Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.612
Filtrar
1.
Medicine (Baltimore) ; 98(30): e16522, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348266

RESUMO

INTRODUCTION: Paradoxical embolism (PDE) refers to direct passage of venous thrombi into the arterial circulation through an arteriovenous shunt. It is well-known that the pulmonary thromboembolism (PTE) can cause opening of the foramen ovale leading to paradoxical arterial embolism. Long term follow up of PDE patient over 10 years was not reported in the literature. PATIENT CONCERNS: A 57-year-old woman presented with initial symptoms of numbness/weakness and hypoxemia. Ultrasonography and pulmonary arteriography indicated pulmonary thromboembolism. DIAGNOSIS: Pulmonary embolism and paradoxical multiple arterial embolism or acute PTE concomitant with paradoxical multiple arterial embolism. INTERVENTIONS: Craniectomy and anticoagulation treatment was administered and the patient received low-dose warfarin therapy for 10 years. OUTCOMES: The patient is currently stable with no abnormalities seen in the deep veins of the bilateral lower limbs. The international normalized ratio (INR) was controlled within the range of 1.20 to 1.51. As this is a 10-year follow-up case report, the patient has responded well to the treatment and has been followed-up. The follow-up has been annual and the patient has been stable CONCLUSION:: Low intensity and persistent anticoagulation therapy can inhibit blood thrombophilia and reduce the risk of bleeding. It is noteworthy that such an approach used effectively in this patient. To best our knowledge, it is first report for long term follow up PDE patient successfully over 10 years.


Assuntos
Embolia Paradoxal/etiologia , Forame Oval/irrigação sanguínea , Extremidade Inferior/irrigação sanguínea , Embolia Pulmonar/etiologia , Trombose Venosa/complicações , Anticoagulantes/uso terapêutico , Craniotomia/métodos , Embolia Paradoxal/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/terapia , Resultado do Tratamento , Trombose Venosa/terapia
2.
Medicine (Baltimore) ; 98(24): e16052, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192964

RESUMO

RATIONALE: Postpartum deep vein thrombosis is a unique condition in diagnosis and treatment. Rivaroxaban, a novel oral anticoagulant, is indicated for acute deep vein thrombosis, but limited data have been reported for postpartum women. Catheter-directed thrombolysis is a common procedure for treating acute deep vein thrombosis, but it is rarely used for postpartum patients, especially after more than 3 months. PATIENT CONCERNS: A 31-year-old Asian woman suffered from progressive erythematous swelling and local heat of the left lower limb after twin delivery. DIAGNOSES: Venous duplex ultrasound examination showed thrombus formation in the left femoral vein and popliteal vein with reduced compressibility. After standard treatment of novel oral anticoagulant therapy for 4 months, we observed only partial improvement of the symptoms, and the condition deteriorated after her ordinary activities. INTERVENTIONS: Venography was performed and a large amount of thrombus lining from left femoral vein to left iliac vein was noted with total occluded left common iliac vein. After catheter-directed thrombolysis and balloon dilatation, better flow was regained and her symptoms improved completely after procedure. OUTCOMES: During a 1-year follow-up without medication, the patient did not complain about leg swelling, exercise aggravation, or any other post-thrombotic symptoms. LESSONS: Pregnancy seems to be a transient provoking factor for deep vein thrombosis, but it is sometimes refractory even during the postpartum period.Follow-up imaging studies should be encouraged to confirm the vessel condition, particularly for applying down-titration or discontinuation strategies of medication.Catheter-directed thrombolysis could be considered as an alternative method for postpartum iliofemoral deep vein thrombosis. Postpartum women usually have favorable functional status and lower bleeding risk.Rivaroxaban is a favorable choice for deep vein thrombosis, but its use in postpartum women is still controversial, and evidence of its effectiveness is not available. Thus, endovascular intervention can be a relatively safe therapy, in addition to anticoagulation therapy for premenopausal patients with recurrent deep vein thrombosis.


Assuntos
Transtornos Puerperais/terapia , Terapia Trombolítica/métodos , Trombose Venosa/terapia , Adulto , Cateterismo , Feminino , Veia Femoral , Humanos , Veia Ilíaca , Período Pós-Parto , Transtornos Puerperais/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
3.
Medicine (Baltimore) ; 98(23): e15874, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169692

RESUMO

RATIONALE: Pulmonary artery sarcomas (PAS) are easily misdiagnosed as thromboembolic disease of pulmonary arteries, because of rarity and presenting with nonspecific signs, symptoms, or imaging findings. PATIENT CONCERNS: A 26-year-old man was admitted to the department of invasive technology with fever and dyspnea. Blood tests showed inflammatory activity, a slight increase of D-dimer and Fibrin Degradation Product. A chest enhanced computed tomography (CT) scanning revealed multiple filling defects occurred in the main trunk of both pulmonary arteries and branches of the left pulmonary artery DIAGNOSES:: It was initially diagnosed with pulmonary embolism (PE) and deep vein thrombosis (DVT), but was eventually diagnosed with pulmonary artery sarcoma that was confirmed by biopsy. INTERVENTIONS: The transcatheter thrombolysis therapy, inferior vena cava filter implantation, and operation were performed. OUTCOMES: The Organized mass was removed by the operation and was pathologically diagnosed as pulmonary artery sarcoma, the patient received postoperative chemotherapy according to the recommendation of oncology department. LESSONS: Coagulation markers have been reported to differentiate PAS from PE, but this case suggested that PAS can be associated with DVT and abnormal coagulation-fibrinolysis system.


Assuntos
Artéria Pulmonar/patologia , Sarcoma/diagnóstico , Neoplasias Vasculares/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Erros de Diagnóstico , Humanos , Masculino , Trombólise Mecânica , Artéria Pulmonar/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia , Filtros de Veia Cava , Trombose Venosa/terapia
4.
HNO ; 67(6): 469-482, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31076806

RESUMO

Thromboses in the head and neck region are rare events, particularly in the internal jugular vein. However, they can result in potentially hazardous complications. Possible triggers are inflammatory, traumatic, and (para-)neoplastic diseases. Clinical symptoms often are non-specific, and it is thus important to even consider the possibility of an internal jugular vein thrombosis. Sonography is the diagnostic tool of choice, which can be complemented by CT/MRI if necessary. Depending on the individual etiology, antithrombotic treatment including modern direct oral anticoagulants (DOAC) is advisable. In cases of sepsis, surgery is mandatory to control the focus. However, there is hardly any evidence concerning this unusual problem due to the low incidence.


Assuntos
Trombose Venosa , Humanos , Veias Jugulares , Trombose , Ultrassonografia , Trombose Venosa/diagnóstico , Trombose Venosa/terapia
5.
J Cancer Res Ther ; 15(2): 344-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964109

RESUMO

Aims: The aim of this study is to analyze the clinical features and prognosis of cancer patients with venous thromboembolism (VTE). Subjects and Methods: This was a retrospective observational study that selected cancer patients with a new VTE event from January 2003 to 2013 using the hospital information system in Beijing Hospital. The patients were divided into three groups according to the site of thrombosis as follows: pulmonary thromboembolism (PTE), deep venous thrombosis (DVT), or PTE plus DVT. The clinical manifestations and prognosis among the three groups were compared. Results: Among the 18,531 patients diagnosed with a malignant tumor, 280 (1.51%) patients presented with VTE at first diagnosis or during the disease course; of these, 26 had incidental pulmonary embolism (IPE). Dyspnea was the most common symptom in the PTE group (51.65%), and lower limb swelling was found mostly in the DVT group (65.27%). Approximately 53.92% and 63.21% of patients had VTE events within the first 3 and 6 months after cancer diagnosis, respectively. The median survival time of all VTE patients was 24.0 ± 7.85 months, with the DVT group having the longest survival time among the three groups (P < 0.05). About 29.23% of the 130 patient deaths occurred within the first 30 days after VTE diagnosis, and 46.92% occurred within the first 3 months. Conclusions: The incidence of IPE in cancer patients was not rare. Most VTE events occurred within the first 6 months after the cancer diagnosis, and nearly half of the deaths occurred within the first 3 months of VTE diagnosis in cancer patients.


Assuntos
Neoplasias/complicações , Neoplasias/mortalidade , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Análise de Sobrevida , Avaliação de Sintomas , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Trombose Venosa/terapia
6.
Gastroenterology ; 157(1): 34-43.e1, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30986390

RESUMO

DESCRIPTION: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership. The intent is to evaluate the current data on mechanism of altered coagulation in patients with cirrhosis, provide guidance on the use of currently available testing of the coagulation cascade, and help practitioners use anticoagulation and pro-coagulants appropriately in patients with cirrhosis. METHODS: This review is framed around the best practice points, which were derived from the most impactful publications in the area of coagulation in cirrhosis and agreed to by all authors. BEST PRACTICE ADVICE 1: Global tests of clot formation, such as rotational thromboelastometry, thromboelastography, sonorheometry, and thrombin generation, may eventually have a role in the evaluation of clotting in patients with cirrhosis, but currently lack validated target levels. BEST PRACTICE ADVICE 2: In general, clinicians should not routinely correct thrombocytopenia and coagulopathy before low-risk therapeutic paracentesis, thoracentesis, and routine upper endoscopy for variceal ligation in patients with hepatic synthetic dysfunction-induced coagulation abnormalities. BEST PRACTICE ADVICE 3: Blood products should be used sparingly because they increase portal pressure and carry a risk of transfusion-associated circulatory overload, transfusion-related acute lung injury, infection transmission, alloimmunization, and/or transfusion reactions. BEST PRACTICE ADVICE 4: The following transfusion thresholds for management of active bleeding or high-risk procedures may optimize clot formation in advanced liver disease: hematocrit ≥25%, platelet count >50,000, and fibrinogen >120 mg/dL. Commonly utilized thresholds for international normalized ratio correction are not supported by evidence. BEST PRACTICE ADVICE 5: Thrombopoietin agonists are a good alternative to platelet transfusion, but require time (about 10 days) to elevate platelet levels. BEST PRACTICE ADVICE 6: The large volume of fresh frozen plasma required to reach an arbitrary international normalized ratio target, limitations of the usual target, minimal effect on thrombin generation, and adverse effects on portal pressure limit the utility of this agent significantly. BEST PRACTICE ADVICE 7: The 4-factor prothrombin complex concentrate contains both pro- and anticoagulant factors that offer an attractive low-volume therapeutic to rebalance a disturbed hemostatic system. However, dosage is, in part, based on international normalized ratio, which is problematic in cirrhosis, and published experience in liver disease is limited. BEST PRACTICE ADVICE 8: Anti-fibrinolytic therapy may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity. Both ε-aminocaproic acid and tranexamic acid inhibit clot dissolution. Neither is believed to generate a hypercoagulable state, although both may exacerbate pre-existing thrombi. BEST PRACTICE ADVICE 9: Desmopressin releases von Willebrand factor as its primary hemostatic mechanism. As this factor is usually elevated in cirrhosis, the agent lacks a sound evidence-based foundation, but may be useful in patients with concomitant renal failure. BEST PRACTICE ADVICE 10: Systemic heparin infusion is recommended for symptomatic deep vein thrombosis and portal and mesenteric vein thrombosis, but there are unresolved issues regarding monitoring with both the anti-Xa assay and the partial thromboplastin time due to cirrhosis-related antithrombin deficiency (heparin cofactor). BEST PRACTICE ADVICE 11: Treatment of incidental portal and mesenteric vein thrombosis depends on estimated impact on transplantation surgical complexity vs risks of bleeding and falls. Therapy with low-molecular-weight heparin, vitamin K antagonists, and direct-acting anticoagulants improve portal vein repermeation vs observation alone. BEST PRACTICE ADVICE 12: Direct-acting anticoagulants, such as the factor Xa and thrombin inhibitors, are relatively safe and effective in stable cirrhotic patients, but are in need of further study in patients with more advanced liver disease.


Assuntos
Transtornos da Coagulação Sanguínea/terapia , Transfusão de Sangue/métodos , Cirrose Hepática/sangue , Trombofilia/terapia , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Antifibrinolíticos/uso terapêutico , Antitrombinas/uso terapêutico , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/complicações , Fatores de Coagulação Sanguínea/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Fibrinogênio/metabolismo , Hematócrito , Heparina/uso terapêutico , Humanos , Coeficiente Internacional Normatizado , Cirrose Hepática/complicações , Plasma , Contagem de Plaquetas , Veia Porta , Tromboelastografia , Trombocitopenia , Trombofilia/sangue , Trombofilia/complicações , Trombopoetina/agonistas , Reação Transfusional , Trombose Venosa/sangue , Trombose Venosa/complicações
7.
Ann Vasc Surg ; 56: 17-23, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30982504

RESUMO

BACKGROUND: Inferior vena cava thrombosis (IVCT), although rare, has a potential for significant morbidity and mortality. IVCT is often a result of IVC filter thrombosis, but it can also occur de novo. Although anticoagulation remains the standard of care, endovascular techniques to restore IVC patency have become key adjunctive therapies in recent years. This study examines a single-center experience with diagnosis and management of IVCT. METHODS: A retrospective Institutional Review Board-approved review of a single-center institutional database was screened to identify IVCT thrombosis using International Classification of Diseases code 453.2 over a 3-year period. Etiology of IVCT was separated into 2 groups: those with IVC thrombosis in the setting of prior IVC filter place and those in whom IVCT occurred de novo. Patient demographics, presenting characteristics, and management of IVCT were examined. Treatment options included expectant management with anticoagulation versus catheter-directed thrombolysis (CDT), mechanical thrombectomy, stenting, or a combination. For those who underwent intervention, technical success, defined as restoration of IVC patency, was assessed. RESULTS: Forty-one unique patients were identified with radiographically confirmed diagnosis of ICVT (mean age 61, range 25-91; 21 female, 51.2%). Eighteen (43.9%) patients presented with thrombosed IVC filter. Risk factors for venous thromboembolism included tobacco usage, current or prior smoking (n = 17, 41.5%), history of prior deep vein thrombosis (n = 25, 61.0%), malignancy (n = 17, 41.5%), use of hormonal supplements (n = 3, 7.3%), known thrombophilia (n = 4, 9.8%), and obesity (body mass index: mean 29, range 18.8-58.53). Eleven patients (26.8%) presented with pulmonary embolism (PE), and of those 63.6% had IVC filter thrombosis (n = 7). Risk of PE was not significantly different between those patients presenting with a thrombosed IVC filter compared to those with de novo IVCT (38.9% vs. 17.4%, P = 0.12) Management of IVCT included anticoagulation alone (n = 27, 65.9%), CDT (n = 5, 12.2%), mechanical thrombolysis (n = 10, 24.4%), and adjunctive IVC stent (n = 3, 7.3%). Among the 14 (34.1%) patients who had intervention for IVCT, patency was restored in 12 patients (85.7%). CONCLUSIONS: IVCT is a rare event and is associated with known risk factors for venous thromboembolism. PE can occur in roughly 25% of patients presenting with IVCT. Presence of a filter does not appear to confer an advantage in preventing PE when IVCT occurs. Although majority of IVCT is managed with anticoagulation alone, endovascular interventions, including lysis and stenting, can safely restore patency in most properly selected patients.


Assuntos
Anticoagulantes/uso terapêutico , Trombectomia , Terapia Trombolítica , Veia Cava Inferior , Trombose Venosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Estudos Retrospectivos , Fatores de Risco , Stents , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Grau de Desobstrução Vascular , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/fisiopatologia
8.
J Stroke Cerebrovasc Dis ; 28(6): 1440-1447, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30952531

RESUMO

BACKGROUND AND PURPOSE: 15% of cerebral venous thrombosis (CVT) patients have poor outcomes despite anticoagulation. Uncontrolled studies suggest that endovascular approaches may benefit such patients. In this study, we analyze Nationwide Inpatient Sample (NIS) data to evaluate the safety and efficacy of endovascular therapy (ET) versus medical management in CVT. We also examined the yearly trends of ET utilization in the United States. METHODS: International Classification of Diseases, Ninth Revision, Clinical Modification codes were utilized to identify CVT patients who received ET. To make the data nationally representative, weights were applied per NIS recommendations. Since ET was not randomly assigned to patients and was likely to be influenced by disease severity, propensity score weighting methods were utilized to correct for this treatment selection bias. Outcome variables included in-hospital mortality and discharge disposition. To determine if our primary outcomes were associated with ET, we used weighted multivariable logistic regression analyses. RESULTS: Of the 49,952 estimated CVT cases, 48,704 (97%) received medical management and 1248 (3%) received ET (mechanical thrombectomy [MT] alone, N = 269 [21%], MT ± thrombolysis, N = 297 [24%], and thrombolysis alone, N = 682 [55%]). Patients who received ET were older with more CVT associated complications including venous infarct, intracranial hemorrhage, coma, seizure, and cerebral edema. There was a significant yearly rise in the use of ET, with a trend favoring MT versus thrombolysis alone. ET was independently associated with an increased risk of death (odds ratio 1.96, 95% confidence interval 1.15-3.32). CONCLUSIONS: Patients receiving ET experienced higher mortality after adjusting for age and CVT associated complications. Large, well designed prospective randomized trials are warranted for further evaluation of the safety and efficacy of ETs.


Assuntos
Procedimentos Endovasculares/tendências , Pacientes Internados , Trombose Intracraniana/terapia , Padrões de Prática Médica/tendências , Trombectomia/tendências , Terapia Trombolítica/tendências , Trombose Venosa/terapia , Adulto , Idoso , Fármacos Cardiovasculares/uso terapêutico , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/mortalidade , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade
9.
Ann Vasc Surg ; 59: 208-216, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30826434

RESUMO

BACKGROUND: The aim of the study was to assess results of interventions for iliocaval obstruction or compression in patient with acute and chronic venous disease. METHODS: Patients with chronic venous insufficiency (CVI) C3-C6 (Clinical, Etiology, Anatomy, Pathology - classification of venous insufficiency) and acute deep venous thrombosis were assessed by ultrasound scan, computed tomography, venography, and/or intravascular ultrasound, and if an obstruction in their iliocaval or iliofemoral segments were confirmed, they underwent venoplasty and stenting. Acute deep venous thrombosis cases were treated with pharmacomechanical and/or catheter-directed thrombolysis and residual obstruction was then stented. RESULTS: One hundred eighteen consecutive limbs were treated between October 2011 and December 2017. Thirty-two limbs had an active ulcer (27%), 27 limbs had healed ulcer or advanced skin changes (23%), 39 limbs had swelling with or without other symptoms of CVI (33%), 15 limbs had acute symptomatic deep venous thrombosis (13%), and the residual 5 iliac vein cases were causing pelvic congestion syndrome (4%). Patency rates of the stents in acute cases were 84.6%, 76.9%, 76.9%, and in chronic cases (combined thrombotic and nonthrombotic) 93.1%, 91%, and 89.9% in 3, 6, and 12 months, respectively. A relief of symptoms was achieved in 81.5 % of limbs at some stage during the first 12 months (most of them within the first 3 months), although at the end of this period only 59.3% remained free of symptoms. There was no limb loss and no mortality within 30 days from the intervention. CONCLUSIONS: Iliocaval and iliofemoral venoplasty and stenting in both acute and chronic obstruction cases can be performed safely with good patency rates and reasonable improvement of symptoms of CVI.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Femoral , Veia Ilíaca , Stents , Veia Cava Inferior , Insuficiência Venosa/terapia , Trombose Venosa/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Salvamento de Membro , Pessoa de Meia-Idade , Flebografia/métodos , Medição de Risco , Fatores de Risco , Terapia Trombolítica , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Adulto Jovem
10.
J Wound Care ; 28(Sup3b): s25-s28, 2019 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-30840534

RESUMO

Side-effects occurring in patients treated by multilayer bandaging may be neurological, dermatological or arterial. We report on two cases of venous thrombosis involving outpatients treated for venous leg ulcers (VLU). In the first case, a lack of understanding of multilayer bandages and training on their use by the nursing staff was likely the cause of a superficial vein thrombosis (SVT) in a great saphenous vein tributary. The second case occurred in a patient suffering from an ulcer complicated by oedema. Insufficient education of the patient in alert symptoms for his condition and an inappropriate medical follow-up were the direct causes of a non-severe distal vein thrombosis. We conclude that, as it has been suggested over a number of years, patients being treated with bandage therapy must be rigorously and carefully monitored.


Assuntos
Bandagens Compressivas/efeitos adversos , Úlcera da Perna/terapia , Veia Safena , Insuficiência Venosa , Trombose Venosa/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Escleroterapia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/terapia
11.
BMJ Case Rep ; 12(3)2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30852504

RESUMO

A 62-year-old man presented to the Emergency Department with dyspnoea and central pleuritic chest pain radiating posteriorly to between the scapulae. His medical history included hypertension, osteoporosis and chronic kidney disease secondary to focal segmental glomerulosclerosis with relapsing nephrotic syndrome. Significant examination findings included a loud palpable P2 and a displaced apex beat. An ECG revealed sinus tachycardia with a right-bundle branch block and p-pulmonale. A CT pulmonary angiogram and aortogram demonstrated extensive bilateral pulmonary emboli and a descending thoracic aortic dissection. Subsequent ultrasound of the lower limbs confirmed an extensive, non-occlusive deep vein thrombosis in the right calf. Management of this patient involved therapeutic anticoagulation and tight blood pressure control, with plans for surgical repair delayed due to worsening renal impairment and subsequent supratherapeutic anticoagulation. Co-existence of an aortic dissection and PE has been rarely described and optimal management remains unclear.


Assuntos
Aneurisma Dissecante/terapia , Glomerulosclerose Segmentar e Focal/complicações , Síndrome Nefrótica/complicações , Embolia Pulmonar/terapia , Trombose Venosa/terapia , Aneurisma Dissecante/etiologia , Anticoagulantes/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Osteoporose/etiologia , Embolia Pulmonar/etiologia , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Trombose Venosa/etiologia
12.
Ann Vasc Surg ; 58: 363-370, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769054

RESUMO

BACKGROUND: Deep vein thrombosis (DVT) is associated with significant complications, including the development of post-thrombotic syndrome (PTS). Traditional management is with oral anticoagulation, but the endovascular techniques of catheter-directed thrombolysis (CDT), pharmacomechanical thrombolysis, and venous stenting are now increasingly used. This study aims to review the evidence for these endovascular techniques in the management of acute lower limb DVT, and their role in the reduction of complications such as PTS. METHODS: A systematic review and meta-analysis was carried out, with studies that compared CDT, pharmacomechanical thrombolysis, and/or venous stenting with oral anticoagulation included. Primary outcome measure was the incidence of PTS; secondary outcome measures were the incidence of recurrent venous thromboembolism (VTE) and bleeding complications. Treatment effects were calculated as risk ratios (RR) with their 95% confidence interval (CI). RESULTS: Five studies met the final inclusion criteria. CDT reduced the incidence of PTS (RR 0.56, 95% CI 0.43-0.73), whereas pharmacomechanical thrombolysis had only a minor effect on the incidence of PTS that did not achieve statistical significance (RR 0.87, 95% CI 0.75-1.01). Recurrent VTE following CDT was reduced compared to oral anticoagulation (RR 0.62, 95% CI 0.34-1.13), while bleeding complications were more likely following CDT (RR 5.11, 95% CI 2.16-12.08). CONCLUSIONS: CDT decreases the incidence of PTS when treating iliofemoral DVT, but pharmacomechanical thrombolysis does not. CDT also reduces the incidence of recurrent VTE, but leads to more bleeding complications when compared to oral anticoagulation. Further randomized controlled trials are needed to determine the role of endovascular management of DVT occurring below the iliofemoral level, and the role of venous stenting.


Assuntos
Procedimentos Endovasculares , Extremidade Inferior/irrigação sanguínea , Trombectomia/métodos , Terapia Trombolítica , Trombose Venosa/terapia , Adulto , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Síndrome Pós-Trombótica/epidemiologia , Recidiva , Fatores de Risco , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
13.
Clin Appl Thromb Hemost ; 25: 1076029618821190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30808224

RESUMO

Early catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce postthrombotic morbidity. Pharmacomechanical thrombolysis (PMT) is a new therapy that can be selected for the treatment of iliofemoral deep vein thrombosis (IFDVT). We performed a meta-analysis of clinical trials comparing PMT versus CDT for treatment of acute IFDVT. Literature on this topic published between January 1, 1990, and June 1, 2018, was identified using PubMed, Embase, Cochrane Library, and Web of Science. Six trials were included in the meta-analysis. Compared to CDT, PMT significantly reduced the Villalta score ( P = .007; I2 = 0%), thrombus score ( P = .01; I2 = 0%), the duration in the hospital ( P = .03; I2 = 64%), and thrombolysis time ( P < .00001, I2 = 0%). There was no significant difference in valvular incompetence events ( P = .21; I2 = 0%), minor bleeding events ( P = .59; I2 = 0%), stent events ( P = .09; I2 = 24%), and clot reduction grade I events ( P = .16; I2 = 43%) between PMT and CDT. Subgroup analysis was performed by dividing the clot reduction grade I events group into PMT plus CDT versus CDT group and significant differences were found ( P = .03, I2 = 0%) as well as for PMT alone versus CDT group ( P = .88, I2 = 37%). This meta-analysis shows that PMT reduces the severity of postthrombotic syndrome (PTS), thrombus score, duration in hospital, and thrombolysis time compared to CDT. More specifically, PMT plus CDT reduces clot reduction grade I events. No significant difference in valvular incompetence events, stent events, and minor bleeding events were found when PMT was compared to CDT.


Assuntos
Trombectomia/métodos , Terapia Trombolítica/métodos , Trombose Venosa/cirurgia , Trombose Venosa/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombose Venosa/patologia
14.
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
16.
Gastroenterology ; 156(6): 1582-1599.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771355

RESUMO

Portal vein thrombosis unrelated to solid malignancy is common in patients with cirrhosis, but less frequently observed in patients without cirrhosis. Prompt diagnosis and management of acute symptomatic portal vein thrombosis are essential. Failure to detect and treat thromboses can result in mesenteric ischemia, chronic cavernous transformation, and complications of portal hypertension. In patients with cirrhosis, development of portal vein thrombosis is often insidious and remains undetected until its incidental detection. Management of portal vein thrombosis in patients with cirrhosis is more controversial. However, there are data to support treatment of specific patients with anticoagulation agents. We review the common and distinct features of portal vein thromboses in patients without liver tumors, with and without cirrhosis.


Assuntos
Transtornos da Coagulação Sanguínea/complicações , Cirrose Hepática/complicações , Neoplasias/complicações , Veia Porta , Trombofilia/complicações , Trombose Venosa/etiologia , Trombose Venosa/terapia , Doença Aguda , Doença Crônica , Humanos , Fatores de Risco , Trombose Venosa/complicações , Trombose Venosa/diagnóstico
18.
Chirurg ; 90(1): 71-84, 2019 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30607459

RESUMO

Acute deep pelvic vein thrombosis (DVT) is usually a non-fatal disease that causes lifelong damage. In the case of clinical suspicion of DVT, D­dimer determination and/or imaging must be performed. If a timely diagnosis is not possible, anticoagulation should be started. The focus of treatment is the safety of the patient. All studies on thrombus-eliminating procedures, such as thrombolysis, operative open thrombectomy and endovascular revascularization, did not show any advantages over pure anticoagulation and are associated with specific risks. The minimum duration of anticoagulation is 3 months. Thereafter, the decision of prolonged anticoagulation must be made individually for each patient. Compression therapy is an integral part of the treatment of acute TVT in Germany, even the evidence for its effectivenes with respect to the prevention of post-thrombotic syndrome is low.


Assuntos
Trombose Venosa , Adolescente , Alemanha , Humanos , Pessoa de Meia-Idade , Flebografia , Trombectomia , Terapia Trombolítica , Resultado do Tratamento , Trombose Venosa/diagnóstico , Trombose Venosa/terapia
19.
Thromb Haemost ; 119(4): 633-644, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30699446

RESUMO

BACKGROUND AND OBJECTIVES: The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial reported that pharmacomechanical catheter-directed thrombolysis (PCDT) did not reduce post-thrombotic syndrome (PTS), but reduced moderate-to-severe PTS and the severity of PTS symptoms. In this analysis, we examine the effect of PCDT in patients with femoral-popliteal deep vein thrombosis (DVT) (without involvement of more proximal veins). PATIENTS AND METHODS: Within the ATTRACT trial, 300 patients had DVT involving the femoral vein without involvement of the common femoral or iliac veins and were randomized to receive PCDT with anticoagulation or anticoagulation alone (no PCDT). Patients were followed for 24 months. RESULTS: From 6 to 24 months, between the PCDT versus no PCDT arms, there was: no difference in any PTS (Villalta scale ≥ 5: risk ratio [RR] = 0.97; 95% confidence interval [CI], 0.75-1.24); moderate-or-severe PTS (Villalta scale ≥ 10: RR = 0.93; 95% CI, 0.57-1.52); severity of PTS scores; or general or disease-specific quality of life (p > 0.5 for all comparisons). From baseline to both 10 and 30 days, there was no difference in improvement of leg pain or swelling between treatment arms. From baseline to 10 days, major bleeding occurred in three versus none (p = 0.06) and any bleeding occurred in eight versus two (p = 0.032) PCDT versus no PCDT patients. Over 24 months, recurrent venous thromboembolism occurred in 16 PCDT and 12 no PCDT patients (p = 0.24). CONCLUSION: In patients with femoral-popliteal DVT, PCDT did not improve short- or long-term efficacy outcomes, but it increased bleeding. Therefore, PCDT should not be used as initial treatment of femoral-popliteal DVT. (NCT00790335).


Assuntos
Veia Femoral/fisiopatologia , Veia Poplítea/fisiopatologia , Terapia Trombolítica/métodos , Trombose Venosa/terapia , Adolescente , Adulto , Idoso , Anticoagulantes/uso terapêutico , Cateterismo , Cateterismo Periférico , Feminino , Fibrinólise , Fibrinolíticos/uso terapêutico , Hemorragia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Síndrome Pós-Trombótica/prevenção & controle , Qualidade de Vida , Meias de Compressão , Tromboembolia , Pesquisa Médica Translacional , Resultado do Tratamento , Adulto Jovem
20.
Vasa ; 48(4): 331-339, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30667348

RESUMO

Background: The optimal duration of anticoagulation therapy (AT) following catheter-based therapy of acute iliofemoral deep vein thrombosis (IFDVT) with stent placement is unknown. Theoretically, resolving the underlying obstructive iliac vein lesion by a stent may eliminate the main trigger for recurrence, the post-thrombotic syndrome (PTS), and the need for extended-duration AT. Patients and methods: From 113 patients with acute IFDVT who underwent endovascular thrombus removal and stent placement, we compared patency rates and clinical outcomes between 58 patients on limited-duration AT (3-12 month) and 55 patients on extended-duration AT (> 12 months). Results: Mean follow-up duration was 26 ± 18 (range 3-77) months; it was 24 ± 18 (range 3-69) months after cessation of AT in the limited-duration AT group. In comparison to patients with extended-duration AT, patients with limited-duration AT were younger (38 versus 54 years; p < 0.001), more often female (74 % versus 49 %; p = 0.01), and had less often prior venous thromboembolism (VTE) (9 % versus 35 %; p = 0.001). May-Thurner syndrome was more frequent in the limited-duration AT group (66 % versus 38 %; p = 0.004). Overall, primary and secondary patency rates at 24 months were 80 % (95 % CI, 70-87 %) and 95 % (95 % CI, 88-98 %), respectively, with no difference between the groups. Overall, 17 (15 %) patients developed recurrent VTE, of which 14 (82 %) events were thrombotic stent occlusions, and 13 (76 %) events occurred during AT. In the limited-duration AT group, 98 % patients were free from the PTS at two years with a VTE recurrence rate of 3.5 per 100 patient years after cessation of AT. Conclusions: In selected patients with acute IFDVT and patent venous stent, particularly in younger and otherwise healthy patients with May-Thurner syndrome, it appears to be safe to discontinue AT 3-12 months after endovascular treatment. Clinical Trial Registration: The study is registered on the National Institutes of Health website (ClinicalTrials.gov; identifier NCT02433054).


Assuntos
Veia Femoral , Trombose Venosa , Adulto , Anticoagulantes , Feminino , Humanos , Veia Ilíaca , Pessoa de Meia-Idade , Stents , Terapia Trombolítica , Resultado do Tratamento , Trombose Venosa/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA