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1.
Angiol Sosud Khir ; 25(4): 92-99, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855205

RESUMO

BACKGROUND: Post-thrombotic iliac vein lesion is one of the causes of secondary pelvic varicose veins (PVV) in women. Endovascular treatment of this cohort of patients requires further studies. AIM: The study was undertaken to investigate the aspects of endovascular treatment of female patients diagnosed as having PVV secondary to post-thrombotic alterations of the iliac veins. PATIENTS AND METHODS: Presented herein are the results of diagnosis and treatment of nine women suffering from PVV in obstructive lesion of the iliac veins. All patients underwent phlebography with stenting of the iliac veins, followed by clinical and instrumental assessment of efficacy of treatment. RESULTS: The technical success rate of stenting amounted to 100%. In the early postoperative period thrombotic complications developed in two women and in the remote period in one. The operation was followed by a decrease in the intensity of PVV manifestations, as well as chronic venous insufficiency of the lower limbs, which was confirmed by clinical and instrumental methods of objectification and visualization. The composite index of quality of life was noted to decrease from 47±5.3 to 27.8±3.3 points (p<0.05). The median of the composite value of the Pelvic Venous Clinical Severity Score decreased by 8.6±1.8 points (p<0.05). The average value of the composite index of the Venous Clinical Severity Score (VCSS) diminished by 6.8±1.4 points (p<0.05) and that of the Villalta score by 8.3±1.6 points (p<0.05). CONCLUSION: Pelvic varicose veins appear to develop in two of three women after endured thrombosis. The experience with stenting of the iliac veins demonstrated good efficacy and safety. Efficiency of the intervention was determined by improved quality of life of the patients and positive dynamics of the clinical course of the disease.


Assuntos
Procedimentos Endovasculares , Veia Ilíaca/cirurgia , Trombose/complicações , Varizes/cirurgia , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Flebografia , Qualidade de Vida , Stents , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/etiologia
2.
Medicine (Baltimore) ; 98(41): e17547, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593135

RESUMO

RATIONALE: Leakage of bone cement from femoral medullary cavity is a rare complication after hip arthroplasty, and there is no report on the leaked bone cement entering into iliac vessels. PATIENT CONCERNS: An 89-year-old woman presented with a fracture in the right femoral neck. She had well-fixed right femoral head replacement after careful preoperative examinations, and no adverse reactions appeared. She was able to get off bed to walk at the 2nd day after surgery. DIAGNOSES: Postoperative radiograph showed leakage of bone cement into the joint through femoral medullary cavity entering into iliac vessels, but the patient complained no discomforts. She received a treatment with low-molecular weight heparin and rivaroxaban. OUTCOMES: The patient was able to walk with normal gait, without swelling in both lower extremities and discomfort in the hip. There was no other complication concerning intravascular foreign bodies. LESSONS: This case calls into the phenomenon of leakage of injected bone cement in femoral head replacement regardless of complete and nonfractured femur, which may be into the lower limb and pelvic veins, given that, dangerous consequences will not occur.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/efeitos adversos , Cabeça do Fêmur/cirurgia , Veia Ilíaca/patologia , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Veia Ilíaca/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiografia/métodos , Rivaroxabana/uso terapêutico , Resultado do Tratamento
3.
Heart Surg Forum ; 22(4): E289-E293, 2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-31398094

RESUMO

Phlegmasia cerulea dolens is an acute fulminating form of extensive venous thrombosis. Limb loss, post-thrombotic syndrome and life-threatening conditions can occur without appropriate management. Treatment methods vary; there presently is no consensus on the best form of treatment. Endovascular procedures have been a good option for treating deep vein thrombosis, yet they may be insufficient for patients suffering from phlegmasia cerulea dolens. Venous thrombectomy with the guidance of venography quickly relieves symptoms, hardly causes complications, yields optimal mid-term results, and can be a justifiable treatment for phlegmasia cerulea dolens.


Assuntos
Perna (Membro)/irrigação sanguínea , Trombectomia/métodos , Trombose Venosa/cirurgia , Angioplastia com Balão/métodos , Embolectomia com Balão/instrumentação , Embolectomia com Balão/métodos , Evolução Fatal , Feminino , Veia Femoral , Humanos , Veia Ilíaca/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Veia Poplítea , Trombectomia/instrumentação , Trombose Venosa/diagnóstico por imagem
4.
Int J Cardiovasc Imaging ; 35(12): 2231-2237, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31446527

RESUMO

The aim of the study was to compare CE-MRV with DANTE-SPACE on a 1.5T MRI system for the diagnosis of DVT. The patients were diagnosed with deep venous thrombosis of the lower extremities based on swelling, pain, and superficial varicose veins of the lower extremities. MRI examination confirmed the diagnosis. DANTE-SPACE images were obtained before the conventional contrast-enhanced MRV, which uses gadolinium. The scanning field started from the end of the inferior vena cava to the end of the ankle, divided into five observation segments, namely, the common iliac vein, external iliac vein, femoral vein, popliteal vein, and calf vein. The DANTE-SPACE and CE-MRV results were used for a consistency analysis. For the DANTE-SPACE and CE-MRV images, the signal intensity ratios of the thrombus/cavity and thrombus/muscle were calculated, and the ratio difference was compared using the paired t test. Twenty-six patients completed the examination; one of the patients underwent a right lower limb amputation, yielding a total of 255 lower limb vascular segments. The analysis of the DANTE-SPACE images showed that there were 14 iliac vein thromboses, 18 external iliac vein thromboses, 23 femoral vein thrombi, 21 popliteal vein thromboses, and 18 calf vein thromboses; these findings were consistent with the diagnostic results of CE-MRV. The ratio of the thrombus/cavity signal intensity measured in the DANTE-SPACE and CE-MRV images were as follows: 20.51 ± 12.96 vs. 0.51 ± 0.46; P < 0.05, n = 51; the difference was statistically significant. The ratio of the thrombus/muscle signal intensity measured on the DANTE-SPACE and CE-MRV images were as follows: 1.74 ± 0.57 vs. 0.99 ± 0.53; P < 0.05, n = 51; the difference was statistically significant. Compared with CE-MRV, DANTE-SPACE showed no significant difference in the ability to detect deep venous thrombosis of the lower extremities. DANTE-SPACE did not use contrast-enhancing agents and showed no evidence of inflammatory enhancement, and the display effect of small diameter veins was slightly poor. However, deep venous thrombosis of the lower extremities presents different levels of high signal in the DANTE-SPACE images, making it easy to identify and diagnose. It can also indicate the different components and age of the thrombus and help with the selection of a more accurate clinical treatment plan. MRI DANTE-SPACE is the preferred imaging modality for patients with deep venous thrombosis who are unable or unwilling to use gadolinium contrast agents.


Assuntos
Meios de Contraste/administração & dosagem , Veia Femoral/diagnóstico por imagem , Gadolínio DTPA/administração & dosagem , Veia Ilíaca/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Veia Poplítea/diagnóstico por imagem , Varizes/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
5.
BMC Musculoskelet Disord ; 20(1): 380, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421678

RESUMO

BACKGROUND: At present, bicortical pedicle screws (BPSs) are not used clinically because they carry the potential risk of damaging the prevertebral great vessels (PGVs). The authors observed the anatomical relationship between the PGVs and simulated BPSs at different transverse screw angles (TSAs), exploring the insertion method of the BPS. METHODS: Computed tomography angiography (CTA) images from 65 adults were collected. A total of 4-5 TSAs of the BPSs were simulated on the left and right sides of L1-L5 (L1-L3: 0°, 5°, 10°, 15°; L4-L5: 0°, 5°, 10°, 15°, 20°). There were three types of distances from the anterior vertebral cortex (AVC) to the PGVs (DAVC-PGV); DAVC-PGV < 0.50 cm, DAVC-PGV ≥ 0.50 cm, and DAVC-PGV↑; these distances represented close, distant, and noncontact PGV, respectively. RESULTS: The ratio of every type of PGV was calculated, and the appropriate TSA of the BPS was recommended. In L1, the recommended left TSA of the BPS was 0°, and the ratio of the close PGV was 7.69%, while the recommended right TSA was 0°-10°, and the ratio of the close PGV was 1.54-4.62%. In L2, the recommended left TSA of the BPS was 0° and the ratio of the close PGV was 1.54%, while the recommended right TSA was 0°-15° and the ratio of the close PGV was 3.08-9.23%. In L3, the recommended left TSA was 0°-5°, and the ratio of the close PGV was 1.54-4.62%. In L4, the recommended left TSA was 0°, and the ratio of the close PGV was 4.62%. BPS use was not recommended on the right side of either L3 or L4 or on the either side of L5. CONCLUSIONS: From the anatomical perspective of the PGVs, BPSs were not suitable for insertion into every lumbar vertebra. Furthermore, the recommended methods for inserting BPSs were different in L1-L4.


Assuntos
Vértebras Lombares/irrigação sanguínea , Parafusos Pediculares/efeitos adversos , Fusão Vertebral/métodos , Adulto , Idoso , Aorta Abdominal/anatomia & histologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Artéria Ilíaca/anatomia & histologia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Veia Ilíaca/anatomia & histologia , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/lesões , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Veia Cava Inferior/anatomia & histologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/lesões , Adulto Jovem
6.
BMJ Case Rep ; 12(7)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31278199

RESUMO

May-Thurner syndrome (MTS) is a differential diagnosis to be considered in a patient with recurrent unilateral cellulitis. A 73-year-old woman initially presented with recurrent unilateral cellulitis of her left lower limb. A CT scan demonstrated a stenosed left common iliac vein (CIV) narrowed at its origin by the proximal right common iliac artery consistent with MTS. The chronicity of the condition at the time of diagnosis made attempts to recanalise the CIV unsuccessful. A diagnosis of MTS should be considered in a patient with chronic unilateral limb oedema/cellulitis as it represents a potentially treatable condition if detected early.


Assuntos
Celulite (Flegmão)/diagnóstico , Síndrome de May-Thurner/diagnóstico , Idoso , Celulite (Flegmão)/etiologia , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Extremidade Inferior/patologia , Síndrome de May-Thurner/complicações , Recidiva
7.
Vasc Health Risk Manag ; 15: 115-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190849

RESUMO

Iliac vein compression (LIVC) is a prevalent finding in the general population, but a smaller number of patients are symptomatic. ILVC should be considered in symptomatic patients with unexplained unilateral lower leg swelling. Patients typically complain of one or more of the following symptoms: lower leg pain, heaviness, venous claudication, swelling, hyperpigmentation and ulceration. ILVC can be thrombotic, combined with acute or chronic DVT, or non-thrombotic. ILVC is best diagnosed with intravascular ultrasound (IVUS), but computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have emerged as valid screening tests. Venography underestimates the severity of ILVC but may provide insights into the anatomy and the presence of collaterals. Based on current available evidence, endovascular therapy with stenting remains the main treatment strategy for ILVC. Dedicated nitinol venous stents are currently under review by the Food and Drug Administration for potential approval in the United States. These stents have been released outside the US. There is no consensus to the optimal anticoagulation regimen post-ILVC stenting. Oral anticoagulants, however, remain a preferred therapy in patients with history of thrombotic ILVC.


Assuntos
Anticoagulantes/administração & dosagem , Diagnóstico por Imagem/métodos , Procedimentos Endovasculares , Veia Ilíaca , Síndrome de May-Thurner , Administração Oral , Anticoagulantes/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Veia Ilíaca/cirurgia , Angiografia por Ressonância Magnética , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/epidemiologia , Síndrome de May-Thurner/fisiopatologia , Síndrome de May-Thurner/terapia , Flebografia/métodos , Valor Preditivo dos Testes , Prevalência , Stents , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia de Intervenção
8.
Ann Vasc Surg ; 60: 480.e7-480.e11, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200048

RESUMO

The purpose of this article is to present a case of cauda equina syndrome in a patient with incomplete motor and sensory deficits due to epidural venous plexus engorgement, owing to May-Thurner syndrome successfully treated with venous iliac stenting. A 40-year-old woman, with previous history of deep vein thrombosis and miscarriages, gradually developed right leg and back pain, with functional limitation, perineal hypoesthesia, and sphincter incontinence. Magnetic resonance imaging revealed epidural venous plexus engorgement and cauda equina roots involvement. Phlebography showed perimedullary venous enlargement and left common iliac vein stenosis, leading to the diagnosis of May-Thurner syndrome. Stenting of the left common iliac vein was performed resulting in pain improvement and disappearance of neurological symptoms. Thrombophilia study was positive to heterozygous factor V Leiden. Cauda equina syndrome as the first presentation of a May-Thurner syndrome is very rare. In this case, venous iliac stent placement was an effective and safe treatment.


Assuntos
Síndrome da Cauda Equina/etiologia , Espaço Epidural/irrigação sanguínea , Veia Ilíaca , Síndrome de May-Thurner/complicações , Adulto , Angioplastia com Balão/instrumentação , Síndrome da Cauda Equina/diagnóstico por imagem , Síndrome da Cauda Equina/fisiopatologia , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/terapia , Atividade Motora , Recuperação de Função Fisiológica , Limiar Sensorial , Stents , Resultado do Tratamento
11.
World Neurosurg ; 128: e768-e772, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077904

RESUMO

OBJECTIVE: Safe surgical approaches to the anterolateral lumbar spine require a good working knowledge of the anatomy and anatomic variations of this region. As the iliolumbar vein is in the vicinity of both oblique and lateral transpsoas approaches to the lower lumbar spine, the following study was performed to better elucidate its anatomy, variations, and position during such surgical procedures. METHODS: Fifteen (30 sides) fresh frozen adult cadavers underwent dissection of the iliolumbar vein (ILV). The origin, course, variants, relations, and morphometrics of each vein were documented. Fluoroscopy of the vessels was performed. Lastly, anterior oblique and lateral transpsoas approaches to the lumbar spine were carried out in order to evaluate for potential ILV injury. RESULTS: An ILV was found on all but 2 sides (93.3%). It arose as a common trunk from the common iliac vein on 14 sides. Left ILVs tended to have a more distal origin than right ILVs. ILVs had a mean length of 3.7 cm and a mean width of 0.9 cm and were significantly larger on right versus left sides (P < 0.05). Left-sided ILVs tended to have more branches than right-sided veins. The majority of vertical branches of the ILV traveled anterior to the ventral rami of the lumbar spinal nerves, most commonly L4. The ILV and, in particular, its vertical branches coursed next to the L4 and L5 vertebrae. CONCLUSIONS: The ILV should be considered during both oblique and lateral transpsoas approaches to the lumbar spine.


Assuntos
Veia Ilíaca/anatomia & histologia , Veia Ilíaca/cirurgia , Vértebras Lombares/irrigação sanguínea , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/métodos , Músculos Psoas/anatomia & histologia , Músculos Psoas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Fluoroscopia , Lateralidade Funcional , Humanos , Veia Ilíaca/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Músculos Psoas/diagnóstico por imagem , Fluxo Sanguíneo Regional
12.
Cardiovasc Intervent Radiol ; 42(8): 1117-1127, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062068

RESUMO

OBJECTIVES: To propose a scale of severity for post-thrombotic venous lesions (PTVLs) after ilio-femoral deep venous thrombosis and to compare the grade with the results of endovascular treatment of ilio-femoral PTVLs. METHODS: In this retrospective monocentric observational study, we included 95 patients treated for ilio-femoral PTVLs. We proposed a four-grade scale evaluating the severity of PTVLS caudal to the common femoral vein based on CT phlebography and per-operative phlebography. For most patients, venous patency was assessed with color duplex ultrasonography and the clinical efficacy of the intervention using the Villalta and CIVIQ scores. RESULTS: Recanalization was successful in 100% of patients with a morbidity rate of 4%. After a mean follow-up of 21 months, the overall primary patency was 75%, the assisted primary patency 82%, and the secondary patency 93%. Secondary patency was 100% for grade 0-1, 90% for grade 2, and 63% for grade 3 (p < 0.002). There was no correlation between the extension of stenting caudally of the common femoral vein and venous patency. The mean improvements in the Villalta and CIVIQ-20 scores were, respectively, 4.6 (p < 0.0001) and 18 (p < 0.0001); scores were not correlated with the grade of PTVLs in the thigh. CONCLUSION: Venous patency after endovascular treatment of ilio-femoral PTVLs was strongly linked to the severity of PTVLs caudal to the common femoral vein but not to the extent of stenting.


Assuntos
Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares/métodos , Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Síndrome Pós-Trombótica/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/complicações , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
13.
Diagn Interv Radiol ; 25(3): 242-244, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063143

RESUMO

Self-expanding nitinol stents are routinely used to treat left common iliac vein compression in patients with May-Thurner syndrome. On occasion these stents do not provide adequate radial force to achieve a sufficient iliac lumen. If symptoms persist and persistent iliac vein compression is noted then balloon-expandable stents may be used to provide buttressing support at the compression site. We present a case where the buttressing balloon-expandable stent is crushed and subsequently removed percutaneously prior to placement of a high radial force self-expanding stent at the compressive site.


Assuntos
Angioplastia com Balão/instrumentação , Veia Ilíaca/patologia , Síndrome de May-Thurner/complicações , Stents Metálicos Autoexpansíveis/normas , Adulto , Ligas , Angioplastia com Balão/efeitos adversos , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Síndrome de May-Thurner/patologia , Flebografia/métodos , Desenho de Prótese , Falha de Prótese , Stents/efeitos adversos , Instrumentos Cirúrgicos , Resultado do Tratamento , Grau de Desobstrução Vascular
14.
Diagn Interv Radiol ; 25(3): 238-241, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063144

RESUMO

A 47-year-old male with a remote renal transplant due to pediatric glomerulonephritis on oral anticoagulation for symptomatic deep venous thrombosis and pulmonary emboli presented with sudden hip and groin pain. The patient was found to have a spinal epidural hematoma, underwent reversal of anticoagulation, and subsequently developed worsening renal function. Imaging revealed occlusive iliocaval venous thrombosis with extension to the renal allograft. Given risk of epidural hematoma expansion, the patient was deemed high risk for thrombolysis. The AngioVac system was used for single session thrombus removal. The patient's renal function improved and no focal neurologic sequelae was noted postprocedure. Six-month follow-up showed persistent vessel patency.


Assuntos
Hematoma Epidural Espinal/diagnóstico , Veia Ilíaca/patologia , Transplante de Rim/efeitos adversos , Trombectomia/instrumentação , Veia Cava Inferior/patologia , Aloenxertos/irrigação sanguínea , Aloenxertos/patologia , Hematoma Epidural Espinal/complicações , Humanos , Veia Ilíaca/diagnóstico por imagem , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Trombose/patologia , Trombose/cirurgia , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem
15.
Med Sci Monit ; 25: 3771-3777, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31110168

RESUMO

BACKGROUND Venous thromboembolism (VT) is a leading cause of maternal mortality and morbidity worldwide. Catheter-directed thrombolysis (CDT) is an effective and safe treatment modality for VT patients. However, the long-term outcome of CDT in pregnancy-related venous thrombosis are unclear. The aim of this study was to assess long-term results of pregnancy-related VT patients. MATERIAL AND METHODS We reviewed 41 pregnancy-related deep venous thrombosis (DVT) patients who underwent CDT from February 2008 to May 2015. Clinical data, including demographic variables, disease location, vascular risk factors, treatment regimen, interventional procedure and complications, were collected retrospectively. Clinical and color-duplex ultrasonography were performed to monitor venous patency during follow-up. Post-thrombotic syndrome (PTS) was assessed with the Villalta scale and quality of life (QOL) was evaluated by the VEINES-QOL/Sym questionnaire. RESULTS Twenty-three patients underwent spontaneous abortion or induced abortion within 3 months before DVT, and 18 patients had DVT during the first 3 months after delivery. Technical success was achieved in all patients. Grade III (complete) lysis was obtained in 15 patients and grade II (partial) lysis was obtained in 21 patients. The follow-up period was 3 years. Twenty-eight patients had venous patency at 3-year follow-up; 36.6% of patients developed mild or moderate PTS (Villalta score 5-14) and 4.8% with severe PTS (Villalta score ≥15). VEINES-QOL/Sym scores were 55.24±7.35 and 53.25±6.65, respectively. CONCLUSIONS Catheter-directed thrombolysis is a reliable and safe treatment modality for postnatal or abortion patients with DVT. CDT can reduce the incidence rate of PTS and increase the quality of life.


Assuntos
Terapia Trombolítica/métodos , Trombose Venosa/terapia , Adulto , Anticoagulantes/uso terapêutico , Cateterismo Periférico/métodos , Cateteres , Feminino , Seguimentos , Humanos , Veia Ilíaca/diagnóstico por imagem , Pessoa de Meia-Idade , Flebografia/métodos , Gravidez , Complicações na Gravidez/terapia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/diagnóstico
17.
Ann Vasc Surg ; 59: 313.e1-313.e3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009730

RESUMO

BACKGROUND: Pregnancy is a hypercoagulable state associated with a fivefold increase in the risk of venous thromboembolism. Thrombolysis is the preferred level of care for patients with acute iliofemoral deep vein thrombosis (DVT); however, most studies exclude pregnant patients, highlighting the lack of data regarding the efficacy and safety of thrombolytic therapy for mother and fetus. METHODS: We describe the successful use of thrombolytic therapy in conjunction with ultrasound to remove a large ileofemoral DVT in a first-trimester patient with phlegmasia cerulea dolens. The procedure was performed safely for both mother and fetus. RESULTS: No radiation or contrast dye was used, and intravascular ultrasound confirmed patency of the entirety of the venous system. She delivered a healthy term baby after the procedure and had no further sequalae. CONCLUSION: Thrombolysis with intravascular ultrasound may be considered in first-trimester pregnant patients with threatened limb due to DVT.


Assuntos
Veia Femoral/efeitos dos fármacos , Fibrinolíticos/administração & dosagem , Veia Ilíaca/efeitos dos fármacos , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Terapia Trombolítica , Tromboflebite/tratamento farmacológico , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Nascimento Vivo , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Tromboflebite/diagnóstico por imagem , Tromboflebite/fisiopatologia , Resultado do Tratamento , Ultrassonografia de Intervenção , Ultrassonografia Pré-Natal/métodos , Grau de Desobstrução Vascular
18.
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
20.
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
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