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1.
Ann Transplant ; 26: e909493, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34907151

RESUMO

BACKGROUND Portal vein thrombosis (PVT) after pediatric liver transplantation (LT) is a common but grave complication which could eventually result in life-threatening portal hypertension. A "Rex" shunt between the superior mesenteric vein and the Rex recess of the liver has been reported to be a treatment option for extrahepatic portal vein obstruction; however, its application to living donor liver transplantation (LDLT) is limited due to the availability of appropriate vein grafts. In this study, we retrospectively evaluated the effectiveness of Rex shunt as an option for the treatment of PVT after pediatric LDLT. CASE REPORT Three children underwent the Rex shunt for early (n=2) and late (n=1) PVT after LDLT using the greater saphenous vein (n=2) and the external iliac vein (n=1) from the parents who previously donated their livers. Two of the 3 children are free from symptoms with patent shunt grafts at 14 years after the procedures. One child died at 30 days after LDLT due to repeated episodes of PVT, which finally led to hepatic infarction. CONCLUSIONS The Rex shunt is feasible to treat PVT after LDLT. However, additional surgical insults to the living donor need further discussion.


Assuntos
Transplante de Fígado , Trombose Venosa , Criança , Humanos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Veia Porta/cirurgia , Estudos Retrospectivos , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
2.
Georgian Med News ; (318): 24-28, 2021 Sep.
Artigo em Russo | MEDLINE | ID: mdl-34628373

RESUMO

Objective - to evaluate the effectiveness of surgical treatment of varicothrombophlebitis complicated by transfascial thrombosis. The results of examination and treatment of 45 patients with varicothrombophlebitis of the great saphenous vein complicated by transfascial thrombosis. The indications for surgical prophylaxis of pulmonary embolism in transfascial thrombosis in the basin of the great saphenous vein have been substantiated. In the postoperative period, all patients with transfascial thrombosis, regardless of the radical nature of the surgical intervention, were offered to prescribe treatment as in deep vein thrombosis. The introduction of active surgical tactics in transfascial thrombosis allows for effective prevention of pulmonary embolism. In varicothrombophlebitis complicated by transfascial thrombosis, thrombectomy with further prevention of recurrence of the disease and pulmonary embolism should be considered the main standard of treatment. For perforating vein thrombosis, subfascial thrombectomy followed by perforating ligation should be performed. All patients with transfascial thrombosis, regardless of the volume of surgery, should be treated as for deep vein thrombosis.


Assuntos
Embolia Pulmonar , Trombose Venosa , Humanos , Ligadura , Embolia Pulmonar/cirurgia , Veia Safena/cirurgia , Trombectomia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
3.
World J Surg Oncol ; 19(1): 313, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702312

RESUMO

BACKGROUND: The outcomes and management of hepatocellular carcinoma (HCC) have undergone several evolutionary changes. This study aimed to analyze the outcomes of patients who had undergone liver resection for HCC with portal vein tumor thrombosis (PVTT) in terms of the evolving era of treatment. MATERIALS AND METHODS: A retrospective analysis of 157 patients who had undergone liver resection for HCC associated with PVTT was performed. The outcomes and prognostic factors related to different eras were further examined. RESULTS: Overall, 129 (82.1%) patients encountered HCC recurrence after liver resection, and the median time of recurrence was 4.1 months. Maximum tumor size ≥ 5 cm and PVTT in the main portal trunk were identified as the major prognostic factors influencing HCC recurrence after liver resection. Although the recurrence-free survival had no statistical difference between the two eras, the overall survival of patients in the second era was significantly better than that of the patients in the first era (p = 0.004). The 1-, 2-, and 3-year overall survival rates of patients in the second era were 60.0%, 45.7%, and 35.8%, respectively, with a median survival time of 19.6 months. CONCLUSION: The outcomes of HCC associated with PVTT remain unsatisfactory because of a high incidence of tumor recurrence even after curative resection. Although the management and outcomes of patients with HCC and PVTT have greatly improved over the years, surgical resection remains an option to achieve a potential cure of HCC in well-selected patients.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Trombose Venosa , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Veia Porta/cirurgia , Prognóstico , Estudos Retrospectivos , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
4.
Rev Gastroenterol Peru ; 41(1): 48-51, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34347772

RESUMO

Portal vein thrombosis (PVT) is a rare condition in the general population that develops serious complications if left untreated for long time. We present a case of a 29-year-old woman who developed PVT due to protein S deficiency versus neonatal funiculitis. Over time, the patient developed upper gastrointestinal bleeding due to esophageal varices and hypersplenism with splenic sequestration that caused minor bleeding episodes. Laparoscopic splenectomy and proximal splenorenal shunt with distal pancreatectomy due to aneurysmal dilatations of the splenic artery were successfully performed to avoid mayor progression of portal hypertension. Patient was discharged with indefinite anticoagulation and after surgery platelets raised up to 200x103/mm3. Laparoscopic splenectomy and proximal splenorenal shunt for portal hypertension due to portal vein thrombosis is an adequate surgery procedure which should be applied in these medical cases.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Laparoscopia , Deficiência de Proteína S , Derivação Esplenorrenal Cirúrgica , Trombose Venosa , Adulto , Feminino , Hemorragia Gastrointestinal , Humanos , Hipertensão Portal/complicações , Recém-Nascido , Veia Porta/cirurgia , Esplenectomia , Trombose Venosa/complicações , Trombose Venosa/cirurgia
5.
J Cardiothorac Surg ; 16(1): 226, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372883

RESUMO

BACKGROUND: Inferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery. Often only mild symptoms arise from these thrombi; however, due to the chronic nature of some thrombi and the recanalization process, more serious complications can arise. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. In this case, we present a 65-year-old male who underwent IVC filter placement and open-heart surgery who later developed extensive femoral and iliocaval thrombosis leading to right heart failure, which required thrombus extraction with an AngioVac suction device. CASE PRESENTATION: We present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. He progressed to right heart failure and worsening cardiogenic shock despite therapeutic anticoagulation and was taken for a suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) aspiration thrombectomy device. The thrombectomy was successful and he was able to recover and was discharged from the hospital. CONCLUSION: Despite being a rare complication, IVC thrombosis can have detrimental effects. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. Other therapies have been described but because of its rarity, they are only described in case reports. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Choque Cardiogênico/cirurgia , Trombectomia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior , Trombose Venosa/cirurgia , Idoso , Anticoagulantes/uso terapêutico , COVID-19/diagnóstico , Ponte de Artéria Coronária/métodos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pandemias , Implantação de Prótese/efeitos adversos , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , SARS-CoV-2 , Choque Cardiogênico/tratamento farmacológico , Choque Cardiogênico/etiologia , Trombectomia/instrumentação , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia
7.
Transplant Proc ; 53(8): 2580-2587, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34253382

RESUMO

BACKGROUND: Severe/massive portal vein thrombosis (PVT) deteriorates peri-liver transplantation outcomes. Cavoportal hemitransposition (CPHT) is a rescue procedure for severe PVT, and short-term outcomes have been well studied. However, CPHT is associated with some long-term issues caused by portal flow modulation via extraordinary reconstruction. We describe a patient with Yerdel grade 4 PVT who underwent a liver transplant and achieved long-term survival with CPHT and a portosystemic shunt. CASE REPORT: A 50-year-old man with liver cirrhosis underwent a deceased donor liver transplant. Preoperative examinations indicated Yerdel grade 4 PVT; thus, we planned a CPHT. In liver transplant surgery, we confirmed diffusely complete PVT and removed them as possible. After placing a liver graft, we performed CPHT and confirmed that the graft received sufficient portal vein flow. However, the gastroepiploic vein pressure increased significantly. Therefore, we added a portosystemic shunt between the splenic vein and the inferior vena cava, and the pressure improved. The patient was discharged after an uneventful hospital stay, and he reported no unfavorable events for over 12 years. CONCLUSIONS: This case study suggested that a modified CPHT with a portosystemic shunt for Grade 4 PVT was useful in preventing post-liver transplant PVT development and improved the outcome.


Assuntos
Transplante de Fígado , Trombose Venosa , Humanos , Cirrose Hepática/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Veia Porta/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
8.
J Dig Dis ; 22(9): 506-519, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34323378

RESUMO

The presence of portal vein thrombosis (PVT) has previously been considered a contraindication to the insertion of transjugular intrahepatic portosystemic shunts (TIPSS). However, patients with PVT may have portal hypertension complications and may thus benefit from TIPSS to reduce portal venous pressure. There is an increasing body of literature that discusses the techniques and outcomes of TIPSS in PVT. This review summarizes the techniques, indications and outcomes of TIPSS in PVT in published case reports, case series and comparative trials, especially regarding the reduction in portal hypertensive complications such as variceal bleeding. A comprehensive literature search was conducted using MEDLINE and PubMed databases. Manuscripts published in English between 1 January 1990 and 1 March 2021 were used. Abstracts were screened and data from potentially relevant articles analyzed. TIPSS in PVT has been reported with high levels of technical success, short-term portal vein recanalization and long-term PV patency and TIPSS patency outcomes. Several comparative studies, including randomized controlled trials, have shown favorable outcomes of TIPSS compared with non-TIPSS treatment of PVT complications. Outcomes of TIPSS with PVT appear similar to those in TIPSS without PVT. However, TIPSS may be more technically difficult in the presence of PVT, and such procedures should be performed in expert high-volume centers to mitigate the risk of procedural complications. The presence of PVT should no longer be considered a contraindication to TIPSS. TIPSS for PVT has been acknowledged as a therapeutic strategy in recent international guidelines, although further studies are needed before recommendations can be strengthened. KEY POINTS: Portal vein thrombosis (PVT) is no longer a contraindication to the insertion of transjugular intrahepatic portosystemic shunts (TIPSS) TIPSS often leads to the spontaneous dissolution of PVT, but can be combined with mechanical or pharmacological thrombectomy TIPSS reduces portal hypertensive complications of PVT, such as variceal bleeding, and can also facilitate liver transplantation where PVT may otherwise interfere with vascular anastomoses Studies have shown favorable long-term outcomes of TIPSS compared with TIPSS without PVT; as well as compared with non-TIPSS treatment of PVT complications TIPSS in PVT should be performed in high-volume specialist centers due to technical difficulties.


Assuntos
Varizes Esofágicas e Gástricas , Derivação Portossistêmica Transjugular Intra-Hepática , Trombose Venosa , Hemorragia Gastrointestinal , Humanos , Cirrose Hepática/patologia , Veia Porta/patologia , Veia Porta/cirurgia , Resultado do Tratamento , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
9.
Georgian Med News ; (314): 13-20, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-34248021

RESUMO

The aim of the study was to conduct an anatomical and clinical study of IVC and its tributaries, and to determine the pathways of collateral venous blood flow to improve the results of surgical treatment of patients with kidney cancer complicated by venous tumor thrombosis. The anatomical examination of the IVC and its tributaries included the results of autopsy of 27 corpses. The clinical part of the study is based on the results of examination and surgical treatment of 147 patients with renal cell carcinoma complicated by venous tumor thrombosis. Tumor of the right kidney was diagnosed in 96 (65.3%) patients, left - in 51 (34.7%) patients. Venous tumor thrombus was localized exclusively in the renal vein (level 0) in 55 (37.4%) cases, while in different IVC segments (levels I-IV) - in 92 (62.6%) cases. At the same time, level I took place in 32 (21.8%), level II - in 30 (20.4%), III - in 22 (15.0%) and IV level - in 8 (5.4%) patients. The spread of a venous tumor thrombus into the main hepatic veins was diagnosed in 1 (0.7%), in the left gonadal vein - in 4 (7.8%), in the left adrenal vein - in 2 (3.9%), into the contralateral renal vein - in 2 (1.4%) cases. Tumor thrombosis of the infrarenal IVC, combined with hemorrhagic thrombosis occurred in 28 (19.0%) patients. Avascular IVC parts were found in the retrohepatic segment under the main hepatic veins with a median length of 13.1 mm and in the infrarenal segment under the right renal vein with a median length of 17.8 mm. 6 basic anatomical structures involved in the formation of the caval venous collector were identified. Despite the broad anatomical possibilities for compensating venous blood flow during IVC occlusion of tumor and hemorrhagic genesis, only surgical treatment can provide a good functional result for venous return through the IVC to the heart. Thrombotic occlusion of the renal and inferior vena cava contributes to the retrograde spread of venous tumor thrombi with the involvement of the vessels in the process, providing a collateral pathway for the outflow of venous blood. To successfully perform thrombectomy from IVC, it is necessary to actively use avascular parts in its retrohepatic and infrarenal segments, taking into account the existing variability in the localization of the posterior and anterior IVC inflows.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Trombose Venosa , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Nefrectomia , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/cirurgia
10.
J Clin Neurosci ; 89: 43-50, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119293

RESUMO

Effective anticoagulation status may determine the recanalization and outcome of cerebral venous thrombosis (CVT). We report impact of anticoagulation status on recanalization and outcome of CVT. This is a retrospective study on 126 patients with CVT diagnosed on magnetic resonance venography (MRV). Their clinical features and risk factors were noted. The data were retrieved from a prospectively maintained registry, and international normalized ratio (INR) was noted after discharge till 3 months. All the patients were on acenocoumarol. Based on INR value, patients were categorized as Group A (effective anticoagulation INR within the therapeutic range or above) and Group B (ineffective anticoagulation INR > 50% below the therapeutic range). A repeat MRV at 3 months was done for recanalization. Outcome at 3 months was evaluated using modified Rankin Scale (mRS), and categorized as good (mRS ≤ 2) and poor (mRS 2 or more) 101(80.2%) patients were in group A and 25(19.8%) in group B. Their demographic, risk factors, magnetic resonance imaging (MRI) and MRV findings were comparable. On repeat MRV, recanalization occurred in 22/24(91.7%); 15(88%) in group A and 7(100%) in group B. Recanalization was independent of coagulation status. Seven (5.6%) patients died and 107(84.9%) had good outcome; 85(84.2%) in group A and 22(88%) in group B. Kaplan Meier analysis also did not reveal survival or good outcome benefits between the groups. In CVT, outcome and recanalization at 3 months are not dependent on coagulation status. Further prospective studies are needed regarding duration of anticoagulant and its impact on recanalization and outcome.


Assuntos
Anticoagulantes/uso terapêutico , Revascularização Cerebral/tendências , Trombose Intracraniana/tratamento farmacológico , Trombose Intracraniana/cirurgia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Coeficiente Internacional Normatizado/tendências , Trombose Intracraniana/diagnóstico por imagem , Imageamento por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Flebografia/tendências , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Adulto Jovem
11.
BMC Cancer ; 21(1): 627, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044812

RESUMO

PURPOSE: To explore the safety and effectiveness of delayed occlusion of the proximal inferior vena cava (DOPI) technique in retroperitoneal laparoscopic radical nephrectomy (LRN) and thrombectomy for renal tumor with level II-III venous tumor thrombus (VTT). MATERIALS AND METHODS: From August 2016 to October 2018, a total of 145 patients with renal tumor and VTT were admitted to our centre. Seventy-five patients underwent laparoscopic surgery, and 70 patients underwent open surgery. Among these patients, 17 patients underwent retroperitoneal LRN and thrombectomy with the DOPI technique. Clinical data were collected retrospectively, and a descriptive statistical analysis was conducted. RESULTS: All the patients successfully underwent retroperitoneal laparoscopic surgery. The mean operation time was 345.9 ± 182.9 min, the mean estimated blood loss was 466.7 ± 245.5 ml. Postoperative complications occurred in three patients, including two patients of Clavien grading system level IVa and one patient of level II. There were no complications related to carbon dioxide pneumoperitoneum, such as gas embolism, acidosis, and subcutaneous emphysema. During 21 months of median follow-up time, no local recurrence was found, and distant metastasis occurred in four patients. Cancer-specific death occurred in two patients. CONCLUSIONS: The DOPI technique is safe and feasible in the treatment of renal tumor and level II-III VTT. With the DOPI technique, the procedures of dissociating and exposing proximal inferior vena cava are simplified.


Assuntos
Oclusão com Balão/métodos , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Nefrectomia/métodos , Trombectomia/métodos , Trombose Venosa/cirurgia , Adolescente , Adulto , Idoso , Oclusão com Balão/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Duração da Cirurgia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Trombectomia/efeitos adversos , Tempo para o Tratamento , Resultado do Tratamento , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/patologia , Adulto Jovem
13.
AJR Am J Roentgenol ; 217(2): 418-425, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34036807

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of transhepatic pharmacomechanical thrombectomy of symptomatic acute portomesenteric venous thrombosis. MATERIALS AND METHODS. Transhepatic pharmacomechanical thrombectomy (catheter-directed thrombolysis with mechanical thrombectomy) was performed in the treatment of nine patients with symptomatic acute noncirrhotic, nonmalignant porto-mesenteric venous thrombosis. The medical records, imaging examinations, technique of transhepatic pharmacomechanical thrombectomy, and clinical outcomes were reviewed. RESULTS. The mean follow-up period was 23.1 months (range, 8-34) months. Successful recanalization of the portomesenteric venous thrombosis, restoration of hepatopetal portal flow, clinically significant improvement in the signs and symptoms of acute mesenteric ischemia, and prevention of bowel resection were achieved in all patients. The most frequent minor complication (in three patients) was minor hemorrhage through the transhepatic access track. No procedure-related major complications occurred during hospitalization. No patient had rethrombosis or complications related to portal hypertension due to portomesenteric venous thrombosis. One patient died of massive pulmonary embolism on the 7th day after treatment. Cavernous transformation of the right portal vein occurred in one patient. CONCLUSION. Transhepatic pharmacomechanical thrombectomy is a safe and effective method of treatment of symptomatic acute portomesenteric venous thrombosis and prevention of bowel infarction.


Assuntos
Trombectomia/métodos , Trombose Venosa/cirurgia , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Veia Porta/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
Clin Transplant ; 35(6): e14303, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33797802

RESUMO

INTRODUCTION: Postoperative complications and worse prognosis still burden liver transplantations (LT) with complex portal vein thrombosis (CPVT). When an engorged left gastric vein (LGV) is present, the portal inflow is restorable with an anastomosis between the graft portal vein and the LGV of the recipient. We analyzed short- and long-term results of this procedure in 12 LT with CPVT. METHODS: Between 2005 and 2019, 55 patients with CPVT underwent LT. We applied this technique in 12 patients. In six cases, we placed a vascular graft to obtain a tension-free structure. We evaluated patency, short- and long-term results. RESULTS: No intraoperative complication was observed. The median duration of LT, blood transfusion, deceased donor age, and MELD score of the recipients were 7 h, 1250 mL, 72 years, and 19. Seven patients were affected by hepatocellular carcinoma. No major complications or PVT recurrence were observed. One patient required a liver re-transplantation for primary non-functioning syndrome. The mean hospital stay was 20 days. The actuarial patient survival was 85% with a mean FU of 4 years. The two late deaths were due to hepatocellular carcinoma recurrence and sepsis for cholangitis. CONCLUSIONS: This technique in presence of both CPVT and engorged LGV is feasible and safe for patients, with good short- and long-term results.


Assuntos
Neoplasias Hepáticas , Transplante de Fígado , Varizes , Trombose Venosa , Humanos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia , Veia Porta/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
15.
Clin Appl Thromb Hemost ; 27: 10760296211005548, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813903

RESUMO

Early catheter-directed thrombolysis (CDT) for lower extremity deep vein thrombosis (LEDVT) can reduce post-thrombotic morbidity and the AngioJet thrombectomy is a new therapy that can be selected for the treatment of LEDVT. We performed a systematic review and meta-analysis of clinical trials comparing AngioJet versus CDT to assess the efficacy and safety of AngioJet thrombectomy. We systematically searched PubMed and Embase for clinical trials that published before November 1, 2020 and compared AngioJet thrombectomy and CDT in the treatment of LEDVT. We meta-analyzed effective rate of treatment, serious complications, PTS, Villalta score, duration of treatment and drug dose. AngioJet does not result in a significant difference in the effective rate (OR 1.00, CI 0.73-1.36, P = 0.98; I2 = 0%) and complications (OR 1.16 CI 0.84-1.61, P = 0.36; I2 = 39%) compare to CDT. And there was a statistically significant decrease in incidence of PTS (OR 0.58 CI 0.37-0.91, P = 0.02; I2 = 0%) and Villalta score (OR -1.86 CI -3.49 to -0.24, P = 0.02; I2 = 34%) for AngioJet compared to CDT. In addition, there was a statistically significant decrease in duration of the treatment (OR -2.45 CI -2.75 to -2.15, P < 0.0001; I2 = 95%) and drug dose (OR -3.15 CI -3.38 to -2.93, P < 0.0001; I2 = 98%) between AngioJet and CDT. AngioJet results in a low severity of PTS compared to CDT therapy. Moreover, the average duration of treatment and thrombolysis time was shorter in the AngioJet group compared to the CDT group. However, the AngioJet group was not significantly different in effective rate of treatment and serious complications compared to the CDT group.


Assuntos
Extremidade Inferior/cirurgia , Trombectomia/métodos , Terapia Trombolítica/métodos , Trombose Venosa/cirurgia , Feminino , Humanos , Masculino , Fatores de Risco , Resultado do Tratamento
17.
Korean J Radiol ; 22(6): 931-943, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33660456

RESUMO

Lower extremity deep vein thrombosis (DVT) is a serious medical condition that can result in local pain and gait disturbance. DVT progression can also lead to death or major disability as a result of pulmonary embolism, postthrombotic syndrome, or limb amputation. However, early thrombus removal can rapidly relieve symptoms and prevent disease progression. Various endovascular procedures have been developed in the recent years to treat DVT, and endovascular treatment has been established as one of the major therapeutic methods to treat lower extremity DVT. However, the treatment of lower extremity DVT varies according to the disease duration, location of affected vessels, and the presence of symptoms. This article reviews and discusses effective endovascular treatment methods for lower extremity DVT.


Assuntos
Procedimentos Endovasculares , Trombose Venosa , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Embolia Pulmonar , Terapia Trombolítica , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/cirurgia
18.
Gastroenterol Hepatol ; 44(6): 405-417, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33663813

RESUMO

PURPOSE: The aim of this study was to perform a systematic review and meta-analysis to assess the safety and efficacy of interventional treatment for Budd-Chiari syndrome (BCS) complicated by Inferior Vena Cava thrombosis (IVCT) patients. METHODS: We evaluated the published studies on interventional treatment for BCS complicated by IVCT. Meta-analysis was used to calculate the combined effect size and their 95% confidence intervals (CI) based on random effect. The publication bias was assessed by Begg's test. RESULTS: Sixteen studies on interventional treatment for BCS complicated by IVCT patient were selected for meta-analysis, a total of 767 BCS complicated by IVCT patients were included. The combined effect size (95% CI) were 99% (98-100%) for the total successful rate of IVC recanalization, 15% (11-21%) for the rate of IVC restenosis after initial operation, 92.0% (86-97%) for the rate of clinical improvement, 76% (68-84%) for the rate of thrombus clearance and 0.00% (0-1%) for the incidence of pulmonary embolism (PE). Through subgroup meta-analysis about the rate of thrombus clearance, we got the pooled results (95% CI) of individualized treatment strategy (ITS) group and non-individualized treatment strategy (non-ITS) group, were 81% (71-92%) and 73% (63-83%), respectively. CONCLUSIONS: The interventional treatment for BCS complicated by IVCT patients is safe and effective with low incidence of PE, high thrombus clearance rate, high technically successful rate, good patency, and high clinical improvement rate. Moreover, subgroup analysis indicated that management based on the type and extent of the thrombus is proposed.


Assuntos
Síndrome de Budd-Chiari/cirurgia , Veia Cava Inferior/cirurgia , Síndrome de Budd-Chiari/complicações , Intervalos de Confiança , Humanos , Incidência , Viés de Publicação , Embolia Pulmonar/epidemiologia , Recidiva , Resultado do Tratamento , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
19.
J Endourol ; 35(10): 1498-1503, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33787317

RESUMO

Objectives: To compare the perioperative hemodynamic consequences and oncology outcomes of robotic retroperitoneal vs transperitoneal inferior vena cava (IVC) thrombectomy (IVCT) for right renal cell carcinoma (RCC) with IVC tumor thrombus (IVCTT) that located below the first porta hepatis. Patients and Methods: Between January 2018 and June 2019, 35 patients of right RCC with IVCTT that located below the first porta hepatis underwent robotic retroperitoneal IVCT (16 patients) or transperitoneal IVCT (19 patients). We have described the procedures of transperitoneal IVCT earlier. The main procedure of robotic retroperitoneal IVCT include circumferential dissection of the IVC, sequentially clamping subhepatic IVC, the left renal vein and the caudal IVC with vessel loops, IVCT, IVC repair, and radical nephrectomy (RN). The following parameters were compared between the two groups: baselines characteristic, perioperative consequences, and hemodynamic changes. Results: Retroperitoneal and transperitoneal cohorts were comparable in terms of IVC thrombus length (3.2 vs 4.0 cm), IVC block time (18 vs 16 minutes, p = 0.64), postoperative hospital stay (6 vs 6 days, p = 0.67), postoperative complications (0 vs 0), and recurrence or metastasis rate (0 vs 0) for patients with similar baseline characteristic. The retroperitoneal cohort tended to less blood loss (160 vs 240 mL, p = 0.024), shorter operative time (130 vs 145 minutes, p = 0.003), lower central venous pressure (p < 0.05), and smaller diameter of IVC (p < 0.05). Conclusions: Robotic retroperitoneal RN and IVCT is feasible for patients of right RCC with IVCTT located below the first porta hepatis and is superior to transperitoneal IVCT in terms of bleeding control and operation time for skilled surgeons.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Procedimentos Cirúrgicos Robóticos , Trombose Venosa , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Nefrectomia , Estudos Retrospectivos , Trombectomia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia
20.
Vasc Endovascular Surg ; 55(5): 505-509, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33535913

RESUMO

The most common cause of neoplastic thrombotic infiltration of the inferior vena cava is renal cell carcinoma (RCC). In the present report we described a case of a patient with massive RCC and extensive neoplastic thrombosis reaching the retrohepatic tract of the inferior vena cava. After a discussion in a multidisciplinary team meeting we decided to perform a radical nephrectomy with vena cava thrombectomy along with the support of a novel removable vena cava filter in order to avoid thromboembolism during the surgical procedure. Furthermore, a preoperative renal artery embolization with a non-adhesive liquid embolic agent was performed ahead of the surgical procedure in order to reduce the risk of intraoperative bleeding. The surgical procedure performed the day after was based on a hybrid endovascular-surgical approach consisting in nephrectomy, liver derotation, cavotomy with the additional use of a novel temporary caval filter, thus reducing the risk of intraoperative thromboembolic dissemination.


Assuntos
Carcinoma de Células Renais/cirurgia , Embolização Terapêutica , Neoplasias Renais/cirurgia , Nefrectomia , Implantação de Prótese/instrumentação , Trombectomia , Filtros de Veia Cava , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Idoso , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Remoção de Dispositivo , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Masculino , Invasividade Neoplásica , Trombectomia/instrumentação , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia
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