Treatment of iliofemoral deep vein thrombosis: challenges, opportunities, and future perspectives

Marie Josee E. van Rijn, MD, PhD Department of Vascular and Endovascular Surgery, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands Jay M. Bakas, MD Department of Vascular and Endovascular Surgery, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands ABSTRACT Acute iliofemoral deep vein thrombosis (DVT) is more symptomatic than a thrombosis distal to the common femoral vein and increases the risk of postthrombotic syndrome (PTS), which reduces quality of life, and increases medical costs. To provide the best possible medical care, it all starts with identifying iliofemoral DVT. This will be…

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Micronized purified flavonoid fraction in adjunction to rivaroxaban improves outcomes of popliteal-femoral deep-vein thrombosis at 12-month follow-up

Kirill LOBASTOV,1 MD, PhD; Ilya SCHASTLIVTSEV,1,2 MD, PhD; Victor BARINOV,2 MD, PhD 1Pirogov Russian National Research Medical University, Moscow, Russian Federation; 2Clinical Hospital no.1 of the President’s Administration of the Russian Federation Abstract Aim: To assess the efficacy of the long-term use of micronized purified flavonoid fraction (MPFF) in the treatment of popliteal-femoral deep-vein thrombosis (DVT). Methods: In this pilot, comparative, open-label clinical study, patients with the first episode of popliteal-femoral DVT confirmed by duplex ultrasound scan (DUS) were allocated to two groups: the control group received standard treatment with rivaroxaban for 6 months and compression stockings for 12 months,…

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What is the best method of imaging in iliofemoral venous obstruction?

Gerard J. O’SULLIVAN MB, BCh, BAO, FRCR National University of Ireland, Galway, Ireland Abstract Iliofemoral venous obstruction is increasingly recognized as a major cause of post-thrombotic syndrome. Patients can be left with significant symptoms after just one episode of iliofemoral deep-vein thrombosis; ranging from milder problems, such as varicose veins, to itching, leg swelling, and even venous ulceration. With the advent of endovascular techniques to reconstruct the iliofemoral segment has come an understanding that accurate recognition and diagnosis form a central part of the puzzle. Clinical evaluation is limited, and imaging has assumed a central role. This article looks at…

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The history of catheter-directed thrombolysis of deep venous thrombosis

The history of catheter-directed thrombolysis of deep venous thrombosis Niels Bækgaard, MDa Rikke Broholm , MD, PhDb aVascular Clinic, Gentofte Hospital and Rigshospitalet, University of Copenhagen, Denmark bDepartment of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark Abstract Catheter-directed thrombolysis (CDT) is a relatively new treatment modality that actively removes a venous thrombosis. CDT has been chiefly practiced for acute iliofemoral deep venous thrombosis because this vein segment has a poor rate of spontaneous recanalization compared with more distal vein segments. This can be explained by the frequent occurrence of the May-Thurner syndrome (also known as Cockett’s…

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Management of superficial vein thrombosis of the lower limbs: update and current recommendations

Management of superficial vein thrombosis of the lower limbs: update and current recommendations Jean-Luc GILLET Vascular Medicine and Phlebology, Bourgoin-Jallieu, France Abstract Initially, superficial vein thrombosis (SVT) was considered a benign disease or a common complication of varicose veins. Recent studies have shown the potential severity of SVT and defined its place within the venous thromboembolic (VTE) diseases, along with deep vein thrombosis (DVT) and pulmonary embolism (PE). A concomitant DVT was identified in 25% to 30% of patients at presentation and a PE in 4% to 7% of patients. Subsequent VTE were reported in 3 to 20% of patients,…

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Deep vein thrombosis and air travel: risk management in 2015

Deep vein thrombosis and air travel: risk management in 2015 Michèle CAZAUBON Vascular Unit, Vein Clinic, American Hospital of Paris, France. Abstract Long-haul flights increase the risk of venous thromboembolism (VTE) for several weeks after the flight by 3-fold among passengers compared with the general population. The risk increases with flight duration and persists for several weeks (until week 8) after landing. This risk is not the same for all passengers and should be determined before any long flight, especially among frequent travellers. The calculation of risk is based on simple clinical data, easily obtained by the treating physician. If…

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Thrombosis and pulmonary embolism risk in patients undergoing varicose vein surgery

Andreas Oesch Chirurgie FMH, Kramgasse 16, CH 3011, Bern, Switzerland ABSTRACT Varicose veins are not by themselves dangerous. Nevertheless, when treating them, it is important to prevent the occurrence of complications with potentially serious consequences such as deep vein thrombosis or pulmonary embolism. Vein operations are among the procedures carrying the lowest risk of all surgical interventions. Publications on thromboembolism after vein surgery show a striking discrepancy in the number of reported cases of thromboembolism, which is partially due to the different methods used to record them. Most thromboses are localized in the calf and their damage potential is limited,…

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What have we learned from recent guidelines on the treatment of venous thromboembolism?

Russell D. HULL, Jeanne SHELDON Department of Medicine, University of Calgary, Calgary, Canada ABSTRACT Overwhelming evidence indicates that the quality of randomized, controlled trials reporting has been suboptimal. Accordingly, the extended CONSORT statementprovides recommendations that will profoundly impact the design, conduct, and reporting of new drug trials. Additionally, registration of all trials in a public repository ensures that every trial becomes part of the public record, allowing clinicians to explore the full range of clinical evidence. Finally, QUORUM addresses standards for improving the quality of reporting meta-analyses of randomized, controlled, clinical trials. These improvements in the reporting of trials will…

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Update on anticoagulants: clinical support for the use of selective factor Xa inhibitors

Joseph A. CAPRINI Louis W. Biegler Professor of Surgery and Bioengineering Department of Surgery, Evanston Northwestern Healthcare, Evanston, IL, USA Northwestern University Feinberg School of Medicine, Chicago, IL, USA and Robert R. McCormick School of Engineering and Applied Sciences, Evanston, IL, USA ABSTRACT Over the past decade, a number of new anticoagulant compounds have been developed, including the low-molecular-weight heparins (LMWHs) and the factor Xa inhibitors fondaparinux and idraparinux. Factor Xa inhibitors are powerful anticoagulants that act by producing a reversible conformational change in the antithrombin III molecule. Unlike unfractionated heparin and warfarin, these new compounds, which have a linear…

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Recurrence of venous thromboembolism and its prevention

Paolo PRANDONI Department of Medical and Surgical Sciences Department of Medical and Surgical Sciences Thromboembolism Unit University of Padua, Italy ABSTRACT The risk of recurrent venous thromboembolism (VTE) approaches 40% in all patients after 10 years of follow-up. This risk is higher in patients with permanent risk factors for thrombosis, such as active cancer, prolonged immobilization because of disease, and antiphospholipid antibody syndrome; in patients with idiopathic presentation; and in carriers of several thrombophilic abnormalities, including carriers of AT, protein C or S, increased factor VIII, hyperhomocysteinemia, homozygous carriers of factor V Leiden or prothrombin G20210A variant, and carriers of…

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