Subacute Deep Venous Thrombosis Research Articles

Shear wave elastography values of thrombus in patients with lower extremity deep vein thrombosis for pulmonary embolism detection: the ROC analysis

Rationale: Thrombosis of the iliac (IV) and femoral veins (FV) is one of the most common causes of pulmonary embolism (PE). Modern ultrasound scanners are equipped with the technology of shear wave elastography, which gives a quantitative assessment of thrombus stiffness by Young's modulus reconstruction. However, the lack of convincing data on the role of thrombus stiffness for clinical manifestations of PE hinders the active use of shear wave elastography to diagnose the risk of embolism.
 Aim: To determine the threshold values of the venous thrombus Young’s modulus for deep venous thrombosis (DVT) of the lower extremities complicated by massive PE and/or PE with acute cor pulmonale (ACP).
 Materials and methods: This was a single center cross-sectional study in 101 patients who were hospitalized with the diagnosis of acute (duration of less than 2 weeks) or subacute (from 2 weeks to 3 months) IV and FV thrombosis. Doppler ultrasound of the lower extremity veins and echocardiography were done in all patients. Forty eight patients with clinical signs of PE had chest computed tomography. The venous thrombus stiffness was assessed by shear wave elastography with the Young's modulus reconstruction. We performed the ROC analysis for mean values of the Young's modulus for proximal segments of IV and FV thrombi in patients with DVT and massive PE and ACP.
 Results: PE was diagnosed in 40.6% (26/64) of the patients hospitalized with acute DVT and in 54.1% (20/37) of those with subacute DVT. Echocardiographic signs of ACP in massive PE were found in 47.4% (9/19) of the patients, in submassive and minor PE in 55.6% (15/27). In DVT complicated with PE, the ROC analysis of the shear wave elastography results gave the following threshold values of the mean Young’s modulus for the proximal thrombus segment: for acute IV thrombosis + PE and ACP, ≤ 16.7 kPa (AUC 0.714, sensitivity 100%, specificity 42.1%), in subacute IV thrombosis + PE and APC, ≤ 23.7 kPa (0.939, 100 and 90.9%, respectively), in acute FV thrombosis + massive PE, ≥ 9.5 kPa (0.706, 100 and 50%, respectively), in subacute FV thrombosis + massive PE, ≥ 24.4 kPa (0.550, 60.0 and 68.8%, respectively).
 Conclusion: Shear wave elastography of deep vein thrombi of the lower extremities makes it possible to identify patients with PE and ACP during acute and subacute IV thrombosis and to determine massive PE in acute FV thrombosis.

Clinical efficacy of ZelanteDVT™ catheter rheolytic thrombectomy in the single-session treatment of patients with subacute deep venous thrombosis.

To evaluate the clinical efficacy and safety of novel ZelanteDVT™ catheter rheolytic thrombectomy in the single-session endovascular management of subacute deep venous thrombosis (DVT). A retrospective study was performed on 31 patients with subacute DVT who underwent ZelanteDVT™ catheter rheolytic thrombectomy. Procedure data, associated complications, and venous patency score were recorded. The deep venous patency and post-thrombotic syndrome (PTS) rate were assessed in all patients during follow-up visits. After procedure, 19.4% (6/31) patients improved to grade III thrombus removal, while the remaining patients improved to grade II. Significant iliac vein compression syndrome was identified in 54.8% (17/31) patients, and 82.4% (14/17) of them received stent implantation. No serious procedure-related complications occurred. The median follow-up time was 13months. The primary patency rate at 12months was 83.87%, and the incidence of PTS was 19.35%. This novel rheological thrombectomy catheter seems to have a promising application prospect for single-session treatment of subacute DVT.

Endovascular Porcine Model of Iliocaval Venous Thrombosis

To develop a large animal model of iliocaval deep venous thrombosis (DVT), which enables development and evaluation of interventional management and existing imaging modalities. The experimental protocol consisted of a total endovascular approach. Pigs were percutaneously accessed through the right internal jugular and bilateral femoral veins. Three balloon catheters were inflated to induce venous stasis in the infrarenal inferior vena cava (IVC) and bilateral common iliac veins (CIVs). Hypercoagulability was induced by injecting 10 000 IU of thrombin. After 2.5 hours, the balloon catheters were removed before animal recovery. After seven, 14, 21, 28, or 35 days, animals were euthanised; the IVC and CIV were harvested en bloc, cross sectioned and prepared for histological examination. Multimodal imaging was performed before and after thrombus creation, and before animal euthanasia. Thirteen female domestic pigs with a mean weight of 59.3 kilograms were used. The mean maximum IVC diameter and area were 16.4 mm and 1.2 cm2, respectively. The procedure was successful in 12 animals with occlusive venous thrombosis in the region of interest on immediate post-operative magnetic resonance venography and a mean thrombus volume of 19.8 cm3. Clinical pathology results showed platelet consumption, D dimer increase, and inflammatory response. Histological evaluation demonstrated a red cell, fibrin, and platelet rich thrombus on day 1, with progressive inflammatory cell infiltration from day 7. Collagen deposition appeared in week 2 and neovascularisation in week 3. Endovascular occlusion combined with thrombin infusion is a reliable minimally invasive approach to produce acute and subacute DVT in a large animal model.

Efficacy of Shear Wave Elastography in the Differentiation of Acute and Subacute Deep Venous Thrombosis.

It is important to know the age of clot formation to determine an appropriate treatment for deep vein thrombosis (DVT). The present study aims to differentiate between acute and subacute DVT using the shear wave elastography (SWE) technique. Patients with complaints no longer than 4 weeks and who were found to have early-stage (acute-subacute) thrombus on ultrasound (US) between January 2020 and May 2020 were included in the study. All of the patients underwent SWE using a Philips Healthcare EPIQ 5 Ultrasound System Inc. device with a high-resolution linear US probe (eL18-4, 22-2 MHz). Included in the study were 50 patients, including 23 with acute DVT and 27 with subacute DVT. Of the patients, 22 were women and 28 were men, and the mean age was 46.32 ± 11.33 years (range: 24-74 years). The mean SWE value was 2.63± 0.16 (2.39-2.96) in patients with acute DVT and 3.34± 0.31 (2.65-3.88) in patients with subacute DVT. The findings were statistically significant in the comparison of the 2 groups using an independent samples t test (P < 0.001). In the receiver operating characteristic analysis, the area under the curve was found to be 97.6%. When the cutoff value was taken as 2.85 according to the area under the curve, sensitivity was found to be 96.3%, and specificity was 91.3%. Thrombus stage plays a critical role in treatment decisions in DVT in the lower extremities. The present study reveals that the shear wave US elastography technique can be used to discriminate between acute and subacute DVT.

Interval Results of Totally Percutaneous Approach for Creation of Large Animal Long Segment Iliac Deep Venous Thrombosis

Large animal deep venous thrombosis models are essential for testing of drugs and devices. Published criteria for ideal animal models include the following: minimally invasive, reproducible, and utilize similar size vessels to human. A common shortcoming is inadequate length of thrombus for assessment of efficacy and safety of interventions. There is no published subacute deep venous thrombosis model that currently meets these criteria.

Feasibility of anticoagulation using low molecular-weight heparin during catheter-directed thrombolysis for lower extremity deep venous thrombosis

BackgroundThe optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular-weight heparin (LMWH) during CDT for DVT.MethodsThe clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.ResultsA total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) × 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) × 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (> 90%) and partial thrombolysis (50 ~ 90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant differences in baseline characteristics, clinical improvement, thrombolysis results, and complications.ConclusionsAnticoagulation therapy using low molecular-weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

Effects of pharmacomechanical therapy on late complications in deep venous thrombosis

Introduction: We investigated the effects of pharmacomechanical therapy (PMT) on post-thrombotic syndrome; which is a late complication in patients with acute and subacute iliofemoral deep venous thrombosis (DVT). Method: A total of 25 (14 males, 11 females) patients; who were diagnosed with acute and subacute iliofemoral DVT and treated in the cardiovascular surgery clinic of Elaz?? Training and Research Hospital from September 2016 to November 2018, were evaluated retrospectively by using data in the hospital's digital archiving system. The effects of PMT applied to the patients were evaluated on the development of post-thrombotic syndrome and venous reflux as the late complications. Results: No complications occurred in patients during the intervention and therapeutic processes. After the treatment, patency and flow were achieved in 92% of the patients and significant reductions in the subjective complaints were observed in 88% of the patients. Maintained patency ratios of 92%, 84%, and 80% were confirmed in the first month, the first year, and the second year, respectively, by venous doppler ultrasonography. Post-thrombotic syndrome did not develop in 80% of the patients clinically. Discussion: We suggest that PMT is a favourable treatment option for the prevention of the development of post-thrombotic syndrome and venous reflux as the late complications in acute and subacute proximal DVT patients.

LARGE SADDLE PULMONARY EMBOLUS IN AN ASYMPTOMATIC PATIENT

SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary embolism (PE) represents a mechanical obstruction of one or more branches of the pulmonary vasculature, usually due to a blood clot. Saddle PE lodges at the bifurcation of the main pulmonary artery, often extending into the right and left main pulmonary arteries. Approximately 3 to 6 percent of patients with PE present with a saddle embolus. We report an atypical case of asymptomatic large saddle PE with normal right heart function. CASE PRESENTATION: A 47-year-old male with history of diabetes, OSA, hypertension, obesity and family history of Factor V Leiden mutation presented with 1-day history of progressively worsening left leg pain and swelling. He denied any fevers, chills, SOB, cough or palpitations, recent surgery, or long car rides. On physical examination, the patient was comfortable, alert and oriented, afebrile, respiratory rate 21/minute, saturating 97% on room air. Laboratory workup was insignificant. EKG showed sinus tachycardia. Venous scan of left lower extremity revealed subacute deep venous thrombosis (DVT) involving the left femoral and popliteal veins. CT pulmonary angiography (CTPA) revealed extensive bilateral pulmonary emboli with large saddle. 2D ECHO revealed normal left ventricle (LV) systolic function with ejection fraction >55% and normal right ventricle (RV) size and function. Patient was started on heparin drip and switched to Eliquis. He was discharged home in a stable condition. DISCUSSION: Saddle PE is a radiologic definition and refers to thrombus that straddles the bifurcation of the pulmonary artery trunk. Saddle PE is found in 2.6% to 5.4% of patients with PE.1,2 Patients with saddle PE presented more frequently with concurrent DVT on hospital admission (75%).3 The presenting symptoms are dyspnea (72%), syncope (43%). Our patient presented with progressive left leg swelling and pain with DVT and no respiratory symptoms. Alkinj et al in 20172 had reported that 18% of patients with saddle PE had normal RV systolic function. One third patients had hemodynamic instability fulfilling the definition of massive PE unlike in our patient. Our patient was hemodynamically stable and had normal RV function, the risk of bleeding outweighed the benefits of fibrinolytic therapy, therefore this patient was managed with conventional treatment. CONCLUSIONS: Despite looking sinister in appearance on imaging studies, patients with saddle pulmonary embolus may be nearly asymptomatic, hemodynamically stable and can be successfully managed with conventional treatment. Reference #1: Ryu JH, Pellikka PA, Froehling DA, Peters SG, Aughenbaugh GL.Saddle pulmonary embolism diagnosed by CT angiography: frequency,clinical features and outcome. Respir Med. 2007;101(7):1537-1542. Reference #2: Alkinj B, Pannu BS, Apala DR, Kotecha A, Kashyap R, Iyer VN. Saddle vs Nonsaddle Pulmonary Embolism: Clinical Presentation, Hemodynamics, Management, and Outcomes. Mayo Clin Proc. 2017;92(10):1511-1518. Reference #3: Girard P, Musset D, Parent F, Maitre S, Phlippoteau C, Simonneau G. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. Chest 1999;116:903-8. DISCLOSURES: No relevant relationships by Salil Avasthi, source=Web Response No relevant relationships by DEEPTI AVASTHI, source=Web Response No relevant relationships by Rathnavali Katragadda, source=Web Response No relevant relationships by Shanti Pittampalli, source=Web Response

Consensus among Chinese experts on standard interventional therapy for deep venous thrombosis of lower extremity (second edition)

This is an update on the first edition of the expert consensus. This document discusses the indications and contraindications of interventional treatment methods for deep venous thrombosis such as anticoagulation, catheter-directed thrombolysis, percutaneous mechanical thrombectomy, percutaneous transluminal angioplasty and stent implantation. The operational procedures, considerations, preoperative management, and prevention of complications were also updated, supplemented, and revised. Emphasis is placed on the interventional treatment of acute and subacute deep venous thrombosis to effectively reduce the incidence of post-thrombosis syndrome.

The Efficacy and Safety of AngioJet Rheolytic Thrombectomy in the Treatment of Subacute Deep Venous Thrombosis in Lower Extremity

The aim of this study is to examine the efficacy and safety of AngioJet rheolytic thrombectomy for the treatment of subacute deep venous thrombosis (DVT) in lower limbs. A retrospective study was performed on 90 patients with subacute DVT (15-90days) in lower limbs in our center from November 2015 to December 2016. In total, 27 patients with subacute DVT in lower limbs treated with AngioJet rheolytic thrombectomy were included in the study, including 17 men and 10 women. The onset time of thrombosis was between 15 and 75days. Five patients were diagnosed bilaterally; 5 patients were diagnosed in the right lower limb; and 17 patients were affected by thrombosis in left lower limb. All the 27 cases received AngioJet rheolytic thrombectomy. After AngioJet thrombectomy, 17 cases were improved to grade II (50-99%), and 10 cases were grade I (<50%). Nineteen cases were treated with subsequent catheter-directed thrombolysis (CDT), and the average time of thrombolysis was 3.2days, with an average urokinase administration dose of 7.32 million units. Among the 27 cases, 21 of them received iliac venous balloon dilation, with 10 of them being implanted with the iliac vein stent; 12 stents were implanted in total. Finally, the angiography suggested that 25 cases (92.6%) obtained a recanalization rate higher than grade II, and no serious complications occurred during the perioperative period. All patients were followed up regularly for 3 to 15months, and 2 patients died from malignant tumor during the follow-up period. Twenty-three cases were followed up for more than 6months; 17 cases finished 12-month follow-up. The primary patency rate at 6 and 12months was 96.3% and 88.9%, respectively. The Villalta score of postoperative postthrombosis syndrome symptom at 6 and 12months was 3.3±2.8 and 3.5±2.8, respectively. It is safe and feasible to use the AngioJet rheolytic thrombectomy in the treatment of subacute DVT in lower limbs. In patients without high risk of bleeding, combination of AngioJet thrombectomy and CDT is an effective treatment to reduce the thrombus volume.

Is real-time elastography helpful to differentiate acute from subacute deep venous thrombosis? A preliminary study.

To detect and characterize changes in stiffness of thrombus in patients with acute and subacute deep venous thrombosis (DVT) by using real-time elastography (RTE). Fifty-eight patients with acute or subacute DVT were prospectively evaluated by B-mode sonography (US), color Doppler US (CDUS), and RTE. Two radiologists evaluated the thrombus echogenicity, compressibility, and recanalization of the affected vein, and thrombus stiffness in consensus. The thrombi were classified into 3 groups as soft, intermediate, and hard on RTE images. The final study group consisted of 30 patients with acute DVT, among whom 10 were women (33%), and 19 patients with subacute DVT, among whom 6 were women (32%). The presence of hypoechoic thrombus, incompressible vein, and absence of recanalization on US and CDUS were significantly associated with acute DVT (P < .001 for all variables). The differences in elasticity pattern of the thrombi between acute and subacute DVT were not significant (P = .202). Venous thrombus hardens with age; however, elastography pattern on RTE, in its present form, may not be able to differentiate acute DVT from subacute DVT.

Early and long-term outcomes for postpartum deep vein thrombosis: the role of endovascular treatment

Objective To investigate the effect of endovascular treatment to initial and long-term outcomes of postpartum deep venous thrombosis (DVT) . Methods The clinical data, venography and 3-yaer follow up data of 30 female patients with acute or subacute deep vein thrombosis in the postpartum period who received endovascular therapy consisting of catheter-directed thrombolysis with angioplasty(stenting for some patients with iliac vein compression syndrome (IVCS)) were retrospectively evaluated. Clot removal was graded as grade Ⅲ(>95%), grade Ⅱ(50% to 95%), and grade Ⅰ(<50%). Grade Ⅱ, Ⅲ considered effective. Data from onset time, vaginal delivery or by elective, patients ages, IVCS or not and stenting or not were included in this analysis. And the χ2 test and survival analysis was used for statistical analysis of initial and long-term patency respectively. Results In 30 cases, the initial result included 14 cases(46.7%) of grade Ⅲ, 12 cases(40.0%) of grade Ⅱ and 4 cases(13.3%) of grade Ⅰ. Patients' onset time, vaginal delivery or by elective, patients ages and IVCS or not have no significant statistical difference to initial patency (χ2=0.88, 1.28, 1.15, 3.08, P>0.05) .For 18 patients with IVCS, there was significant statistical difference between patients implanting stents(initial patency was 100.0% (7/7) and whom not implanting stents(initial patency was 63.6% ,7/11) (χ2=5.14, P 0.05). Conclusions Endovascular therapy consisting of catheter-directed thrombolysis with angioplasty could be considered as a primary therapeutic procedure in patients with acute or subacute postpartum DVT. Stenting for treatment of iliac compression which contributed to postpartum DVT is very valuable to ensuring higher long-term patency rate. Key words: Venous thrombosis; Postpartum period; Radiology, interventional

Prevalence and Clinical Outcome of Free-Floating Thrombus Formation in Lower Extremity Deep Veins.

Most published guidelines for treatment of acute and subacute deep venous thrombosis (DVT) recommend early ambulation over initial bed rest. However, formation of free-floating thrombus in the lower extremity deep veins carries a high risk of fatal pulmonary embolism (PE) during ambulation. Furthermore, the natural history of free-floating thrombus in this patient population is not known. The purpose of this study was to identify the prevalence and outcome of free-floating thrombus among patients with acute DVT. Between January 2013 and December 2013, 427 patients were diagnosed as having DVT by compression ultrasound. The anatomic distributions of the thrombi were divided into iliofemoral, femoropopliteal, and calf DVT. The ultrasound features of the thrombi were classified as firmly or loosely attached and free-floating. PE was confirmed with computed tomography angiography. Among 427 patients with DVT, seven (1.7%) were found to have free-floating thrombus. The risk factors for DVT included recent knee surgery in two (28.5%), recent hip surgery in one (14.3%), immobilization in one (14.3%), malignant neoplasm in one (14.3%), hormone replacement therapy in one (14.3%), and stroke in one (14.3%). Initial treatment of these patients included bed rest and anticoagulation therapy. Two of these patients underwent temporary insertion of an inferior vena cava filter. The thrombus was located predominantly in the femoropopliteal segment (five patients, 71.4%), and the prevalence of femoropopliteal DVT was significantly higher in patients with free-floating thrombus than in those without (P = .0002). PE was found in three patients (42.9%), and the incidence of PE was significantly higher in patients who had free-floating thrombus than in those who did not (P = .0001). The free-floating thrombus resolved spontaneously in four patients (57.1%) within a mean period of 19 days. On the other hand, the thrombus became firmly attached to the vein wall in the remaining three patients (42.9%) within a mean period of 9 days, leading to secondary thrombus recanalization. No further thromboembolic complications were encountered in these patients. Although the prevalence of free-floating thrombus formation is low among patients with DVT, it can be detected by compression ultrasound in daily practice. Our data show that the natural history of free-floating thrombus treated by anticoagulation can be largely classified into two patterns: early spontaneous thrombus resolution and initial adhesion to the vein wall with secondary thrombus recanalization. Insertion of an inferior vena cava filter can be reserved for patients in whom anticoagulation is contraindicated.

8:27 AM Abstract No. 23 - Same day endovascular therapy for lower extremity deep venous thrombosis: technique and initial results

Treatment of deep venous thrombosis(DVT) using catheter-directed thrombolysis (CDT) has been limited by long procedure time and associated high costs, high doses of thrombolytics, and increased utilization of intensive ICU monitoring. The purpose of this study is to describe a single center technique of same day pharmacomechanical catheter-directed thrombolysis (PCDT) for lower extremity DVT. A single center retrospective review was performed on 39 consecutive patients (25 males and 14 females; mean age 51; range 18-84) treated with PDCT in a single day without ICU admission. Technique included power pulse spray with Angioget (Bayer Healthcare, Warrendale, PA) thrombectomy followed by short duration CDT and second session venoplasty and stenting. All patients received at least 6 months of anticoagulation and graded compression stockings post procedure. Data collected included: patient demographics, procedural technical success (defined as 1- the ability to successfully cross the occlusion and 2- restoration of flow to the IVC), major and minor adverse events up to 30 days, freedom from reintervention (FFR) as well as 1 and 6 month follow-up with ultrasound or clinical examination. 15 patients with acute DVT (<14 days), 8 patients with subacute DVT (14-28 days) and 17 patients with chronic DVT (>28 days) were treated. DVT location included: iliocaval (n=10), iliofemoral (n=23) and femoropopliteal (n=6). Technical success was achieved in all cases. FFR was 76%. Reintervention was successfully performed in 10/10 patients (100%). One and six month follow-up was obtained for 32/39 patients (82%) with 72% (23/32) and 56% (18/32) patency at 1 and 6 months, respectively. Adverse events were noted in 5 patients (13%) including breast hematoma, groin hematoma, rapid atrial fibrillation, contrast-induced nephropathy, and death (unrelated to the procedure). Same day PDCT without ICU admission for lower extremity DVT is feasible with high technical success and FFR. Adverse events are rare. Further studies are needed to demonstrate long-term vessel patency as well as reduction in the incidence of post-thrombotic syndrome.

A Prospective Randomized Trial of Catheter-Directed Thrombolysis With Additional Balloon Dilatation for Iliofemoral Deep Venous Thrombosis: A Single-Center Experience

Catheter-directed thrombolysis (CDT) is effective for acute iliofemoral deep venous thrombosis (DVT), but CDT remains partially effective for subacute DVT. The aim of this study was to conduct a prospective randomized controlled single-centre clinical trial to compare CDT alone with CDT with additional balloon dilatation for the treatment of iliofemoral DVT. The trial was performed between February 2007 and January 2011. Iliofemoral DVT patients lacking effective therapy before enrollment were randomly assigned either to CDT (control group) or to CDT with additional balloon dilatation (intervention group). Insufficiency Epidemiological and Economic Study-Quality of Life (VEINES-QOL), Severity of Venous Lower Limb Symptoms (VEINES-Sym), 36-Item Short-Form Health Survey (SF-36), and Villalta scores were obtained at scheduled follow-up. Seven hundred twenty-two patients were screened, and 386 eligible patients were randomized. No significant difference for mean total Villalta score was observed between the intervention group (4.20±3.05) and the control group (4.89±3.45). However, post hoc analysis of the scores in subacute patients showed significant differences between the intervention group and the control group from 1month (6.79±4.23, 8.28±5.03, P=0.02) to 24months (4.21±3.08, 5.67±3.71, P=0.006). A significant difference was also observed in subacute patients at the end of follow-up for VEINES-QOL/Sym (52.87±6.52, 50.31±6.07, P=0.009; 51.87±6.37, 49.72±5.96, P=0.02) and SF-36 PCS/MCS (45.02±12.07, 41.13±11.68, P=0.03; 53.26±11.43, 49.50±11.06, P=0.03). Subacute iliofemoral DVT patients lacking effective therapy during acute phase, might receive more benefits from CDT with additional balloon dilatation. However, CDT alone is highly effective for acute patients.

Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis using manual aspiration thrombectomy: long-term result of 139 patients from a single center

To evaluate the immediate and long-term outcomes of percutaneous manual aspiration thrombectomy with provisional stent placement in treating acute and subacute iliofemoral deep venous thrombosis (DVT). One hundred and thirty-nine consecutive patients (75 women; mean age, 51 years) with acute (n=110) or subacute (n=29) iliofemoral DVT underwent endovascular treatment (total of 148 limbs). All patients were treated with percutaneous manual aspiration thrombectomy by using large-bore guiding catheters with adjunctive catheter-directed thrombolysis and stent placement, if needed. Venography was used to grade thrombus removal. Thrombus removal was less than 50% in five limbs (3.4%), between 50% and 95% in 45 limbs (30.4%), and more than 95% in 98 limbs (66.2%). At least one stent was placed in 99 limbs. Recurrent thrombosis occurred in 27 patients, mostly during the first few months after the procedure. Rethromboses were more frequent among postpartum patients. One patient had a major pulmonary embolism. No major hemorrhage or procedure-related deaths occurred. Manual aspiration thrombectomy is a safe, rapid, and effective treatment option for acute and subacute iliofemoral DVT. Hence, catheter-directed thrombolysis may not be required in a majority of patients.

Combined thrombectomy and isolated limb perfusion with streptokinase in the treatment of deep venous thrombosis.

A new mode of treatment for extensive acute and subacute deep venous thrombosis of the lower extremities combines the beneficial effects of surgical thrombectomy and of thrombolysis with streptokinase during the course of a single surgical intervention. Rapid-flow regional perfusion is the vehicle used to administer streptokinase and probably represents the third arm of this therapeutic approach by adding a hemodynamic washout effect. Because the thrombolytic agent is rinsed out of the circuit at the end of regional perfusion, the usual side effects and contraindications of this drug are avoided. Early and late results of this treatment are assessed clinically and with repeat phlebograms in a group of 6 unselected patients. Highly satisfactory results were achieved by 4 patients, 3 of whom experienced complete anatomic and functional restoration of deep veins along their entire length. Continued use of this method appears to be warranted.