Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 103
Filtrar
1.
Expert Rev Cardiovasc Ther ; 19(3): 191-200, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33455484

RESUMO

Introduction: Post-thrombotic syndrome (PTS) is a common lifelong condition affecting up to 50% of those suffering from deep vein thrombosis (DVT). PTS compromises function and quality of life with subsequent venous ulceration in up to 29% of those affected.Areas covered: A literature review of surgical and non-surgical approaches in the prevention and treatment of PTS was undertaken. Notable areas include the use of percutaneous endovenous interventions and the use of graduated compression stockings (GCS) after acute proximal DVT.Expert opinion: In patients with acute iliofemoral DVT, we think it is important to have a frank conversation with the patient about catheter-directed thrombolysis, aiming to reduce the severity of PTS experienced. We advocate ultrasound-accelerated thrombolysis with adjunctive procedures, such as deep venous stenting for proximal iliofemoral DVT. For patients with isolated femoral DVT, we believe that anticoagulation and GCS should be recommended. In patients with established PTS, we recommend GCS for symptomatic relief. We recommend that patients engage in regular exercise where possible with the prospect of gaining symptomatic relief. For those with severe PTS that has a significant effect on quality of life, we discuss the patient's case at a multi-disciplinary team meeting to plan for endovenous intervention.


Assuntos
Síndrome Pós-Trombótica/terapia , Terapia Trombolítica/métodos , Trombose Venosa/terapia , Doença Aguda , Cateterismo Periférico , Veia Femoral/fisiopatologia , Humanos , Extremidade Inferior , Síndrome Pós-Trombótica/fisiopatologia , Qualidade de Vida , Stents , Resultado do Tratamento
2.
Eur J Vasc Endovasc Surg ; 61(3): 484-489, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33388238

RESUMO

OBJECTIVE: The aim was to compare the safety and effectiveness of rivaroxaban and warfarin as anticoagulants for treating patients with post-thrombotic syndrome (PTS) with chronic iliofemoral venous occlusion undergoing iliofemoral venous stenting. METHODS: This single institution retrospective study analysed patients with PTS with chronic iliofemoral venous occlusion who were prescribed rivaroxaban or warfarin for one year after successfully undergoing iliofemoral venous stenting. The primary safety and efficacy endpoints were bleeding complication rate and primary patency rate at one year. Secondary outcomes included Villalta score, symptom recurrence rate, ulcer healing rate, and clinically driven target lesion revascularisation (CD-TLR) rate during follow up. RESULTS: From January 2016 to December 2017, 154 legs from 154 patients were included in this study (69 in rivaroxaban group and 85 in warfarin group). The groups were well matched for patient demographics, clinical characteristics, and procedural details. There was no significant difference between the rivaroxaban group and warfarin group in bleeding complication rate (10% vs. 16%, p = .23, hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.25 - 1.37) at one year, as well as major bleeding complication rate (0% vs. 2%, p = .20, HR 0.16, 95% CI 0.01 - 2.61) and minor bleeding complication rate (10% vs. 14%, p = .40, HR 0.67, 95% CI 0.27 - 1.66). The primary patency rate was higher in the rivaroxaban group at one year (84% vs. 71%, p = .049, HR 0.50, 95% CI 0.26 - 0.96) and at two years (79% vs. 63%, p = .037, HR 0.52, 95% CI 0.29 - 0.93). At a mean follow up of 24 months (range 1 - 42 months), the rivaroxaban group had a significantly lower post-operative Villalta score (4.87 ± 3.51 vs. 6.88 ± 5.85, p = .010, t = 2.64, 95% CI 0.50 - 3.52), lower rate of symptom recurrence (4% vs. 32%, p < .001), lower CD-TLR rates (3% vs. 13%, p = .039), and higher ulcer healing rate (90% vs. 59%, p = .004) than the warfarin group. CONCLUSION: For PTS patients with chronic iliofemoral venous occlusion undergoing iliofemoral venous stenting, rivaroxaban probably exhibited similar safety but superior efficacy to warfarin. However, further prospective control studies with large sample size are necessary to confirm the results.


Assuntos
Anticoagulantes/uso terapêutico , Procedimentos Endovasculares/instrumentação , Inibidores do Fator Xa/uso terapêutico , Veia Femoral , Veia Ilíaca , Síndrome Pós-Trombótica/terapia , Rivaroxabana/uso terapêutico , Stents , Varfarina/uso terapêutico , Idoso , Anticoagulantes/efeitos adversos , Doença Crônica , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Hemorragia/induzido quimicamente , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Sistema de Registros , Estudos Retrospectivos , Rivaroxabana/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Varfarina/efeitos adversos
3.
J Med Vasc ; 45(2): 55-61, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32265015

RESUMO

OBJECTIVES: To assess: (1) lower limb primary lymphedema or post-thrombotic syndrome patient's pathway in terms of health care professional use and (2) if aetiology of edema has an impact on this pathway. METHODS: Ancillary survey of the transversal prospective CHROEDEM pilot study. Forty patients with either lower limb primary lymphedema or post-thrombotic syndrome were invited to participate. RESULTS: Seventy-five percent of primary lymphedema patients and 50% of post-thrombotic patients benefited from a multidisciplinary management (P=0.10) including the general practitioner, the vascular medicine physician and either a physiotherapist (particularly in case of primary lymphedema), a registered nurse (particularly in case of post-thrombotic syndrome). Main ambulatory health care professionals' correspondent of hospital-based vascular medicine physicians were general practitioners (80%) in post-thrombotic patients, and general practitioners (60%) and physiotherapists (45%) in primary lymphedema patients. Pharmacists were also involved in patient education. CONCLUSION: Management of primary lymphedema and post-thrombotic related chronic edema is usually multidisciplinary. General practitioners and vascular medicine physicians are the cornerstones of this management, that also involves the physiotherapist in case of primary lymphedema and in a lesser extent the registered nurse and the pharmacist. This suggests that these five healthcare professional should play a key role in case of development of standardized patient pathways for primary lymphedema and post-thrombotic syndrome.


Assuntos
Procedimentos Clínicos , Linfedema/terapia , Equipe de Assistência ao Paciente , Síndrome Pós-Trombótica/terapia , Adulto , Idoso , Doença Crônica , Terapia Combinada , Feminino , França/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Extremidade Inferior , Linfedema/diagnóstico , Linfedema/epidemiologia , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/epidemiologia , Síndrome Pós-Trombótica/fisiopatologia , Prognóstico , Fatores de Risco
4.
Ann Vasc Surg ; 67: 293-299, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31931131

RESUMO

BACKGROUND: In this article, we report the ultrasound aspects and recanalization rates of patients with deep venous thrombosis (DVT) in the lower limbs treated with the rivaroxaban, focusing on the recanalization rate and the ultrasonographic aspects. METHODS: This was a prospective and consecutive cohort study of patients admitted with DVT who were submitted to treatment with rivaroxaban for 6 months at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, between March 2016 and July 2018. RESULTS: Fifty-one patients with DVT were admitted to the Vascular Surgery Department and received rivaroxaban for 6 months. The follow-up time was 360 days. Analyses were performed at 180 and 360 days. The rate of total venous recanalization at 360 days was 76.4% (39 patients). The incidence of partial venous recanalization was 23.5% (12 patients). At the first month, 11 patients (21.7%) continued with total occlusion of the vein, with 4 patients (6.5%) with no residual thrombi. However, at 6 months, only 2 patients (2.2%) continued with total occlusion of the vein, with 26 patients (47.8%) with no residual thrombi. At 12 months, there were 39 patients (76.4%) with no residual thrombi. Univariate and multivariate logistic regression identified the following factors related to total venous recanalization: the absence of popliteal vein reflux (odds ratio [OR], 0.386; P = 0.007), no residual thrombi (OR, 3.213; P = 0.008), femoropopliteal clot length at 1 month (OR, 3.021; P = 0.016), femoropopliteal clot length at 6 months (OR, 2.234; P = 0.008). The incidence of post-thrombotic syndrome (PTS) at 12 months was 8.3%. CONCLUSIONS: In this study, patients who received oral rivaroxaban displayed satisfactory total vein recanalization rate after 6 months and 12 months. The factors associated with better total recanalization rates were the absence of popliteal vein reflux, the absence of residual thrombi in the veins, femoropopliteal clot length at 1 month (OR, 3.021; P = 0.016), and femoropopliteal clot length at 6 months (OR, 2.234; P = 0.008). Moreover, the incidence of PTS at 12 months was 8.3%.


Assuntos
Inibidores do Fator Xa/administração & dosagem , Extremidade Inferior/irrigação sanguínea , Rivaroxabana/administração & dosagem , Ultrassonografia de Intervenção , Grau de Desobstrução Vascular/efeitos dos fármacos , Veias/efeitos dos fármacos , Trombose Venosa/tratamento farmacológico , Administração Oral , Brasil/epidemiologia , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/epidemiologia , Síndrome Pós-Trombótica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Rivaroxabana/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Veias/diagnóstico por imagem , Veias/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
5.
J Vasc Interv Radiol ; 31(2): 260-264, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31883936

RESUMO

The diagnosis and treatment of pelvic venous disease is complicated by a number of potential venous anatomic variants. Stent-assisted recanalization of a chronically occluded left external iliac vein draining directly into the inferior vena cava, with absence of the left common iliac vein, is described here. Variant iliac venous anatomy is reviewed in 3 categories: additional iliac vessels, absence/shortening of iliac vessels, and deviations in the drainage pattern of iliac vessels. Additionally, variations of the ascending lumbar and iliolumbar veins, the identification of which can aid in the treatment of pelvic venous disease, are described.


Assuntos
Angioplastia com Balão , Veia Ilíaca/anormalidades , Síndrome Pós-Trombótica/terapia , Trombose Venosa/terapia , Adulto , Angioplastia com Balão/instrumentação , Anticoagulantes/uso terapêutico , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Flebografia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
6.
J Vasc Surg Venous Lymphat Disord ; 8(2): 167-173, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31879231

RESUMO

BACKGROUND: The development of post-thrombotic syndrome (PTS) after iliofemoral deep vein thrombosis (DVT) continues to be a considerable issue for both pregnant and postpartum women with rates as high as 70% among those managed with anticoagulation alone. This study aims to characterize the outcomes of interventional treatment for acute iliofemoral DVT in this at-risk population. METHODS: A retrospective analysis of all postpartum patients treated for acute iliofemoral DVT with lysis and stenting between January 2012 and December 2017 at a referral center. Patient demographics, risk factors, procedural factors. and complications were collected. Post-treatment outcomes were compared with all nonpostpartum females treated within the same time period. These included the severity of PTS evaluated using the Villalta scale, duration of vessel patency and factors affecting reintervention timing and success. Further detailed review of cases needing reintervention was also conducted through a retrospective review of documentation and an analysis of all imaging by a consultant radiologist. RESULTS: A total of 11 postpartum women were identified. The median age was 28 years (range, 22-41 years) and intervention was performed at a median of 3 weeks after birth (range 2-12 weeks). No major or minor complications associated with intervention were reported in any patients. The median Villalta score was 3 at 6 months, improving to 2 at 12 months. Overall, two patients were classified as mild having PTS (18%), with no cases of moderate to severe PTS. On comparison with nonpostpartum (n = 68) Villalta scores, no significant difference in outcome was observed at 6 months (median score, 3; range, 0-15 months; P = .95) or at 1 year (median score, 1; range, 0-15; P = .84). Cumulative patency at 1 year was found to be 64% in postpartum women compared with 93% in nonpostpartum women. The postpartum state was found to be a significant predictor of cumulative patency loss (hazard ratio, 0.10; 95% confidence interval, 0.02-0.62; P = .01). However, no significant difference in primary and primary-assisted patency was observed. Of the postpartum patients, 55% required reintervention (6/11) compared with 29% of nonpostpartum patients (20/68). The mean time to initial reintervention was 62 days (range, 7-233 days). Reintervention was unsuccessful in all cases presenting with 100% vessel occlusion (4/11), but successful in both cases with partial occlusion (2/11). Analysis of the etiologic factors associated with reintervention revealed that all reintervention cases were associated with technical failure to fully lyse and stent beyond residual disease at the initial procedure. No technical, flow, or hematologic factors were identified in the four cases that retained primary patency. CONCLUSIONS: This study suggests that percutaneous intervention to achieve early thrombus removal and venous stenting provides a favorable alternative to conservative therapies owing to its potential to decrease the severity of PTS. Completion of lysis and adequate stenting of disease is essential to prevent reocclusion, for which reintervention carries a lower likelihood of success. Further research is warranted to further characterize the appropriate management of postpartum women with iliofemoral DVT.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Veia Femoral , Veia Ilíaca , Síndrome Pós-Trombótica/etiologia , Terapia Trombolítica/efeitos adversos , Trombose Venosa/terapia , Doença Aguda , Adulto , Bases de Dados Factuais , Procedimentos Endovasculares/instrumentação , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Período Pós-Parto , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Síndrome Pós-Trombótica/terapia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Stents , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Adulto Jovem
8.
J Vasc Surg Venous Lymphat Disord ; 8(2): 231-236, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31420259

RESUMO

OBJECTIVE: Proximal venous outflow obstruction (PVOO) in the iliac veins and superficial venous disease are inter-related in ways not fully understood. We observed among our patients undergoing vein stent placement for PVOO a significant number having had prior endovenous thermal ablations (EVTA) in their history. This study was undertaken to better characterize these patients and develop an algorithm in their management. METHODS: In a combined retrospective and prospective data registry of 682 patients who underwent vein stent placement for chronic PVOO at a single institution from March 2013 to November 2017, 100 limbs of 99 patients (14.5% of all patients) had a history of EVTA or other superficial venous procedures before their vein stenting. Limbs with dilated truncal veins on ultrasound examination or limbs that underwent poststent EVTA or superficial venous procedures were excluded. The mean age of these 99 patients was 60.2 years (range, 28-88 years; standard deviation, 13.855). Fifty-one percent of the patients were male. The most common presenting symptom of the patient cohort was edema (n = 59), followed by venous-related skin changes (n = 22). RESULTS: Bilateral stents were performed in 58%, with a mean number of 2.06 stents per patient. EVTA was the primary superficial vein procedure in 97%. Bilateral EVTA were performed in 53% and unilateral EVTA in 47%. The mean time between the first EVTA to vein stenting was 1202.7 days. Patients were followed at 30 days, 90 days, 6 months, 1 year, and >1 year. The outcome for each patient at each postoperative visit was compared with preoperative parameters (subject's assessment, physical examination, and provider assessment) and was scored as follows: -1 (worse than preoperative), 0 (no change), +1 (mildly improved), +2 (significantly improved), or +3 (completely recovered). The mean outcome score at 30 days was 1.63 (84 patients), 2.05 at 90 days (62 patients), 2.09 at 6 months (74 patients), 1.93 at 1 year (54 patients), and 1.97 at >1 year (39 patients). CONCLUSIONS: Approximately 15% of patients undergoing vein stent placement for chronic PVOO have an antecedent history of superficial venous disease and EVTA. PVOO should be considered and the patient evaluated accordingly if symptoms persisted or recurred after EVTA. Vein stent placement among these patients with PVOO will result in further symptomatic relief, but complete symptomatic relief is not observed in everyone. The algorithm for the management of these patients warrants further investigation.


Assuntos
Técnicas de Ablação , Procedimentos Endovasculares , Veia Ilíaca , Síndrome de May-Thurner/terapia , Síndrome Pós-Trombótica/terapia , Veia Safena/cirurgia , Insuficiência Venosa/terapia , Técnicas de Ablação/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , 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 , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Stents , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
9.
J Vasc Surg Venous Lymphat Disord ; 8(2): 237-243, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31699665

RESUMO

OBJECTIVE: The aim of this paper was to describe the obturator hook sign (OHS), a distinctive dilated angled vein similar to a hook, by computed tomography venography (CTV). It is identified mainly on direct CTV (DCTV) as opposed to indirect CTV (ICTV), evidencing obturator vein engorgement as a marker of hemodynamically significant collateralization and representing an indirect sign for chronic iliac vein outflow obstruction. METHODS: All CTV studies of lower limbs performed from January 2014 to August 2018 in Galway University Hospital and the Galway Clinic were retrospectively reviewed. Data were analyzed using SPSS software (version 25.0; IBM Corp, Armonk, NY). RESULTS: In total, 531 CTV studies were reviewed, of which 122 (23%) were performed for acute deep venous thrombosis, 183 (35%) for follow-up after iliac stenting, and 109 (21%) for etiologic study of chronic venous disease. For the purpose of analysis for the presence of OHS, only first-time CTV studies were included in patients who were never submitted to venous intervention (n = 296), of which 40 were DCTV (14%) and 256 were ICTV (86%). Two groups were defined according to whether OHS was present, and significant predictors were identified: female sex (P = .038), younger age (P < .0001), DCTV (P < .0001), nonthrombotic iliac vein lesion (P < .001), past history of iliofemoral deep venous thrombosis (P < .0001), and dilated pelvic veins (P < .0001). OHS was significantly more common in chronic occlusions compared with chronic stenosis or acute occlusion (P < .0001). Findings from DCTV and ICTV were compared with results from ascending venography as the "gold standard," and the sign proved to have high specificity and positive predictive value (100% for both tests), whereas sensitivity and negative predictive value were low for both DCTV (65% [95% confidence interval (CI), 43%-84%] and 11% [95% CI, 7%-18%], respectively) and ICTV (8% [95% CI, 4%-14%] and 6% [95% CI, 9%-20%], respectively). From analysis of the remaining CTVs, particularly follow-up after iliac stenting, an interesting fact was recognized: successful venous stenting was associated with OHS disappearance, and stent occlusion was also sometimes associated with OHS reappearance or appearance de novo. CONCLUSIONS: The identification of hemodynamically significant lesions in patients with clinically significant chronic venous disease is the aim of any form of imaging. In this study, we have depicted a previously undescribed sign that is straightforward to identify, particularly in DCTV, immediately pointing us toward hemodynamically significant chronic iliac venous outflow obstruction diagnosis. It is too early to call it pathognomonic, but perhaps comparative analysis involving data from additional centers could lead to this conclusion.


Assuntos
Angiografia por Tomografia Computadorizada , Veia Femoral/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Síndrome de May-Thurner/diagnóstico por imagem , Flebografia , Síndrome Pós-Trombótica/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem , Idoso , Doença Crônica , Circulação Colateral , Feminino , Veia Femoral/fisiopatologia , Hemodinâmica , Humanos , Veia Ilíaca/fisiopatologia , Incidência , Irlanda/epidemiologia , Masculino , Síndrome de May-Thurner/epidemiologia , Síndrome de May-Thurner/fisiopatologia , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/epidemiologia , Síndrome Pós-Trombótica/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Insuficiência Venosa/epidemiologia , Insuficiência Venosa/fisiopatologia
11.
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
12.
J Vasc Surg Venous Lymphat Disord ; 7(6): 870-881, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31444090

RESUMO

BACKGROUND: Angioscopy has been widely used in the diagnosis and management of vascular disorders and in particular in coronary artery disease. However, few applications have been developed in the diagnosis or management of venous disease. METHODS: Endovenous angioscopy was performed to explore applications of this modality in phlebology. Procedures were performed in a sterile setting. Access was obtained by ultrasound guidance and a 9F introducer sheath. An 8.5F videoscope was used to visualize target veins. Continuous saline irrigation was used to displace blood and to clear the visual field. RESULTS: Fifteen procedures were performed. We describe diagnostic or interventional applications of endovenous angioscopy that include diagnosis and characterization of chronic venous occlusion, deployment of venous stents, angioscopy-guided thrombectomy, foam sclerotherapy, and endovenous laser ablation. Chronic venous occlusion was observed to be fibrotic rather than thrombotic. CONCLUSIONS: Endoscopic imaging of the venous system has great potential to improve access and to guide endovenous interventions. Chronic venous occlusion in post-thrombotic syndrome is a fibrotic process, and chronic venous fibrosis is a better description of the type of occlusion and should replace chronic venous thrombosis.


Assuntos
Angioscopia , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome Pós-Trombótica/diagnóstico por imagem , Veias/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Constrição Patológica , Procedimentos Endovasculares , Feminino , Fibrose , Humanos , Masculino , Síndrome de May-Thurner/fisiopatologia , Síndrome de May-Thurner/terapia , Posicionamento do Paciente , Projetos Piloto , Síndrome Pós-Trombótica/fisiopatologia , Síndrome Pós-Trombótica/terapia , Valor Preditivo dos Testes , Estudos Retrospectivos , Veias/anormalidades , Veias/fisiopatologia , Trombose Venosa/fisiopatologia , Trombose Venosa/terapia , Adulto Jovem
13.
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
14.
J Vasc Surg Venous Lymphat Disord ; 7(4): 527-534, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31203859

RESUMO

OBJECTIVE: Iliocaval stenting has gained increased use over recent years for a variety of indications, including May-Thurner syndrome (MTS), post-thrombotic syndrome (PTS), and acute deep vein thrombosis (DVT). METHODS: A retrospective review of 155 patients undergoing iliocaval venous stenting at a large teaching hospital was performed. Clinical and procedural data, mode and duration of anticoagulation or antiplatelet therapy, and outcomes were recorded. RESULTS: Forty-five patients were treated for MTS, 49 for PTS. and 61 for acute DVT. The median follow-up was 19 months (interquartile range, 9-30 months). Primary patency rates were 97.8% in the MTS group, 85.7% in PTS, and 85.2% for the acute DVT group. Stent restenosis or occlusion occurred in one patient with MTS (2.2%), seven patients with PTS (14%), and nine patients with acute DVT (15%). An ipsilateral DVT recurred in 7 patients with PTS (14%) and 15 patients with acute DVT (25%). The stents that occluded had a tendency toward longer length (162.2 vs 125.2 mm; P = NS) and extension into the common femoral vein (18.8 vs 5.3%; P = NS). The patent stent group had statistically larger nominal diameter stents (P = .013). The duration of anticoagulation did not seem to be a significant factor in stent patency. CONCLUSIONS: Stent diameter has a significant influence on iliocaval stent patency rates.


Assuntos
Anticoagulantes/administração & dosagem , Procedimentos Endovasculares/instrumentação , Veia Ilíaca/efeitos dos fármacos , Síndrome de May-Thurner/terapia , Inibidores da Agregação de Plaquetas/administração & dosagem , Síndrome Pós-Trombótica/terapia , Stents , Grau de Desobstrução Vascular/efeitos dos fármacos , Veia Cava Inferior/efeitos dos fármacos , Trombose Venosa/terapia , Adulto , Idoso , Anticoagulantes/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , 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 , Inibidores da Agregação de Plaquetas/efeitos adversos , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Desenho de Prótese , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
15.
J Vasc Surg Venous Lymphat Disord ; 7(4): 592-600, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31068275

RESUMO

OBJECTIVE: After a first episode of lower extremity deep venous thrombosis, post-thrombotic syndrome (PTS) develops in 20% to 50% of patients despite adequate anticoagulation. Symptoms of PTS can vary from leg swelling to venous ulceration with disabling venous claudication. It significantly affects the patient's quality of life and has considerable socioeconomic consequences. This review gives an update on diagnosis and current treatment strategies in patients with PTS due to chronic venous obstruction, in particular regarding the role of endovenous procedures. METHODS: This review article is based on a selective literature search in PubMed and the Cochrane Library. The terms "postthrombotic syndrome," "post-thrombotic syndrome," "chronic venous obstruction," "venous outflow obstruction," and "venous stent" were used as keywords. Selected publications addressed the diagnosis of and therapy for PTS. Acute deep venous thrombosis, thrombolysis, case reports, complications as a result of caval vein filters, animal experiments, PTS of the upper extremity, and PTS in children were excluded. RESULTS: In addition to conservative treatment of PTS, the following invasive procedures are also available: open surgical reconstructions, hybrid procedures, and endovenous recanalization of the occluded iliocaval venous tract with stent angioplasty. Since introduction of dedicated venous stents in 2012, technical success, patency rates, and improvement in quality of life have been at least as good as results of open surgical reconstruction if not better. CONCLUSIONS: First-line treatment should be conservative therapy. In case of therapy-resistant PTS with poor quality of life, the possibility of an invasive treatment should be evaluated. All invasive procedures are recommended with low levels of evidence. Therefore, deciding on an invasive treatment and type of procedure should be made individually. Because PTS is rarely a threat to life or limb, a minimally invasive treatment is preferred. Therefore, endovenous recanalization appears to be appropriate as the therapy of choice. In patients with involvement of the femoral confluence, endophlebectomy of the common femoral vein in addition to venous recanalization is inevitable to ensure an adequate inflow into the recanalized venous tract. It also secures a sufficient drainage of blood from the peripheral venous system. Because this hybrid procedure is burdened with a significantly higher risk of complications, strict criteria must be fulfilled to legitimize the indication for this procedure. For the best possible results to be achieved, the following perioperative and postoperative management must be considered: therapeutic anticoagulation, early mobilization, compression therapy, and systematic follow-up with duplex ultrasound.


Assuntos
Tratamento Conservador , Procedimentos Endovasculares , Síndrome Pós-Trombótica/terapia , Procedimentos Cirúrgicos Vasculares , Trombose Venosa/terapia , Doença Crônica , Tratamento Conservador/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/epidemiologia , Síndrome Pós-Trombótica/fisiopatologia , Fatores de Risco , Stents , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
16.
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
17.
Phlebology ; 34(10): 675-682, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30871438
18.
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
19.
J Vasc Surg Venous Lymphat Disord ; 7(3): 392-398, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30612971

RESUMO

BACKGROUND: Post-thrombotic obstruction can be adequately treated by percutaneous transluminal angioplasty and stenting. This procedure is rapidly emerging as a minimally invasive alternative to traditional open surgical operations. However, the patient will be exposed to a significant amount of radiation during preoperative planning and operation. The aim of this study was to evaluate the amount of radiation exposure to patients during venous recanalization. METHODS: All patients undergoing endovenous recanalization from February 2016 to February 2018 were included in this study. The operations were performed in an operating room using a mobile C-arm angiography system. Indirect parameters of cumulative air kerma, kerma-area product, and fluoroscopy time (FT) were recorded concurrently with direct measurements of dose (effective dose [ED]) in the pelvic and neck area using two electronic personal dosimetry devices. The direct measured doses were then correlated with indirect parameters provided by the imaging equipment manufacturers. RESULTS: In total, 78 cases were included in the study. During a median operation time of 154.5 minutes (90-323 minutes), the median FT was 43.7 minutes (15.9-77.7 minutes). Body mass index did not correlate with FT or ED. ED correlated with duration of the intervention (r = 0.59) but better with FT, cumulative air kerma, and kerma-area product (r = 0.76, 0.94, and 1.00, respectively). No patients had evidence of radiation-induced skin injury. CONCLUSIONS: Radiation exposure to patients during endovenous recanalization does not reach the threshold to have a deterministic effect. Indirect parameters of radiation exposure correlated with direct measurements of the ED. Direct dosimetry is likely to be an unnecessary effort for these types of procedures when indirect dose metrics are available.


Assuntos
Angioplastia , Síndrome de May-Thurner/terapia , Síndrome Pós-Trombótica/terapia , Doses de Radiação , Exposição à Radiação , Radiografia Intervencionista , Adulto , Angioplastia/efeitos adversos , Angioplastia/instrumentação , Doença Crônica , Feminino , Humanos , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Estudos Prospectivos , Exposição à Radiação/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
20.
J Pediatr ; 207: 42-48, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30528575

RESUMO

OBJECTIVE: To assess the validity of existing clinical scales assessing the presence of physical and functional abnormalities for diagnosing post-thrombotic syndrome (PTS) in children, including specific evaluation of use in children with congenital heart disease (CHD). STUDY DESIGN: One hundred children aged >2 years (average age, 6 years), including 33 with CHD and previously proven extremity deep vein thrombosis (DVT), 37 with CHD and no previous DVT, and 30 healthy siblings, were blindly assessed for PTS using the modified Villalta Scale (MVS). All patients aged <6 years underwent neurodevelopmental testing and an age-appropriate quality of life assessment. RESULTS: The MVS identified mild PTS in 20 children and moderate PTS in 1 child (including 14 of 33 [42%] in the CHD/DVT group, 5 of 37 [14%] in the CHD/no DVT group, and 2 of 30 controls [7%]). The diagnosis of PTS was confirmed clinically in 14 patients, all of whom had previous thrombosis and 1 of whom was MVS-negative. MVS had an accuracy of 91% and performed reasonably well as a screening tool but poorly as a diagnostic tool. MVS reliability was acceptable. Children with PTS had similar quality of life as those without PTS but had higher rates of neurodevelopmental delays in gross motor skills (70% vs 24%; P = .02) and problem-solving indicators (60% vs 15%; P = .008). CONCLUSIONS: Using the MVS scale for PTS screening in children with CHD is feasible and reliable, and the scale has good correlation with a clinical diagnosis of PTS despite a high prevalence of false-positive findings. Further research is needed to determine the clinical relevance of PTS in this population.


Assuntos
Transtornos do Neurodesenvolvimento/etiologia , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/etiologia , Qualidade de Vida , Trombose Venosa/complicações , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Pós-Trombótica/fisiopatologia , Valor Preditivo dos Testes , Trombose Venosa/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...