Iliofemoral Thrombosis Research Articles

The Long-Term Prognosis of Endovascular Thrombectomy in Patients with Acute Left Iliofemoral Vein Thrombosis Combined with Left Iliac Vein Compression

This study investigated the long-term outcomes of different thrombus removal methods in patients with acute left iliofemoral vein thrombosis (IFDVT) accompanied by left iliac vein compression (LIVC). This was a single-center cohort study. 240 patients with acute left-sided IFDVT complicated by LIVC were categorized based on their treatment approach into two groups: those receiving anticoagulation alone (No-PCDT group) and those undergoing anticoagulation combined with pharmacomechanical catheter-directed thrombolysis (PCDT group). The PCDT group was further divided into three subgroups: anticoagulation combined with percutaneous mechanical thrombectomy (PMT group), anticoagulation combined with catheter-directed thrombolysis (CDT group), and anticoagulation combined with both percutaneous mechanical thrombectomy and catheter-directed thrombolysis (PMT+CDT group). The incidence of post-thrombotic syndrome (PTS) was assessed using Villalta scores and Venous Clinical Severity Scores (VCSS). Patients were followed up for 24 months to compare long-term outcomes. The No-PCDT group consisted of 123 individuals, while the PCDT group comprised 117, with 36 in the CDT subgroup, 41 in the PMT subgroup, and 40 in the PMT+CDT subgroup. The follow-up period ranged from 3 to 24 months. The PCDT group was associated with a reduced incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or presence of ulcer: 22% PCDT vs. 39% No-PCDT; OR, 0.446; 95% CI, 0.253-0.787; P=0.005; and VCSS≥4: 22% PCDT vs. 34% No-PCDT; OR, 0.551; 95% CI, 0.311-0.978; P=0.042). Among the three subgroups of PCDT cohort, compared to the CDT group, the PMT group showed a decreased incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or ulcer: 12% PMT vs. 39% CDT; OR, 0.218; 95% CI, 0.069-0.690; P=0.010; and VCSS≥4: 12% PMT vs. 36% CDT; OR, 0.246; 95% CI, 0.077-0.781; P=0.017). The PMT+CDT group also demonstrated a reduced incidence of PTS (18% PMT+CDT vs. 39% CDT; OR, 0.333; 95% CI, 0.116-0.958; P=0.041) compared to the CDT group, but did not show a significant reduction in the risk of high VCSS (20% PMT+CDT vs. 36% CDT; P=0.121). Compared to the PMT group, the PMT+CDT group did not significantly reduce the incidence of PTS (12% PMT vs. 18% PMT+CDT; P=0.504) or the rate of high VCSS (12% PMT vs. 20% PMT+CDT; P=0.343). In patients with acute left IFDVT complicated by LIVC, PMT may serve as a more efficacious method for thrombus removal compared to CDT and combined PMT+CDT in reducing both the incidence of PTS and the risk of high VCSS.

Features of diagnosis and treatment of thromboses of the inferior vena cava

Annotation. Treatment of venous thromboembolism remains a complex and unsolved problem today. To date, there are no consensuses and guidelines that clearly regulate the treatment of patients with thrombosis of the inferior vena cava (IVC), considering the rather low prevalence of this pathology. Therefore, a more detailed study of this pathology, analysis of the treatment results, will allow to form a treatment strategy and obtain positive results of treatment in patients with IVC thrombosis. We analyzed the results of treatment of 44 patients with venous thrombosis in the Vinnytsia Regional Clinical Hospital named after Pirogov for the period from 2009 to 2023. The analysis was carried out in two groups, one consisted of 40 patients who survived, the second group included 4 patients who died. Fisher's exact test (one-sided) was used to analyze differences. Analysis of gender distribution did not reveal significant differences between groups. Bilateral iliofemoral thrombosis occurred in 3 (7.5%) patients from the group of survivors. The floating nature of IVC thrombosis was observed in 2 (5%) patients in the group of survivors and in 4 (100%) patients in the group of the dead. PE was observed in 5 (12.5%) patients in the survivor group and in 4 (100%) patients in the deceased group and was the cause of death in all cases of mortality. Thus, in 4 (9%) cases, floating thrombosis led to the occurrence of fatal PE in the case of IVC thrombosis. Operative treatment was more often performed in patients who survived: 4.5% versus 0%. When analyzing individual types of invasive treatment, it was found that the use of a cava filter was more often performed in deceased patients, and thrombectomy and catheter-directed thrombolysis - in those patients who survived. So, intravenous thrombosis is a dangerous and complex disease with a high mortality rate, which in our study was 9%. The floating nature of IVC thrombosis is one of the main risk factors for the occurrence of fatal PE. Performing thrombectomy is an effective method of treatment of IVC thrombosis and prevention of PE.

Influence of Timing of Stenting on Condition of Venous Valves of Lower Extremities, Frequency and Severity of Development of Post-Thrombotic Disease

INTRODUCTION: Acute deep vein thrombosis (DVT) of the lower extremities (LE) is a life-threatening condition, accompanied by high rates of disability among people of working age. Despite early detection of DVT and the use of recommended antithrombotic therapy, damage to the venous wall, development of valvular reflux and post-thrombotic disease (PTD) inevitably occur. The clinical picture of PTD becomes evident after the development of valve incompetence, which leads to vertical venous reflux and chronic venous hypertension. Timely elimination of venous obstruction can preserve the functionality of valve structures, which will subsequently help reduce the frequency and severity of PTD. AIM: To evaluate the impact of the timing of stenting on the condition of the venous valves, the frequency and severity of the development of PTD in patients with acute DVT of LE. MATERIALS AND METHODS: A prospective interventional study included 49 patients with acute iliofemoral thrombosis. After selective thrombolysis, 25 patients underwent early (within 7 days) and 24 patients underwent delayed (7–30 days) stenting. The incidence and severity of PTD was assessed on the Villalta scale at 3, 6 and 12 months. The effect of treatment on the condition of the venous valves of the LE was assessed at 12 months. On ultrasound examination, reflux was assessed using a scoring system. RESULTS: At 12 months, 2 (8%), 13 (52%), and 10 (40%) patients who underwent delayed stenting, developed severe, moderate, or mild PTD, respectively. In the early stenting group, 6 (25%) patients had no symptoms of PTD, 15 (62.5%) and 3 (12.5%) developed mild and moderate PTD, respectively (p = 0.0005). At 12 months, in the early stenting group, the absence of reflux was recorded in 6 (25%) patients, 4 (17%) patients had valve reflux in the femoral segment, and 14 (58%) in the popliteal segment. In the delayed stenting group, valvular incompetence of both segments was detected in 12 (48%) patients; in 4 (16%) and 9 (36%) patients, the valves of the femoral and popliteal veins were preserved; there were no patients without reflux in both segments. Treatment results for this indicator were better if early stenting was performed (p = 0.0005). CONCLUSION: Early stenting after selective thrombolysis in patients with proximal DVT of LE leads to a decrease in the incidence and severity of symptoms of PTD, and can reduce the incidence of reflux in the deep veins.

Long-term results after ultrasound-assisted catheter-directed thrombolysis for acute iliofemoral thrombosis

Zusammenfassung Hintergrund und Fragestellung Unter der konservativen Standardbehandlung der proximalen Phlebothrombose (DVT) entwickeln 40–70 % der Patienten ein postthrombotisches Syndrom (PTS). Zur Vermeidung eines PTS kann in Einzelfällen eine chirurgische Thrombektomie oder eine interventionelle Rekanalisierung in Betracht gezogen werden. Ziel unserer Studie war die Untersuchung der Effektivität der frühzeitigen Intervention mittels ultraschallassistierter Katheterthrombolyse (UACDT) mit dem EKOS EndoWave Katheter im Langzeitverlauf. Methodik In einer monozentrischen retrospektiven Studie wurden 42 Patienten (49,9 ± 18,1 Jahre) nachuntersucht, die zwischen Juli 2011 und November 2019 mit einer UACDT bei iliofemoraler Thrombose behandelt wurden. Primäre Endpunkte waren die PTS-Rate gemessen anhand der Villalta-Skala sowie die Erhebung der krankheitsspezifischen Lebensqualität anhand des VEINS-QOL. Ergebnisse Bei 40 Patienten (95,2 %) konnte primär erfolgreich eine Rekanalisierung der Beckenetage bei einer durchschnittlichen Lyse-Dauer von 56,5 (SD ± 17,2) Stunden erreicht werden. Es wurden 22 Patienten (52,4 %) nach einem mittleren Beobachtungszeitraum von 50,4 Monaten (± 30,9) nachuntersucht. Die PTS-Rate lag insgesamt bei 27,3 % (6 Patienten). Das Venensystem zeigte sich in der Duplexsonographie bei 80 % der nachuntersuchten Patienten durchgängig. Schlussfolgerung Die UACDT als frühe thrombusbeseitigende Maßnahme bei proximaler DVT zeigt eine niedrige PTS-Rate im Langzeitverlauf und kann die krankheitsspezifische Lebensqualität dieser Patienten verbessern. Sie ist aber mit einem Risiko der Blutungskomplikation assoziiert, sodass die Indikationsstellung weiterhin kritisch gestellt werden sollte.

Risk factors of moderate to severe post-thrombotic syndrome within 2 years in patients with subacute thrombosis: A case-control study

ObjectiveThe aim of this study was to study the risk factors influencing the occurrence of moderate to severe post-thrombotic syndrome (PTS) within 2 years in patients with subacute lower extremity deep vein thrombosis (DVT). MethodsSeventy patients who developed moderate to severe PTS within 2 years after subacute lower extremity DVT from June 2018 to June 2022 were retrospectively selected as the case group. They were matched 1:1 by sex and age (±5 years) with 70 patients who did not develop moderate to severe PTS during the same follow-up period as the control group. Multiple logistic regression, stratified analysis, and interaction analyses were used to explore the risk factors for moderate to severe PTS. ResultsThe multiple logistic regression model showed that patients with iliofemoral vein thrombosis had a significantly increased risk of developing moderate to severe PTS within 2 years. Patients who underwent intraluminal intervention treatment during hospitalization had a significantly reduced risk. The odds ratios were 4.000 (95% confidence interval, 1.597-10.016) for the femoral-popliteal vein thrombosis and 0.262 (95% confidence interval, 0.106-0.647) for the anticoagulation treatment group. The stratified analysis showed that intraluminal intervention treatment was a protective factor against moderate to severe PTS within 2 years across different strata of hypertension, thrombus type, body mass index, duration of anticoagulation, and wearing compression stockings. Additionally, there was an interaction between thrombus type and treatment method, with intraluminal intervention treatment having a more pronounced effect on preventing moderate to severe PTS in patients with iliofemoral vein thrombosis. ConclusionsIliofemoral vein thrombosis is a risk factor for the development of moderate to severe PTS within 2 years in patients with subacute lower extremity DVT. Intraluminal intervention treatment can reduce the risk of moderate to severe PTS, especially in patients with iliofemoral vein thrombosis.

Effectiveness and Safety of Early Versus Routine Switching from Low-Molecular-Weight Heparin to Maintenance Therapy of Rivaroxaban for Acute Iliofemoral Vein Thrombosis: A Retrospective Cohort Study

The anticoagulation strategy of switching to rivaroxaban after 1week of initial low-molecular-weight heparin (LMWH) therapy is recommended by a guideline for the treatment of acute iliofemoral deep vein thrombosis (DVT). However, the initial rivaroxaban dose in the switching strategy, as well as the effectiveness and safety of the early switching (less than 1week) to rivaroxaban, remain inadequately substantiated. We aimed to evaluate the effectiveness and safety of early switching from LMWH to maintenance therapy of rivaroxaban (20mg once daily) for acute iliofemoral DVT. A retrospective cohort study was conducted using data from patients with acute iliofemoral DVT who received initial LMWH anticoagulation followed by rivaroxaban maintenance therapy. The clinical outcomes were compared between early (LMWH course ≤7days) and routine (LMWH course >7days) switching strategies within 3months of initiating anticoagulation. 217 patients were included, 59 (27.2%) receiving early switching and 158 (72.8%) receiving routine switching. Compared with routine switching, patients with early switching had a significantly shorter hospital stay (7days vs. 14days, P<0.001). The length of hospital stay was significantly positively correlated with the duration of LMWH (r=0.762, P<0.001). The incidences of recurrent venous thromboembolism (5.1% vs. 2.5%, P=0.606), major bleeding (0% vs. 1.9%, P=0.564), clinically relevant nonmajor bleeding (1.7% vs. 2.5%, P=1.000) and all-cause mortality (6.8% vs. 2.5%, P=0.283) were not statistically different between the 2 groups. Direct early switching from LMWH to maintenance therapy of rivaroxaban is effective and safe for acute iliofemoral DVT.

Multimodal Approach for the Treatment of Extensive Bilateral Iliofemoral Deep Vein Thrombosis

Abstract Iliofemoral vein thrombosis is the primary cause of deep vein thrombosis (DVTs) in the lower extremities in around 25% of the cases. Restoration of venous outflow is the primary goal in the management of DVT which can be achieved by combined endovascular techniques such as balloon venoplasty and/or stenting, thrombectomy, and pharmacomechanical thrombolysis. At presently, percutaneous mechanical thrombectomy (PMT) devices, such as rheolytic thrombectomy device, are replacing conventional approaches for clot removal. Although the use of rheolytic thrombectomy device for DVT is associated with the risk of intravascular hemolysis, we report a safe and successful use of multimodal approach using rheolytic thrombolytic device for the management of a case of bilateral iliofemoral DVT. In our study, we noticed early relief in pain and reduced lower limb edema in a week with a reduced dose of thrombolytic agent and hospital stay in a 44-year-old male who was admitted with bilateral extensive iliofemoral DVT using a multimodal approach.

Гибридная операция при остром тромбозе артерий подвздошно-бедренного сегмента (клиническое наблюдение)

Гибридная операция при остром тромбозе артерий подвздошно-бедренного сегмента (клиническое наблюдение)

A systematic review and meta-analysis of risk prediction models for post-thrombotic syndrome in patients with deep vein thrombosis

ObjectiveThis systematic review and meta-analysis aimed to systematically evaluate the prediction models for the risk of post-thrombotic syndrome (PTS) in deep vein thrombosis (DVT) patients. MethodsThis systematic review and meta-analysis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A systematic search on the following electronic database: PubMed/MEDLINE, EMBASE, and Cochrane Library, and Chinese databases such as WANFANG and CNKI was conducted to look for relevant articles based on the research question. The risk of bias for each studies included was carried out based on Prediction Model Risk of Bias Assessment Tool (PROBAST). ResultsWe identified 10 studies that developed a total of 13 clinical prediction models for PTS risk in DVT patients, 3 models were externally validated, 2 models were temporally validated. The top 5 predictors were: BMI (N = 9), Varicose vein (N = 6), Baseline Villalta Score (N = 6), Iliofemoral thrombosis (N = 5), and Age (N = 4). The high risk of bias was from the analysis domain, which the number of participants and selection of predictors often did not meet the requirements of PROBAST. A random-effects meta-analysis of C-statistics was conducted, the pooled discrimination was C-statistic 0.75, 95%CI (0.69, 0.81). ConclusionAmong the 13 PTS risk prediction models reported in this study, no prediction model has been applied to clinical practice due to the lack of external validation. In the development of prediction models, most models were not standardized in data analysis. It is recommended that future studies on the design and implementation of prediction models refer to Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) and PROBAST.

Practice patterns in the management of pediatric iliofemoral arterial thrombosis

BackgroundAcute arterial thrombosis can be life- and limb-threatening. Most pediatric patients with iliofemoral arterial thrombosis are treated successfully with medical therapy; however, expert consensus is limited, and many recommendations are based on the extrapolation of adult data. We aim to understand treatment patterns and long-term outcomes after pediatric acute iliofemoral arterial thrombosis, from which management recommendations can be informed. MethodsA single-institution retrospective study of pediatric patients diagnosed with iliofemoral arterial thrombosis from 2009 to 2018 was performed. Multiple parameters of management and follow-up were evaluated. Children anticoagulated for ≤28 days versus >28 days were compared. Data analysis used Fisher exact and Mann-Whitney U tests. ResultsTwo hundred thirty-six children were included. Median age at diagnosis was 65 days (interquartile range 17–163), with 207 diagnosed as infants, 15 diagnosed between 1 to 2 years, and 14 diagnosed between 2 to 16 years. The median treatment duration was 28 days (interquartile range 13–42); patients treated for >28 days had a longer time for thrombus resolution, and more follow-up ultrasounds were performed. Limb length discrepancy did not differ between the groups (1.0% vs 6.3%, P = .06), and no patients were documented to have developed peripheral arterial disease over a median 6.5-year follow-up. Multiple treatment strategies were employed, the most common being heparin bridged to enoxaparin (25.0%) and enoxaparin monotherapy (21.6%). Eight patients (3.4%) underwent surgical intervention. ConclusionPediatric iliofemoral arterial thrombosis is primarily a disease of infants treated adequately with heparin or enoxaparin, infrequently requires surgical intervention, and is rarely associated with long-term complications. When guided by thrombus resolution on ultrasound, a four-week or shorter course of anticoagulation does not increase the need for surgical intervention or long-term complications.

A DIFFERENTIATED APPROACH IN THE TREATMENT OF ACUTE FLOATING VENOUS THROMBOSIS OF THE INFERIOR VENA CAVA SYSTEM

We analyzed the results of surgical treatment floating DVT. Unfortunately, there are no randomized studies in the world regarding the determination of clear tactical approaches to the treatment of floating venous thrombosis, in many cases doctors make decisions about the choice of surgical tactics based on their own experience. In our research, we tried to systematize our own experience and form the basic principles of determining surgical tactics in the treatment of floating venous thrombosis. To date, anticoagulants, surgical interventions in the form of thrombectomy, and thrombolytic therapy are used in the treatment of DVT. Unfortunately, at the moment, no consensuses clearly define the issues of surgical treatment of floating venous thrombosis, venous thrombosis in pregnant women, venous thrombosis complicated by pulmonary embolism, venous thromboembolism.&#x0D; The goal. The aim of the research was to develop a surgical tactics in the treatment of floating DVT of the inferior vena cava.&#x0D; Materials and methods. The treatment of 76 patients with floating DVT from 2008 to 2020 were analyzed.&#x0D; In a research among patients with floating DVT in 15(20%) patients experienced thrombosis of the inferior vena cava, 19(25%) patients had ilio-femoral thrombosis in 17(22%) patients with femoral - popliteal thrombosis in 9(12%) patients with popliteal - tibial.&#x0D; Deep vein thrombosis complicated by pulmonary embolism with medium and high risk of death was observed in 10 (13%) patients. Among them, floating thrombosis of the iliac-femoral segment was observed in 4 patients.&#x0D; Floating thrombosis of deep veins in pregnant women was observed in 6 (8%) patients.&#x0D; Among patients, 20 (296%) patients were admitted within 1 day of the onset of the disease, 30 (39%) patients on 2-3 days, 11 (14%) patients on 4-7 days, 8 on 8-14 days (11%) patients, from the 15th day - 7 (10%) patients).&#x0D; The results. Patients with long of floating part of the more than 4 cm, we used an active surgical tactics. In the presence of the floating thrombus a total iliac vein thrombectomy we performed in 12 patients with the removal of the floating thrombus with femoral access. For the prevention of pulmonary embolism in these cases we implanted a temporary cava-filter. When flotation thrombus in the external iliac vein, we used the technique of thrombectomy using Fogarty two catheters in 12 patients. When flotation clots in common femoral vein and distally using a vein thrombectomy with clamping head above floating thrombus. When treating patients with floating DVT, pulmonary embolism complicated with medium and high risk of death, we used systemic thrombolysis with pre- implantation temporary coffee filter in patients with floating DVT, pulmonary embolism complicated with medium and high risk of death, we used systemic thrombolysis with pre- implantation temporary coffee filter. In the presence of pregnancy and floating thrombosis thrombectomy was performed with the removal of the thrombus floating. In our research, when performing the surgical treatment of DVT no cases of pulmonary embolism during or after treatment were observed. In 100 % of patients after treatment has been a clinical improvement in all cases floating DVT was eliminated floating nature of the danger of thrombosis and pulmonary embolism.&#x0D; Conclusions. In the presence of a floating DVT of the inferior vena cava system with a length of the floating part of the thrombus greater than 4 cm, it is necessary to use an active strategy of thrombus removal. When performing thrombectomy, it is necessary to use methods of surgical prevention of PE, taking into account the localization of the floating part.

Unusual presentation of extended iliofemoral deep vein thrombosis caused by giant retroperitoneal abscess: a rare case report.

In this report, the authors present a case of an extended iliofemoral vein thrombosis caused by a giant retroperitoneal abscess (RA) in a 50-year-old woman with underlying type 2 diabetes mellitus, presenting with painful left leg swelling and fever. Color venous Doppler ultrasonography and computed tomography scan of the abdomen and pelvis findings were compatible with a left voluminous RA compressing the left iliofemoral vein with an extended deep vein thrombosis. The mass effect on the venous system is rare in RAs, but it must be kept in mind. In light of this case and literature review, the authors highlight the diagnosis and management difficulties in handling this unusual presentation form of a RA.

Iliofemoral thrombosis in a patient with recurrent nephrotic syndrome

Nephrotic syndrome is one of the most common glomerulopathies in children, accompanied by a high risk of thrombosis due to hypoalbuminemia, hypovolemia, hyperlipidemia, hyperfibrinogenemia, and antithrombin III deficiency. The article describes a clinical case of iliofemoral thrombosis in a 16-year-old boy with recurrent nephrotic syndrome and primary thrombophilia (heterozygote F5 — Leiden mutation) was diagnosed. The presented clinical observation indicates the multifactorial origin of thrombotic complications in nephrotic syndrome, caused by a combination of an imbalance between the proand anticoagulant components of the blood coagulation system and individual risk factors (severity of proteinuria, hypoalbuminemia, comorbidity, hereditary thrombophilia), and therefore further study is needed to determine the tactics of prevention and treatment.

Multi-factor analysis of failure for modified single-session Angiojet rheolytic thrombectomy in treatment of acute iliofemoral venous thrombosis from iliac vein compression syndrome.

To explore the risk factors of failure for modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval in the treatment of iliac vein compression with iliofemoral vein thrombosis. During September 2017 to September 2021, 278 patients with DVT were retrospectively analyzed and 203 were eligible for inclusion. All patients were tried to take modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval treatment. The perioperative factors were analyzed between groups: group 1-modified single-session therapy succeed, and group 2-modified single-session therapy failed. The high risk factors of failure group were evaluated by logistic regression analysis. 48 patients failed in modified single-session therapy, up to 23.64%. Single factor analysis indicated that there were five independent risk factors related with the failure (p < 0.05), including course of disease longer than 7days, lumbar degeneration-related iliac vein compression syndrome (dIVCS), antegrade vein access, balloon-assisted cracking thrombus, and suction time. Logistic regression analysis indicated that course of disease longer than 7days (OR = 19.642.95%CI:6.776∼56.933), dIVCS (OR = 11.586.95%CI:4.016∼33.427) were high risk factors for modified single-session therapy failed, antegrade vein access (OR = 0.171.95%CI:0.047∼0.614) and balloon-assisted cracking thrombus (OR = 0.157.95%CI:0.045∼0.542) were protective factors for therapy failure (p < 0.05). Long course of disease and dIVCS are the high risk factors for failure of modified single-session Angiojet rheolytic thrombectomy combined with directed iliac vein stenting, directed filter retrieval in the treatment of iliac vein compression syndrome (IVCS). But, antegrade vein access and balloon-assisted cracking thrombus intraoperatively may improve the success rate of modified single-session treatment.

Endovascular Thrombus Removal for Treating Post-Partum Iliofemoral Deep Vein Thrombosis: A Single-Centre Retrospective Cohort Study.

To evaluate the safety and efficacy of percutaneous thrombectomy for treating postpartum iliofemoral vein thrombosis. A retrospective analysis was performed on patients with continuous postpartum acute symptomatic iliofemoral deep vein thrombosis who were treated in our center, including all patients who underwent pharmacomechanical thrombolysis (PMT) or only catheter-directed thrombolysis (CDT) (study group), and patients that received simple anticoagulation treatment (control group). We evaluated the incidence of lower extremity postthrombotic syndrome, recanalization rate of lower extremity veins, and complications in the study and control groups. Overall, 72 postpartum women were included in this study, including the PMT combined with CDT group (14 cases, 15 limbs), CDT alone group (26 cases, 27 limbs), and anticoagulant therapy alone group (32 cases, 34 limbs). The thrombectomy group completed the treatment with a technical success rate of 100%, and no serious bleeding complications occurred. The patency rate of lower limb veins in the thrombectomy group was 85.09 ± 16.51% after treatment and 82.60 ± 21.45% after 1 year. At the 1-year follow-up, the Villalta score in the study group was lower (1.90 ± 2.45 vs 8.50 ± 5.33, P < .001), and the incidence of postthrombotic syndrome was significantly different between the groups (17.50% in the study group vs 68.75% in the anticoagulant group, P < .001). Lower extremity venous thrombectomy is a safe and effective treatment for postpartum iliofemoral venous thrombosis. It can improve the patency rate of lower extremity veins and reduce the incidence of postthrombotic syndrome compared with anticoagulation alone.

A clinical case report: stroke in a young patient with systemic lupus erythematosus on the background of secondary antiphospholipid syndrome

The article describes a clinical case report of a young patient with ischemic stroke on the background of antiphospholipid syndrome (APLS). The uniqueness of this case lies in the complex diagnostic search that we performed. On admission, the patient had general cerebral, general infectious and focal syndromes. We suspected encephalitis due to the peculiarities of the onset of the disease and the results of computed tomography. However, after the results of lumbar puncture, the diagnosis of encephalitis required careful differential diagnosis. We performed an extensive diagnostic search. Based on clinical-laboratory, instrumental and immunological data the patient had the following final diagnosis: “Ischemic cardioembolic stroke in the right middle cerebral artery pool (15.10.17) (ICD 11: 8B11.5). Acute period with left pyramidal reflex insufficiency and changes in magnetic resonance imaging. Systemic lupus erythematous (ICD 11: 4A40.0), subacute course, activity II, with the lesion of skin (transient erythematous rash), kidneys (proteinuria, transient impaired renal function), lungs (bilateral pleurisy with immunological disorders). Secondary APLS (ICD 11: 4A45) (Acute iliofemoral thrombosis, May 2017; chronic thrombosis of the inferior vena cava, iliac veins, positive IgG to cardiolipin, beta 2 glycoproteins). Thus, we have to link thrombotic complications in young patients with APLS and to examine the patients for antiphospholipid antibody presence.

Treatment of Bilateral Venous Thrombosis in a Patient with Aplasia of the Inferior Vena Cava

The aim. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients.&#x0D; Materials and methods. Patient B., a 36-year-old man, applied to the vascular surgery clinic of the Vinnytsia Regional Pyrohov Clinical Hospital in July 2010 with complaints of pain, swelling, cyanosis of both lower extremities, which bothered the patient for about 10 days. The patient had no history of venous insufficiency of both lower extremities.&#x0D; An objective examination revealed cyanosis and swelling of both lower extremities.&#x0D; A duplex scan of both lower extremities revealed hyperechoic iliofemoral thrombosis of both lower extremities. Aplasia of the IVC was diagnosed. The common iliac veins on both sides formed a collateral that flowed into the left renal vein. The infrarenal segment of the inferior vena cava was absent. Thrombosis spread from tibial to popliteal, femoral, iliac veins with venous collateral thrombosis up to the level of the left renal vein.&#x0D; The patient received enoxaparin at a dose of 1 mg per kg of body weight twice a day for 7 days with subsequent transition to warfarin under the control of international normalized ratio. Warfarin was prescribed from a starting dose of 5 mg with subsequent control of international normalized ratio in the range of 2.0-3.0. Venotonic and anti-inflammatory drugs were also prescribed. In combination with drug therapy, class 2 elastic compression stockings were recommended.&#x0D; After the treatment, the patient’s condition improved, swelling and cyanosis of both lower extremities regressed. Repeated duplex scanning at the discharge of the patient from the hospital after 7 days showed signs of initial recanalization of the affected venous segments and no progression of thrombosis.&#x0D; Conclusions. Thus, this clinical case showed that the use of anticoagulant therapy allows to obtain satisfactory results in the treatment of patients with congenital anomalies of the development of IVC, to avoid the development of pulmonary embolism and other life-threatening conditions. At the same time, such patients need regular follow-up examinations in order to adjust the treatment and prevent the development of IVC syndrome.

Conservative treatment vs thrombus removal for Iliofemoral vein thrombosis in patients with congenital abnormalities of the inferior vena cava: a case report and systematic review of the literature

Congenital abnormalities of the Inferior Vena Cava (IVC) should be suspected in cases of Deep Venous Thrombosis (DVT), especially in young patients, with no other risk factors and apparent causes. Currently, there is no guidance regarding the management of such patients. We report a case of Iliofemoral vein thrombosis in a young patient with congenital absence of the IVC that was successfully treated with catheter-directed thrombolysis (CDT) and perform a systematic review of the literature to identify evidence about the epidemiology, clinical presentation, management, and prognosis of this rare cause of DVT. A total of 42 studies reporting on 56 cases were included in the review. The mean age of the patients at the presentation of their first DVT episode is 23.6years, 83.9% of patients were males, conservative management with anticoagulation was used in 68% of the reported cases, and thrombolysis was used in 32% of the cases. Only 10.7% of patients presented with PE potentially justified by the abnormal anatomy of the deep veins which makes the propagation of thrombi into the pulmonary arteries less possible. Comparing the long-term outcomes of the two treatment groups; 42.3% of the patients treated conservatively vs 15.4% of the patients treated with thrombolysis developed chronic symptoms (residual heaviness, pain, swelling, and cramping). 11.5% of patients who received conservative treatment developed post-thrombotic syndrome. None of the patients treated with thrombolysis developed post-thrombotic syndrome. There were no procedure-related complications and thrombolysis was well tolerated by the entirety of the thrombolysis treatment group. Recurrence of DVT occurred in 13% of the patients treated conservatively and in 7.7% of patients treated with thrombolysis. Thrombus removal by means of thrombolysis is the recommended treatment and can offer excellent short and long-term results. Anticoagulation with NOACs may be prescribed for life to prevent recurrence or for at least 6months and then reconsidered following further evaluation of patients' bleeding risk. It may be of value to organise an international registry for such patients. Guidelines issued by the relevant scientific societies will then be able to make a clear recommendation about the management of such patients.

Acute left iliofemoral vein thrombosis: Comparison between simple and bony May-Thurner syndrome in CT venography.

To explore the etiology of May-Thurner syndrome (MTS) with acute iliofemoral deep vein thrombosis (DVT) regarding imaging findings and clinical features. We retrospectively analyzed 57 patients with acute left iliofemoral DVT from 2015 to 2020. The diameter of left common iliac vein (LCIV) at the maximal compression site and its percent compression regarding the average diameter of the uncompressed iliac vein were recorded in central and distal portions of the LCIV according to the location in the quadrant of lumbar vertebral body. Compression was categorized into simple and bony MTS; Simple MTS as LCIV compressed by the right common iliac artery (RCIA) versus Bony MTS as LCIV by lower lumbar degenerative changes regardless of RCIA compression. Initial computed tomographic venography (CTV) regarding chronic change of LCIV such as fibrotic atrophy or cordlike obliteration, extent of thrombus, and lumbar degenerative changes were evaluated. Therapeutic effect after initial therapy was assessed in follow-up CTVs after 3-6months. All patients showed LCIV compression with 19 simple MTS (mean age, 42.8 ± 14.1years [23-67years]; 12 females; symptom for 4.4 ± 5.5days) and 38 bony MTS (mean age, 73.0 ± 10.2years [49-85years]; 26 females; symptom for 5.5 ± 4.8days). There was significant difference in age (p < .001) and no significant difference in sex or symptom duration between two groups (p = .691 and 0.415, respectively). All simple MTS showed compression only in the central LCIV and half of bony MTS showed compression in both central and distal LCIV (p < .001). Among the lumbar degenerative changes, symmetric anterolateral osteophyte (p < .001) and asymmetric osteophyte (p < .001) were significantly associated with bony MTS, but not scoliosis (p = .799), compared to simple MTS. Although there was no significant difference in chronic change of LCIV, thrombosis extent, and therapeutic effect between two groups (p > .05), chronic change of LCIV showed significant difference between single and dual compression (23.7% vs. 57.9%, p = .024) and residual thrombus after initial therapy was occurred in 21.1% of single compression and 47.4% in dual compression with non-significant trend (p = .082). Bony MTS related to lumbar degenerative changes with acute iliofemoral DVT occurs in older patients, presenting more than one stenosis at LCIV, inducing more chronic change with possibly weaker therapeutic effect than simple MTS.

Acute Deep Vein Thrombosis Involving the Inferior Vena Cava: Interventional Perspectives

Extension of an iliofemoral thrombosis into the inferior vena cava (IVC), or from the IVC descending into the iliofemoral segments, can confer significant morbidity and mortality. Interventional management of acute deep vein thrombosis (DVT) has been controversial, but there is little doubt that certain subpopulations benefit, such as those with symptomatic IVC thrombosis. When considering an intervention, caval involvement introduces technical difficulties due to its larger diameter, high thrombus burden, bilateral limb clot extension and need for dual access. The frequent coexistence of an IVC filter increases the complexity even more. This review summarises the current indications and treatment modalities available for the management of acute DVT involving the vena cava.