency rate was (77.9±10.5) % and (73.1±9.4) % at 6 and 18 months after treatment, respectively. Recurrence of deep vein thrombosis was found in 6 cases, of which 2 cases had recurrent stent thrombosis, and treatment with CDT again was successful. No severe deep venous thrombosis syndrome (PTS) was found during the follow-up. Conclusions CDT is a minimally invasive procedure and can rapidly resolve limb venous drainage disorders. CDT is safe, has few complications and usually generates satisfactory outcomes. For very-old elderly patients who have no anticoagulation and thrombolytic contraindications, CDT is a useful option for the treatment of acute lower limb DVT. Key words: Venous thrombosis; Catheterization, peripheral; Thrombolytic therapy

Aspiration thrombectomy using a large-size catheter for acute lower extremity deep vein thrombosis.

This study retrospectively evaluated the safety and efficacy of aspiration thrombectomy using a large-size catheter for acute lower extremity deep vein thrombosis (DVT). All patients who underwent aspiration thrombectomy using 9F or 10F catheters for acute lower extremity DVT were included and analyzed. Aspiration thrombectomy was performed in all patients. Additional intravenous thrombolysis was performed in patients with residual thrombus, and stent placement was performed in patients with iliac vein compression syndrome. From October 2010 to September 2013, the study enrolled 68 patients (37 women, 31 men) with a mean age of 61.7 ± 7.8 years (range, 24-86 years). All patients presented with lower extremity swelling and pain, and the duration of symptoms ranged from 1 to 14 days. The DVTs involved popliteal-iliofemoral veins in 29 patients, iliofemoral veins in 31, and iliac veins in 8. Endovascular procedures were performed in all patients with a technical success rate of 100%. Aspiration alone was effective in 47 patients, and additional thrombolysis was required in the remaining 21. An additional stent was required in 32 patients. Significant improvement in presenting symptoms was achieved in all patients after the procedures, with a clinical success rate of 100%. There were no procedure-related or thrombolysis-related complications. The Villalta scores were <5 in 60 patients and from 5 to 9 in four patients. Primary and secondary patency rates were 89.1% (57 of 64) and 96.9% (62 of 64) at 1 year of follow-up. Aspiration thrombectomy using a large-size catheter is safe and effective for acute lower extremity DVT.

Use of Percutaneous Aspiration Thrombectomy vs. Anticoagulation Therapy to Treat Acute Iliofemoral Venous Thrombosis: 1-year Follow-up Results of a Randomised, Clinical Trial

The purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy (PAT) followed by standard anticoagulant therapy, with anticoagulation therapy alone, for the treatment of acute proximal lower extremity deep vein thrombosis. In this randomised, prospective study, 42 patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination, were separated into an interventional treatment group (16 males, 5 females, average age 51years) and a medical treatment group (13 males, 8 females, average age 59years). In the interventional group, PAT with large-lumen 9-F diameter catheterisation was applied, after initiation of standard anticoagulant therapy. Balloon angioplasty (n 19) and stent implementation (n: 14) were used to treat patients with residual stenosis (>50%) after PAT. Prophylactic IVC filters were placed in two patients. The thrombus clearance status of the venous system was evaluated by venography. In both the medical and interventional groups, venous patency rates and clinical symptom scores were evaluated at months 1, 3, and 12 after treatment. Deep venous systems became totally cleared of thrombi in 12 patients treated with PAT. The venous patency rates in month 12 were 57.1 and 4.76% in the interventional and medical treatment groups, respectively. A statistically significant improvement was observed in clinical symptom scores of the interventional group (PAT) with or without stenting (4.23±0.51 before treatment; 0.81±0.92 at month 12) compared with the medical treatment group (4.00±0.63 before treatment; 2.43±0.67 at month 12). During follow-up, four patients in the medical treatment and one in the interventional group developed pulmonary embolisms. For treatment of acute deep vein thrombosis, PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. PAT is a safe, inexpensive, and easily performed method of endovascular treatment with a low rate of major complications. Our present findings and literature data suggest that PAT can be used as first-line treatment in proximal deep vein thrombosis patients, especially when thrombolytic treatment is contraindicated.

Single-session Aspiration Thrombectomy of Lower Extremity Deep Vein Thrombosis Using Large-size Catheter without Pharmacologic Thrombolysis

To retrospectively evaluate the efficacy of single-session aspiration thrombectomy using large catheters without pharmacologic thrombolysis to treat acute and subacute lower extremity deep vein thrombosis (DVT). From January 2008 to December 2011, single-session aspiration thrombectomy using large, 11F introducer catheters to treat acute and subacute lower extremity DVT was performed in 74 limbs of 74 patients (M/F = 23/51, age range 36-88 years), and clinical and imaging follow-up of over 6 months were obtained in 26 patients. Causes of DVT were May-Thurner syndrome (n = 65), malignancy related (n = 6), and pelvic mass (n = 3). A 14F introducer sheath was inserted through the popliteal vein, followed by rotational thrombus maceration and aspiration thrombectomy. Angioplasty and stent placement were performed when needed. Radiological images and medical records were reviewed for immediate and midterm results, complications, and recurrences. Initial technical success rate was 89.2% (66 patients). Stenting was performed in 55 patients. The failures were due to underlying chronic thrombi/DVT (n = 7) and stent failure due to huge pelvic mass (n = 1). There was no procedure-related complication. In the 26 midterm follow-up patients for a duration of 6-48 months, there was no recurrence (n = 20), stent occlusion (n = 3), or femoral vein occlusion (n = 3). One-year primary patency rate in stent/iliac vein, femoral vein, and popliteal/infrapopliteal vein were 88.5, 88.5, and 96.2%, respectively. Single-session aspiration thrombectomy for acute and subacute lower extremity DVT using large introducer catheters without pharmacologic thrombolysis is feasible with acceptable immediate and midterm results, excluding complications related to pharmacologic thrombolysis.

4:18 PM Abstract No. 167 - Balloon-assisted catheter-directed thrombolysis for acute lower extremity deep vein thrombosis

Purpose To investigate the efficacy and safety of balloon-assisted catheter-directed thrombolysis (CDT) for acute lower extremity deep vein thrombosis (DVT). Materials and Methods From Sep 2008 to Feb 2011, 94 patients with acute DVT were admitted and treated by routine CDT (Group A,n=50) in early stage or by balloon-assisted CDT (Group B, n=44) in late stage.The circumference difference between limbs, score of venous patency, rate of venous patency were recorded for judging efficacy. The total dose of urokinase and retention time of catheter was compared between the two groups. The incidence of pulmonary embolism (PE) and bleeding were used to judge the safety. Results The prior treatment circumference difference between limbs were 5.37±1.97 cm (thigh) and 4.14±1.57 cm (calf) in Group A and 5.41±2.22 cm (thigh) and 4.05±1.61 cm (calf) in Group B, without significant difference ( P=0.910; P=0.774). The post treatment correspondences were: 2.96±1.10, 1.93±0.84 cm in Group A and 1.78±1.40, 1.41±1.17 cm in Group B; with significant difference (P Conclusion Balloon-assisted CDT would be a feasible treatment method for acute DVT. It improves the effect of thrombolysis and reduces the dosage of urokinase, and dose not increase the risk of PE.

Diagnostic value of plasma D-dimer and fibrinogen in acute lower extremity deep vein thrombosis after artificial joint replacement

Objective To evaluate diagnostic value of plasma D-dimer (D-D),fibrinogen (Fg) and Ddimer/fibrinogen (D/F) ratio in acute lower extremity deep vein thrombosis (DVT) after artificial joint replacement.Methods From August 2009 to December 2011,273 patients who had undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA) underwent venography of lower extremity deep vein at 35 days postoperatively.According to results of angiography,all patients were divided into DVT group including 66 patients (15 males and 51 females,median age 66 years) and non-DVT group including 207 patients (70 males and 137 females,median age 63 years).Plasma levels of D-D and Fg were measured by immunoturbidimetry and solidification methods respectively preoperatively and at 3-5 days postoperatively.The differences of plasma levels of D-D and Fg and D/F ratio between the two groups were analyzed with statistical method.Furthermore,diagnostic value of postoperative plasma D-D and D/F ratio in acute DVT was assessed using a receiver operating characteristic (ROC) curve.Results There was no statistical significance in preoperative plasma levels of D-D and Fg,and postoperative plasma levels of Fg between two groups.However,the postoperative plasma levels of D-D and D/F ratio were higher in the DVT group than those in the nonDVT group,and there was significant difference between two groups.In addition,the ROC curve analysis showed that the area under curve of postoperative plasma D-D and D/F ratio was 0.688 and 0.684,respectively,but this difference did not reach statistical significance.Conclusion Plasma Fg may be meaningless for the diagnosis of acute DVT after artificial joint replacement.Although plasma D-D and D/F ratio may be useful for diagnosing acute DVT,the diagnostic accuracy is low. Key words: Fibrinogen; Venous thrombosis; Arthroplasty,replacement