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1.
Blood ; 134(12): 970-978, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31395599

RESUMO

Stasis of venous blood triggers deep vein thrombosis by activating coagulation, yet its effects on the fibrinolytic system are not fully understood. We examined the relationship between stasis, fibrinolysis, and the development of experimental venous thrombosis. Effects of stasis-induced deep vein thrombosis and fibrinolysis on thrombosis were examined by inferior vena cava ligation in congenic mice with and without α2-antiplasmin (α2AP), the primary inhibitor of plasmin. Venous thrombus weights were measured and thrombus composition was determined by Martius scarlet blue and immunofluorescence staining. Venous thrombi from α2AP+/+ mice contained plasminogen activators, plasminogen activator inhibitor-1, plasminogen, and α2AP, which changed with thrombus age. Normal, α2AP+/+ mice developed large, occlusive thrombi within 5 hours after ligation; thrombi were even larger in plasminogen-deficient mice (P < .001). No significant thrombus formation was seen in α2AP-/- mice (P < .0001) or in α2AP+/+ mice treated with an α2AP-inactivating antibody (P < .001). Venous stasis activated fibrinolysis, measured by D-dimer levels, in α2AP-/- mice vs α2AP+/+ mice (P < .05). Inhibition of fibrinolysis by the indirect plasmin inhibitor ε-aminocaproic acid or by α2AP restored thrombosis in α2AP-/- mice. In addition to its effects on acute thrombosis, thrombus formation was also markedly suppressed in α2AP-/- mice vs α2AP+/+ mice (P < .0001) 1, 7, and 14 days after ligation. We conclude that experimental venous stasis activates the fibrinolytic system to block the development of venous thrombosis. Suppression of fibrinolysis by α2AP appears essential for stasis-induced thrombus development, which suggests that targeting α2AP may prove useful for preventing venous thrombosis.


Assuntos
Fibrinólise/fisiologia , Síndrome Pós-Trombótica/complicações , Trombose Venosa/prevenção & controle , alfa 2-Antiplasmina/fisiologia , Animais , Modelos Animais de Doenças , Feminino , Fibrinólise/genética , Ligadura , Masculino , Camundongos , Camundongos Congênicos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Síndrome Pós-Trombótica/sangue , Síndrome Pós-Trombótica/genética , Síndrome Pós-Trombótica/fisiopatologia , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Trombose Venosa/sangue , Trombose Venosa/genética , Trombose Venosa/fisiopatologia , alfa 2-Antiplasmina/genética
2.
Vasc Med ; 24(5): 442-451, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31354089

RESUMO

Few studies have documented relationships between endovascular therapy, duplex ultrasonography (DUS), post-thrombotic syndrome (PTS), and quality of life (QOL). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial randomized 692 patients with acute proximal deep vein thrombosis (DVT) to receive anticoagulation or anticoagulation plus pharmacomechanical catheter-directed thrombolysis (PCDT). Compression DUS was obtained at baseline, 1 month and 12 months. Reflux DUS was obtained at 12 months in a subset of 126 patients. Clinical outcomes were collected over 24 months. At 1 month, patients who received PCDT had less residual thrombus compared to Control patients, evidenced by non-compressible common femoral vein (CFV) (21% vs 35%, p < 0.0001), femoral vein (51% vs 70%, p < 0.0001), and popliteal vein (61% vs 74%, p < 0.0001). At 12 months, in the ultrasound substudy, valvular reflux prevalence was similar between groups (85% vs 91%, p = 0.35). CFV non-compressibility at 1 month was associated with higher rates of any PTS (61% vs 46%, p < 0.001), a higher incidence of moderate-or-severe PTS (30% vs 19%, p = 0.003), and worse QOL (difference 8.2 VEINES-QOL (VEnous INsufficiency Epidemiological and Economic Study on Quality of Life) points; p = 0.004) at 24 months. Valvular reflux at 12 months was associated with moderate-or-severe PTS at 24 months (30% vs 0%, p = 0.01). In summary, PCDT results in less residual thrombus but does not reduce venous valvular reflux. CFV non-compressibility at 1 month is associated with more PTS, more severe PTS, and worse QOL at 24 months. Valvular reflux may predispose to moderate-or-severe PTS. ClinicalTrials.gov Identifier NCT00790335.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Terapia Trombolítica , Ultrassonografia Doppler Dupla , Trombose Venosa/terapia , Administração Intravenosa , Adulto , Cateterismo Periférico/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/fisiopatologia , Valor Preditivo dos Testes , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de Doença , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
3.
Vasc Endovascular Surg ; 53(5): 373-378, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30935347

RESUMO

OBJECTIVE: To evaluate the long-term results in endovascular treatment of iliofemoral venous obstructive lesions. METHODS: From January 2009 to March 2017, 75 patients were admitted for endovascular treatment of chronic obstructive lesions of the iliofemoral veins. Of these, 60 patients underwent stenting of postthrombotic obstructions and 15 patients stenting of nonthrombotic obstructive lesions of the iliac veins (May-Thurner syndrome in 11, for tumor-induced compression and cicatricial stenosis in 4). Dynamic control of stent patency was carried out by means of duplex ultrasound. Efficacy of endovascular intervention was evaluated by measuring the venous pressure gradient and malleolar circumference. The clinical result was determined by the Venous Clinical Severity Score (VCSS). RESULTS: Technical success of endovascular intervention in postthrombotic occlusions of iliac vein was 92% and in nonthrombotic iliac vein lesions was 100%. Cumulative primary and secondary patency in postthrombotic lesions at 60 months amounted to 72% and 81%, respectively, in nonthrombotic lesions to 85% (primary patency). Reinterventions were successfully performed in 6 patients including catheter-directed thrombolysis (3 patients) and stenting (3 patients). The mean VCSS score fell from 14.2 (4.2) to 7.5 (2.6; P < .001). The quality of life was improved; its mean score decreased from 62.6 (18.7) to 48.7 (12.8; P < .01). CONCLUSION: Endovascular angioplasty and stenting for obstructive lesions of the iliofemoral veins is a minimally invasive, safe, and highly effective method of treatment, which is confirmed by a significant improvement of the limb's condition and good long-term results of patency of the restored venous segments.


Assuntos
Angioplastia com Balão , Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Síndrome Pós-Trombótica/cirurgia , Insuficiência Venosa/cirurgia , Trombose Venosa/cirurgia , Adolescente , Adulto , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Velocidade do Fluxo Sanguíneo , Doença Crônica , Angiografia por Tomografia Computadorizada , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Grau de Desobstrução Vascular , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Pressão Venosa , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Adulto Jovem
4.
Ann Vasc Surg ; 59: 217-224, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30802569

RESUMO

BACKGROUND: Iliac vein compression syndrome (IVCS) can lead to acute deep venous thrombosis (DVT) and post-thrombotic syndrome (PTS). Endovascular venous stenting has become a preferred treatment for IVCS. In this article, we guide stent implantation by the pressure gradient of iliac vein and inferior vena cava. To evaluate the feasibility of guidance of venous stent implantation based on venous pressure gradient difference. METHODS: A retrospective analysis was performed on patients with acute left lower extremity DVT who were treated in our center from March 2012 to December 2017. The patients were divided into 2 groups: group 1: from January 2015 to December 2017, patients were treated with catheter-directed thrombolysis (CDT) and stent implantation was guided by the pressure gradient of iliac vein and inferior vena cava after thrombectomy; group 2: from May 2012 to December 2014, patients underwent CDT treatment without stent implantation. In group 1, the patients were divided into 2 groups according to the difference in pressure gradient after CDT: the stent group (>2 mm Hg) and the control group (≤2 mm Hg). All patients were evaluated by color Doppler ultrasound at 1, 3, and 6 months after the operation to evaluate the patency of the iliofemoral vein. The Villalta score was used to evaluate the incidence of PTS. RESULTS: The primary and secondary patency rate of group 1 at 1, 3, and 6 months after operation were higher than that in group 2 (P < 0.05). In group 1, there was no significant difference in the primary and secondary patency rate between the stent group and the control group at 1, 3, and 6 months after the operation. The incidence of PTS in group 1 at 6 months after the operation was lower than that in group 2 (P < 0.05). In group 1, there was no significant difference in the incidence of PTS between the stent group and the control group at 6 months after the operation. CONCLUSIONS: Practice proves that it is simple and effective to guide stent implantation according to differences in pressure gradients. Two millimeter of mercury is the traditional standard for venous pressure interference in the pelvic area, and the effectiveness of this method was proved.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Síndrome de May-Thurner/terapia , Stents , Terapia Trombolítica/métodos , Veia Cava Inferior/fisiopatologia , Pressão Venosa , Trombose Venosa/terapia , Doença Aguda , Adulto , China , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Pessoa de Meia-Idade , Flebografia , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Grau de Desobstrução Vascular , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
5.
Eur J Vasc Endovasc Surg ; 57(3): 407-416, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30414801

RESUMO

OBJECTIVE: Stent placements are considered as a treatment for post-thrombotic syndrome (PTS) with iliofemoral obstruction, but the application of these iliofemoral venous stents has also caused a lot of controversy. The purpose of this systematic review and meta-analysis was to summarise the efficacy and safety of venous stents in PTS with obstruction in iliofemoral venous segments. METHODS: MEDLINE, EMBASE, and the Cochrane Central Register for Controlled Trials databases and key references were searched up to 15 January 2018. The main relevant outcomes included technical success, peri-operative complications, symptom resolution, a change of symptom scores, and long-term patency of the stents. RESULTS: Overall, 504 limbs of 489 patients from seven studies were included in this study. A GRADE assessment showed the quality of the evidence was "very low" for 11 relevant outcomes. The technical success rate was 95%. The pooled rate of complications including 30 day thrombotic event, per-operative venous injury, and back pain was 3.4%, 18.14%, and 52%, respectively. The rates of ulcer healing, pain and oedema relief were 75.66%, 52%, and 42%, respectively. The primary, assisted primary and secondary patency rates were 83.36%, 90.59%, and 94.32%, respectively, at 12 months and 67.98%, 82.26%, and 86.10%, respectively, at 36 months. CONCLUSIONS: Endovenous stenting has the potential to be effective and has a low risk of peri-operative complications. The quality of evidence to support this treatment is very low. Endovenous iliofemoral stenting should be considered a treatment option for PTS with iliofemoral obstruction.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Síndrome Pós-Trombótica/cirurgia , Stents , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Adulto Jovem
6.
Vasa ; 47(6): 475-481, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30175948

RESUMO

BACKGROUND: To evaluate the performance of a closed-cell designed venous stent for the treatment of chronic ilio-femoral venous outflow obstruction (VOO) in the shortterm. PATIENTS AND METHODS: Safety, stent patency and clinical outcome after placement of the Vici Venous Stent® in patients with chronic ilio-femoral venous obstruction were assessed retrospectively. Stent patency was evaluated by duplex ultrasound scanning, and clinical outcome was determined using the revised Venous Clinical Severity score (rVCSS). RESULTS: 75 patients (49 % female; median age 57 years; 82 limbs) with symptomatic significant VOO had stents placed in the ilio-femoral veins. Lower limb venous skin changes including ulcers (C-class in CEAP 4-6) were found in 31 patients (41 %). Nonthrombotic iliac vein lesions (NIVLs) and post-thrombotic obstruction (PTO) were found in 40 and 42 limbs, respectively. There were no safety issues. Cumulative primary, assisted-primary, and secondary stent patency in the entire cohort at 12 months were 94 %, 94 % and 96 %, respectively. Five limbs presented with stent occlusion. Two limbs had no intervention, 2/3 remained patent after reintervention. Clinical improvement (a decrease ≥ 2 rVCSS points) was observed in 81 %, 81 %, and 77 % of patients at 1 month, 6 months, and 12 months, respectively. There was a marked drop in the frequency of more marked pain and swelling (VCSS ≥ 2) from 62 % to 5 % and 93 % to 19 %, respectively. Four limbs had venous ulcers, three healed during the follow-up. Cumulative pri- mary stent patency at 12 months was 100 % and 87 % in patients with NIVL and PTO, respectively (p= 0.032). There was no statistical difference in clinical outcome between these subgroups. CONCLUSIONS: The Vici Venous Stent® placed in the ilio-femoral vein segment in patients with symptomatic VOO revealed no safety issues, had excellent primary patency and substantial symptom improvement. Long-term studies are needed to evaluate the durability of this stenting procedure.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Síndrome de May-Thurner/cirurgia , Síndrome Pós-Trombótica/cirurgia , Stents , Varizes/cirurgia , Grau de Desobstrução Vascular , Trombose Venosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Pessoa de Meia-Idade , Flebografia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Adulto Jovem
7.
Wounds ; 30(6): E60-E64, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30059332

RESUMO

INTRODUCTION: Live maggot infestation (myiasis) of wounds can present a host of ailments. Loosely associated with maggot excreta, Morganella morganii is a widespread, gram-negative rod bacterium commonly found in the intestinal tracts of humans. M morganii has been observed as being pathogenic, particularly in nosocomial and postoperative environments, as well as in immunosuppressed and elderly populations. CASE REPORT: Herein, the authors present a rare, previously unreported case of M morganii septicemia (as confirmed by positive blood culture), secondary to myiasis of the lower extremities. The patient was successfully treated with both systemic and topical interventions. Posttreatment examination revealed resolution of myiasis and negative blood cultures. CONCLUSIONS: Myiasis can be invasive, leading to severe systemic infection. In these cases, a broad-spectrum antibiotic combined with systemic and topical antiparasitic therapy should be considered.


Assuntos
Infecções por Enterobacteriaceae/patologia , Hiperceratose Epidermolítica/patologia , Extremidade Inferior/patologia , Morganella morganii/patogenicidade , Miíase/complicações , Síndrome Pós-Trombótica/complicações , Sepse/patologia , Administração Intravenosa , Administração Tópica , Idoso de 80 Anos ou mais , Carbapenêmicos/administração & dosagem , Infecções por Enterobacteriaceae/terapia , Humanos , Hidroterapia/métodos , Hiperceratose Epidermolítica/parasitologia , Hiperceratose Epidermolítica/terapia , Inseticidas/administração & dosagem , Extremidade Inferior/parasitologia , Masculino , Miíase/patologia , Miíase/terapia , Pomadas/administração & dosagem , Permetrina/administração & dosagem , Síndrome Pós-Trombótica/fisiopatologia , Síndrome Pós-Trombótica/terapia , Sepse/parasitologia , Sepse/terapia , Resultado do Tratamento
8.
J Vasc Interv Radiol ; 29(7): 1023-1027, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29859663

RESUMO

PURPOSE: To describe acute venographic changes of external iliac vein (EIV) after ipsilateral common iliac vein (CIV) stent placement. MATERIALS AND METHODS: Retrospective review was performed of 17 cases with placement of a single CIV stent. Central CIV stent diameter and minimal ipsilateral EIV diameter were measured on venogram; vein diameter was measured at the same 2 anatomic locations on venogram obtained before intervention. Relative CIV diameter increase was defined as the ratio of change in central CIV diameter after stent placement to CIV diameter before intervention. Relative EIV diameter reduction was defined as the ratio of change in diameter of EIV after stent deployment in CIV to EIV diameter before intervention. Diameters before and after intervention were compared using a 2-tailed, paired sample t test. Pearson coefficient was calculated for correlations. RESULTS: There was a significant reduction of EIV diameter after ipsilateral CIV stent placement compared with before stent placement (mean 9.3 mm ± 3.1 vs 11.9 mm ± 3.8; P < .01); mean decrease in EIV diameter was 21.7% ± 15.8. There was a correlation between relative CIV diameter increase and relative EIV diameter reduction (r = .8917). CONCLUSIONS: Significant venographic narrowing of the EIV occurs after placement of an adjacent CIV stent, and the degree of narrowing is associated with the relative increase in CIV diameter. These findings may be explained by the inherent anisotropic elasticity of veins. Further study is warranted to guide future venous interventions.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca/diagnóstico por imagem , Flebografia , Stents , Trombose Venosa/terapia , Fenômenos Biomecânicos , Elasticidade , Humanos , Veia Ilíaca/fisiopatologia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
9.
Am J Med Sci ; 356(2): 152-158, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29779730

RESUMO

Postthrombotic syndrome is a common long-term complication of proximal lower extremity deep venous thrombosis, which not only significantly affects the quality of life of patients but also imposes a substantial financial burden on our healthcare system. Due to limited awareness and inability of physicians to recognize and treat this condition early, its prevalence is steadily increasing. In this article, we review the pathophysiology, the risk factors involved, diagnostic workup, and the various management options available to treat this condition.


Assuntos
Qualidade de Vida , Humanos , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/tratamento farmacológico , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/fisiopatologia , Fatores de Risco
10.
J Vasc Interv Radiol ; 29(8): 1142-1147, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29803717

RESUMO

PURPOSE: To analyze whether primary venous stent placement into 1 dominant inflow vein peripheral to the common femoral vein (CFV) confluence is feasible. MATERIALS AND METHODS: Retrospective review was performed of 14 consecutive patients who underwent primary venous stent placement into veins peripheral to the CFV between 2013 and 2016. Mean patient age was 49 years; 6 (43%) patients were women. All patients had successful deep venous stent placement with brisk contrast flow through the stent. Patients had primary percutaneous stent placement when postthrombotic changes extended peripherally to the femoral confluence but a trabeculation-free area in the deep femoral vein (DFV) could be identified. Based on imaging findings, the DFV had to be considered the prominent inflow vein with normal anatomy. Femoral vein, DFV, and collateral inflow were minimally impaired owing to postthrombotic scarring or trabeculations. RESULTS: Primary, assisted primary, and secondary patency rates were 92% at a median follow-up of 481 d (range, 411-792 d). Venous Clinical Severity Score decreased from a mean of 8.9 to 6.4 (P = .03). The Villalta scale decreased from a mean of 11.7 to 4.3 (P = .003). Before intervention, venous claudication was present in 92% and remained in 38% after intervention (P = .016). CONCLUSIONS: Stent placement through the femoral confluence into a dominant inflow vein is a promising option in a carefully selected group of patients.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Femoral , Veia Ilíaca , Doenças Vasculares Periféricas/terapia , Síndrome Pós-Trombótica/terapia , Stents , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Doença Crônica , Circulação Colateral , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/diagnóstico por imagem , Doenças Vasculares Periféricas/fisiopatologia , Flebografia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
Angiol Sosud Khir ; 24(1): 97-101, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29688200

RESUMO

Presented herein are the outcomes of conservative treatment of patients suffering from post-thrombotic disease and chronic venous insufficiency of the lower extremities. Our open prospective randomized study included a total of eighty patients divided into two groups, each consisting of 40 people. All patients were subjected to standard comprehensive conservative treatment, with Group Two patients additionally prescribed Venarus. Efficacy of treatment for post-thrombotic disease was assessed with the use of the Villalta scale. The obtained findings demonstrated clinically significant improvement of the main clinical symptoms in Group Two patients, thus suggesting efficacy of the drug as soon as after a short period of administration. Treatment with Venarus in patients with distal forms of involvement of deep veins of the lower limbs was accompanied and followed by improvement of the tonicoelastic properties of the intact common femoral vein. Healing of small trophic ulcers was conditioned by efficacy of the drug at the level of the microcirculatory bed.


Assuntos
Tratamento Conservador/métodos , Diosmina/administração & dosagem , Hesperidina/administração & dosagem , Extremidade Inferior/irrigação sanguínea , Síndrome Pós-Trombótica , Adulto , Combinação de Medicamentos , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/fisiopatologia , Síndrome Pós-Trombótica/terapia , Resultado do Tratamento , Ultrassonografia Doppler Dupla/métodos , Vasoconstritores/administração & dosagem , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/terapia
12.
Vasa ; 47(4): 319-325, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29512422

RESUMO

BACKGROUND: The aim of the study was to investigate venous patency and clinical outcomes for endovascular treatment of iliofemoral venous obstruction in patients with post-thrombotic syndrome (PTS) and non-thrombotic iliac vein lesion (NIVL) with dedicated self-expanding nitinol stents. PATIENTS AND METHODS: Data were collected from the prospective Swiss Venous Stent Registry, enrolling consecutive patients with a standardized follow-up procedure since January 2008. Patency was evaluated by duplex sonography and clinical outcome by various scores including the Villalta score at baseline, three, six, and 12 months, and then annually after endovascular therapy. RESULTS: Overall, 93 patients (64 PTS, 29 NIVL) were analysed. Mean follow-up time was 20 ± 16 (range 3-70) months. A total of 11 (12 %) patients had a stent occlusion, all of which occurred in the PTS group, and 13 (14 %) patients had a symptomatic stent stenosis. Primary patency was 79 % (95 % CI 68-87 %) at 12 months and 72 % (95 % CI 59-82 %) at 24 months. In PTS patients, primary patency at 12 months was 75 % (95 % CI 61-84 %) vs. 89 % (95 % CI 63-97 %) in NIVL patients (p = 0.10). Secondary patency at 24 months was 94 % (95 % CI 84-98 %) in PTS and 100 % in NIVL, p = 0.19). Overall, 62 (67 %) patients were free from PTS at the latest follow-up with a Villalta score < 5 points. Predictive factors for the loss of primary patency were stents placed below the inguinal ligament (OR 2.59, 95 % CI, 0.99-6.84, p = 0.05). CONCLUSIONS: In symptomatic patients with chronic iliofemoral vein obstruction, endovascular therapy with self-expanding nitinol stents was associated with favourable patency rates and clinical improvement in the majority of patients.


Assuntos
Ligas , Procedimentos Endovasculares/instrumentação , Veia Femoral , Veia Ilíaca , Síndrome Pós-Trombótica/terapia , Stents Metálicos Autoexpansíveis , Insuficiência Venosa/terapia , Adulto , Idoso , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Desenho de Prótese , Sistema de Registros , Suíça , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
13.
Vasa ; 47(4): 259-266, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29514591

RESUMO

Postthrombotic syndrome (PTS) is the most common complication after iliofemoral deep vein thrombosis. It reduces quality of life and increases deep vein thrombosis (DVT)-related costs. The clinical symptoms and severity of PTS may vary; the most common symptoms include edema, pain (venous claudication), hyperpigmentation, lipodermatosclerosis, and ulceration. PTS is based on the principle of outflow obstruction, which may be caused by venous hypertension and may lead to valvular damage and venous reflux or insufficiency. Recent technical developments and new stent techniques now allow recanalisation of even complex venous outflow obstructions within the iliac vein and the inferior vena cava. This manuscript gives an overview on the latest standards for venous recanalisation.


Assuntos
Procedimentos Endovasculares/normas , Veia Ilíaca , Síndrome Pós-Trombótica/terapia , Guias de Prática Clínica como Assunto/normas , Veia Cava Inferior , Trombose Venosa/terapia , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/epidemiologia , Síndrome Pós-Trombótica/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Stents/normas , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
14.
Vasa ; 47(3): 197-201, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29485363

RESUMO

BACKGROUND: Deep vein thrombosis (DVT) affects more than one out of 1,000 people every year, of which 50 % develop post-thrombotic syndrome (PTS). Studies indicated that patients with DVT have deteriorated arterial wall function, while less is known about the association with PTS. We therefore investigated this relationship further. PATIENTS AND METHODS: A total of 120 patients treated for DVT of the lower extremity and a control group of 40 subjects without DVT were included. We assessed the presence of PTS using the Villalta scale. Flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) were calculated and reactive hyperaemia index (RHI) and augmentation index (AI) were obtained. RESULTS: Patients with a history of DVT had lower FMD (4.0 % vs. 8.0 %, p < 0.001), lower NMD (12 % vs. 19 %, p = 0.001), and increased diameter of brachial artery (4.8 mm vs. 4.4 mm, p = 0.017). Peripheral arterial tonometry showed higher AI in patients with DVT (22.0 vs. 6.0, p = 0.004), while there was no difference in RHI. No differences in values between PTS-positive and PTS-negative patients were found. CONCLUSIONS: We confirmed the association between DVT and deteriorated functional properties of the arterial wall. Endothelial dysfunction of the large arteries, increased arterial stiffness, and increased diameter of the brachial artery were found in patients with DVT. However, there was no association between functional capability of the arterial wall and the incidence of PTS in DVT patients.


Assuntos
Artéria Braquial/fisiopatologia , Endotélio Vascular/fisiopatologia , Hemodinâmica , Síndrome Pós-Trombótica/fisiopatologia , Trombose Venosa/fisiopatologia , Adulto , Idoso , Artéria Braquial/diagnóstico por imagem , Estudos de Casos e Controles , Endotélio Vascular/diagnóstico por imagem , Feminino , Humanos , Hiperemia/fisiopatologia , Masculino , Manometria , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico por imagem , Ultrassonografia , Rigidez Vascular , Vasodilatação , Trombose Venosa/diagnóstico por imagem
15.
Eur J Vasc Endovasc Surg ; 55(4): 537-544, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29449145

RESUMO

OBJECTIVE/BACKGROUND: Deep venous stenting is increasingly used in the treatment of deep venous obstruction; however, there is currently no consensus regarding post-procedural antithrombotic therapy. The aim of the present study was to determine the most commonly used antithrombotic regimens and facilitate global consensus. METHODS: An electronic survey containing three clinical scenarios on venous stenting for non-thrombotic iliac vein lesions, acute deep vein thrombosis (DVT), and post-thrombotic syndrome was distributed to five societies whose members included vascular surgeons, interventional radiologists, and haematologists. The results of the initial survey (phase 1) were used to produce seven consensus statements, which were distributed to the respondents for evaluation in the second round (phase 2), along with the results of phase 1. Consensus was defined a priori as endorsement or rejection of a statement by ≥ 67% of respondents. RESULTS: Phase 1 was completed by 106 experts, who practiced in 78 venous stenting centres in 28 countries. Sixty-one respondents (58% response rate) completed phase 2. Five of seven statements met the consensus criteria. Anticoagulation was the preferred treatment during the first 6-12 months following venous stenting for a compressive iliac vein lesion. Low molecular weight heparin was the antithrombotic agent of choice during the first 2-6 weeks. Lifelong anticoagulation was recommended after multiple DVTs. Discontinuation of anticoagulation after 6-12 months was advised following venous stenting for a single acute DVT. No agreement was reached regarding the role of long-term antiplatelet therapy. CONCLUSIONS: Consensus existed amongst respondents regarding anticoagulant therapy following venous stenting. At present, there is no consensus regarding the role of antiplatelet agents in this context.


Assuntos
Anticoagulantes/administração & dosagem , Técnica Delfos , Procedimentos Endovasculares/instrumentação , Veia Femoral , Fibrinolíticos/administração & dosagem , Veia Ilíaca , Inibidores da Agregação de Plaquetas/administração & dosagem , Síndrome Pós-Trombótica/terapia , Stents , Tromboembolia Venosa/terapia , Adulto , Anticoagulantes/efeitos adversos , Consenso , Procedimentos Endovasculares/efeitos adversos , Medicina Baseada em Evidências , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Fibrinolíticos/efeitos adversos , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Inibidores da Agregação de Plaquetas/efeitos adversos , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Inquéritos e Questionários , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/fisiopatologia
16.
J Vasc Surg Venous Lymphat Disord ; 6(3): 321-329, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29396156

RESUMO

OBJECTIVE: Minimally invasive interventions by recanalization, percutaneous transluminal angioplasty, and stenting in post-thrombotic syndrome (PTS) obstructions and iliac vein compression syndrome (IVCS) have shown good results. Until recently, no dedicated venous stents were available, and stent-related issues accounted for a decrease in patency scores. The introduction of dedicated stents with more flexibility and higher radial forces could result in higher patency scores. This study focused on the outcomes of patients treated by a dedicated sinus-Venous stent (OptiMed GmbH, Ettlingen, Germany). Patency rates and clinical evaluation are described for both PTS and IVCS patients. METHODS: A total of 200 patients treated at a tertiary university referral center were analyzed. A percutaneous procedure was performed in 103 (51%) PTS patients and 48 (24%) IVCS patients. In 49 (25%) patients, a hybrid procedure was executed. Patency rates and complications were analyzed by duplex ultrasound. Clinical improvement was scored by Venous Clinical Severity Score, Villalta scale, and venous claudication rates. RESULTS: The mean age was 43.2 ± 14.5 (17-81) years, and 66% were female. Mean Villalta score decreased from 10.5 ± 4.2 (3-24) to 5.3 ± 3.8 (0-14) at the latest follow-up (P < .001). Venous Clinical Severity Score decreased by a total of 3 points (P < .001). At baseline, venous claudication was present in 132 patients, which subsided in 115 (87%). Overall patency scores revealed a primary patency of 68%, assisted primary patency of 83%, and secondary patency of 90% with a median follow-up of 12 (11-12) months. Of all included patients, 122 (61%) did not have a complication during follow-up; the most frequent complications were in-stent restenosis (n = 23) and occlusion (n = 25) of the stented tract. CONCLUSIONS: Short-term clinical results using the sinus-Venous stent are comparable to previous research. Loss of stent patency due to stent-related issues like kinking or tapering is hardly ever seen in this short-term follow-up.


Assuntos
Síndrome de May-Thurner/terapia , Síndrome Pós-Trombótica/terapia , Stents , Grau de Desobstrução Vascular/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Angioplastia/instrumentação , Angioplastia/métodos , Feminino , Seguimentos , Humanos , Claudicação Intermitente/etiologia , Estimativa de Kaplan-Meier , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Pessoa de Meia-Idade , Flebografia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Desenho de Prótese , Falha de Prótese , Recidiva , Índice de Gravidade de Doença , Stents/efeitos adversos , Resultado do Tratamento , Adulto Jovem
17.
Eur J Vasc Endovasc Surg ; 55(3): 406-416, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29329662

RESUMO

OBJECTIVES: Compression stockings are commonly prescribed for patients with a range of venous disorders, but are difficult to don and uncomfortable to wear. This study aimed to investigate compliance and complications of compression stockings in patients with chronic venous disease (CVD) and post-thrombotic syndrome (PTS). METHODS: A literature search of the following databases was carried out: MEDLINE (via PubMed), EMBASE (via OvidSP, 1974 to present), and CINAHL (via EBSCOhost). Studies evaluating the use of compression stockings in patients with CVD (CEAP C2-C5) or for the prevention or treatment of PTS were included. After scrutinising full text articles, compliance with compression and associated complications were assessed. Compliance rates were compared based on study type and degree of compression. Good compliance was defined as patients wearing compression stockings for >50% of the time. RESULTS: From an initial search result of 4303 articles, 58 clinical studies (37 randomised trials and 21 prospective studies) were selected. A total of 10,245 limbs were included, with compression ranging from 15 to 40 mmHg (not stated in 12 studies) and a median follow-up of 12 months (range 1-60 months). In 19 cohorts, compliance was not assessed and in a further nine, compliance was poorly specified. Overall, good compliance with compression was reported for 5371 out of 8104 (66.2%) patients. The mean compliance, weighted by study size, appeared to be greater for compression ≤25 mmHg (77%) versus > 25 mmHg (65%) and greater in the randomised studies (74%) than in prospective observational studies (64%). Complications of stockings were not mentioned in 43 out of 62 cohorts reviewed. Where complications were considered, skin irritation was a common event. CONCLUSIONS: In published trials, good compliance with compression is reported in around two thirds of patients, with inferior compliance in those given higher degrees of compression. Further studies are required to identify predictors of non-compliance, to help inform the clinical management of these patients. Complications of compression are not documented in many studies and should be given more consideration in the future.


Assuntos
Cooperação do Paciente , Síndrome Pós-Trombótica/terapia , Meias de Compressão/efeitos adversos , Veias/fisiopatologia , Insuficiência Venosa/terapia , Doença Crônica , Humanos , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/fisiopatologia
18.
Eur J Vasc Endovasc Surg ; 55(2): 222-228, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29292209

RESUMO

BACKGROUND: The aim was to assess the clinical and anatomical outcomes of iliofemoral stenting, with concomitant femoral stenting or balloon angioplasty alone, in patients with severe post-thrombotic syndrome (PTS) and compromised inflow. METHODS: A database of patients with severe PTS who successfully underwent endovascular iliofemoral stenting was reviewed retrospectively. Patients with impaired inflow with chronic post-thrombotic obstructive lesions in the femoral vein (FV), but patent profunda vein, were selected and divided into two groups: the FV stenting (FV-S) group and the FV angioplasty (FV-A) group. Patients in the FV-S group were treated with concomitant iliofemoral and FV stenting, and patients in the FV-A group were treated with iliofemoral stenting and balloon angioplasty alone of the obstructed femoral vein. The clinical and stent outcomes were recorded and compared in the two groups. RESULTS: There were 45 patients in the FV-S group and 69 patients in the FV-A group. The groups were well matched for age, gender, and diseased limbs. The pre-procedural symptoms, CEAP classifications, VCSS scores, Villalta scores, and prevalence of active ulcers were also similar between the two groups. Immediate failure (<30 days post-procedure) in the femoral segment occurred more frequently in the FV-A group (70% in FV-A group vs. 24% in FV-S group, p < .001); however, all treated femoral vein segments had occluded at 12 months. There was no significant difference between the FV-S and FV-A groups in cumulative primary and secondary patency rates of the iliofemoral stent at 3 years (55% vs. 52%, p = .71, and 77% vs. 85%, p = .32, respectively). Complete pain relief, swelling relief, VCSS score, Villalta score, and freedom from ulcers at a median of 22 months (1-48 months) following the procedure were similar in the two groups. CONCLUSIONS: Stent placement to treat post-thrombotic iliofemoral obstruction with concomitant obstructed femoral vein but patent profunda vein shows cumulative patency rates and clinical outcomes similar to previous reports. Adjunctive femoral stenting or angioplasty of the obstructed femoral vein does not appear to improve clinical or stent outcomes in patients with severe PTS.


Assuntos
Angioplastia com Balão/métodos , Implante de Prótese Vascular/métodos , Constrição Patológica/cirurgia , Veia Femoral/transplante , Veia Ilíaca/transplante , Síndrome Pós-Trombótica/cirurgia , Adulto , Idoso , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Doença Crônica/terapia , Feminino , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Flebografia , Síndrome Pós-Trombótica/fisiopatologia , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Índice de Gravidade de Doença , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
Phlebology ; 33(4): 234-241, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28956493

RESUMO

Objectives To evaluate health-related quality of life after venous thromboembolism. Methods We conducted a cohort study, TEHS follow-up, including 1040 women with a first episode of venous thromboembolism and 994 women unexposed to venous thromboembolism. Patients were recruited from the "Thrombo Embolism Hormonal Study" (TEHS), a Swedish nation-wide case-control study on risk factors for venous thromboembolism in women 18-64 years of age. Quality of life was measured using SF-36 and VEINES-QoL/VEINES-Sym. Results On average there were no difference in mean SF-36 summary scales scores between exposed and unexposed women. Twenty percent of exposed women developed postthrombotic syndrome during follow-up. Women with postthrombotic syndrome had severely impaired quality of life with lower scores on all scales. Other predictors of low quality of life after venous thromboembolism were age, obesity, physical inactivity, and recurrent venous thromboembolism. Conclusion Long-term quality of life after venous thromboembolism in women was severely impaired among those developing postthrombotic syndrome, while quality of life in women not developing postthrombotic syndrome was similar to a control population.


Assuntos
Síndrome Pós-Trombótica/fisiopatologia , Qualidade de Vida , Tromboembolia Venosa/fisiopatologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/terapia , Tromboembolia Venosa/complicações , Tromboembolia Venosa/terapia
20.
Angiol Sosud Khir ; 23(3): 62-67, 2017.
Artigo em Russo | MEDLINE | ID: mdl-28902815

RESUMO

Balloon angioplasty and stenting have increasingly been gaining widespread application for treatment of post-thrombotic alterations in the system of the vena cava. Endovascular ultrasonographic examination makes it possible with the utmost degree of reliability to determine both the extension and degree of the narrowing of venous segments, thus proving a possibility of choosing a venous stent of an appropriate diameter. Restoration of an adequate venous lumen leads to normalization of blood flow and elimination of venous hypertension. However, unsolved as yet remains the problem concerning proper management of post-thrombotic obstructions of the inferior vena cava at the level of a cava filter. Owing to a wide variety of configurations of cava filters to deploy, there are no common approaches to elimination of such obstruction. Presented herein is a clinical case report regarding successful endovascular treatment of a patient diagnosed with post-thrombotic disease secondary to endured thrombosis. The findings of both phlebography and endovascular ultrasonographic examination made it possible to diagnose obstruction of the left common iliac vein, external iliac vein, and inferior vena cava to the level of the cava filter previously deployed. In the segment of the inferior vena cava at the level of the cava filter also revealed was a pronounced luminal narrowing exceeding 90% of its diameter. We carried out stenting of the common and external iliac veins, inferior vena cava, and the cava filter. Swelling of the left leg subsided spontaneously within 2 weeks and the first postoperative month was accompanied by gradual disappearance of the previously existing feeling of heaviness in the lower limbs and a dramatic decrease in fatigue by the end of the working day.


Assuntos
Angioplastia com Balão , Veia Ilíaca , Síndrome Pós-Trombótica , Stents , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior , Trombose Venosa/cirurgia , Adulto , Angioplastia com Balão/instrumentação , Angioplastia com Balão/métodos , Constrição Patológica/diagnóstico , Constrição Patológica/patologia , Constrição Patológica/fisiopatologia , Constrição Patológica/cirurgia , Procedimentos Endovasculares/métodos , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/cirurgia , Masculino , Flebografia/métodos , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/patologia , Síndrome Pós-Trombótica/fisiopatologia , Síndrome Pós-Trombótica/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Trombose Venosa/complicações
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