Deep vein thrombosis surgery: Difference between revisions

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Latest revision as of 16:14, 21 August 2014

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet

Overview

Operative venous thrombectomy can be considered for the treatment of iliofemoral deep vein thrombosis (DVT), mainly when catheter directed thrombolysis (CDT) and pharmacomechanical catheter directed thrombolysis (PCDT) can not be performed.^[1]

Surgery

A single small randomized controlled trial showed that operative venous thrombectomy and anticoagulation therapy may lead to better iliac vein patency and less post-thrombotic syndrome as compared to anticoagulation therapy alone.^[2] Operative venous thrombectomy is invasive and requires general anesthesia. It also carries a small risk of pulmonary embolism. Operative venous thrombectomy should be considered only if all of the following criteria are met:^[1]

Iliofemoral DVT
Symptoms < 7 days
Good functional status
Life expectancy ≥1 year

2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis (DO NOT EDIT)^[1]

Treatment of Acute DVT

Class II
"1. In patients with acute proximal DVT of the leg, we suggest anticoagulant therapy alone over operative venous thrombectomy (Level of Evidence: C)."

2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)^[3]

Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)^[3]

Class IIb
"1. Surgical venous thrombectomy by experienced surgeons may be considered in patients with IFDVT (Level of Evidence: B)."

References

↑ ^1.0 ^1.1 ^1.2 Kearon C, Akl EA, Comerota AJ; et al. (2012). "Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e419S–94S. doi:10.1378/chest.11-2301. PMID 22315268. Unknown parameter |month= ignored (help)
↑ Plate G, Eklöf B, Norgren L, Ohlin P, Dahlström JA (1997). "Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study". Eur J Vasc Endovasc Surg. 14 (5): 367–74. PMID 9413377.
↑ ^3.0 ^3.1 Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (2011). "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association". Circulation. 123 (16): 1788–830. doi:10.1161/CIR.0b013e318214914f. PMID 21422387.

Template:WH Template:WS

[pmid22315268-1] 1.0 ^1.1 ^1.2 Kearon C, Akl EA, Comerota AJ; et al. (2012). "Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e419S–94S. doi:10.1378/chest.11-2301. PMID 22315268. Unknown parameter |month= ignored (help)

[pmid9413377-2] Plate G, Eklöf B, Norgren L, Ohlin P, Dahlström JA (1997). "Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study". Eur J Vasc Endovasc Surg. 14 (5): 367–74. PMID 9413377.

[pmid21422387-3] 3.0 ^3.1 Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (2011). "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association". Circulation. 123 (16): 1788–830. doi:10.1161/CIR.0b013e318214914f. PMID 21422387.

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
+{| class="infobox" style="float:right;"
+|-
+| [[File:Siren.gif|30px|link=Deep vein thrombosis resident survival guide]]|| <br> || <br>
+| [[Deep vein thrombosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
+|}
 '''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}} ; [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]]
 {{Deep vein thrombosis}}
+==Overview==
+Operative venous thrombectomy can be considered for the treatment of iliofemoral deep vein thrombosis (DVT), mainly when [[catheter directed thrombolysis]] (CDT) and [[pharmacomechanical catheter directed thrombolysis]] (PCDT) can not be performed.<ref name="pmid22315268">{{cite journal |author=Kearon C, Akl EA, Comerota AJ, ''et al.'' |title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e419S–94S |year=2012 |month=February |pmid=22315268 |doi=10.1378/chest.11-2301 |url=}}</ref>
 == Surgery ==
-=== Mechanical Thrombectomy ===
+A single small randomized controlled trial showed that operative venous thrombectomy and anticoagulation therapy may lead to better iliac vein patency and less [[post-thrombotic syndrome]] as compared to [[anticoagulation therapy]] alone.<ref name="pmid9413377">{{cite journal| author=Plate G, Eklöf B, Norgren L, Ohlin P, Dahlström JA| title=Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study. | journal=Eur J Vasc Endovasc Surg | year= 1997 | volume= 14 | issue= 5 | pages= 367-74 | pmid=9413377 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9413377  }} </ref>
-{{main|Thrombectomy}}
+Operative venous thrombectomy is invasive and requires general anesthesia.  It also carries a small risk of [[pulmonary embolism]]. Operative venous thrombectomy should be considered only if all of the following criteria are met:<ref name="pmid22315268">{{cite journal |author=Kearon C, Akl EA, Comerota AJ, ''et al.'' |title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e419S–94S |year=2012 |month=February |pmid=22315268 |doi=10.1378/chest.11-2301 |url=}}</ref>
-* Percutaneous mechanical thrombectomy without concomitant thrombolysis has not been examined in randomized trials.
+* Iliofemoral DVT
-* Its use is not recommended as it often fails to remove most of the thrombus.
+* Symptoms < 7 days
-* It can also dislodge the clot leading to a high-risk of [[pulmonary embolism]].
+* Good functional status
+* Life expectancy ≥1 year
-=== Operative Venous Thrombectomy ===
-* A single small randomized controlled trial showed that operative venous thrombectomy may lead to better iliac vein patency and less [[post-thrombotic syndrome]].
-* It should be considered only if all of the following criteria are met<ref name="pmid22315268">{{cite journal |author=Kearon C, Akl EA, Comerota AJ, ''et al.'' |title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e419S–94S |year=2012 |month=February |pmid=22315268 |doi=10.1378/chest.11-2301 |url=}}</ref>:
-** Iliofemoral [[DVT]]
-** Symptoms < 7 days
-** Good functional status
-** Life expectancy ≥1 year
-* ACCP recommends catheter-directed thrombolysis above operative venous thrombectomy, if required.
-'''ACCP recommendations<ref name="pmid22315268">{{cite journal |author=Kearon C, Akl EA, Comerota AJ, ''et al.'' |title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e419S–94S |year=2012 |month=February |pmid=22315268 |doi=10.1378/chest.11-2301 |url=}}</ref>:'''
-{{cquote|
-'''1.''' In patients with acute proximal DVT of the leg, we suggest anticoagulant therapy alone over operative venous thrombectomy (Grade 2C).
-'''2.''' In patients with acute DVT of the leg who undergo thrombosis removal, we recommend the same intensity and duration of anticoagulant therapy as in similar patients who do not undergo thrombosis removal.}}
-=== Inferior vena cava filter ===
-{{main|Inferior vena cava filter}}
-* [[Inferior vena cava filter]]s decrease the incidence of [[pulmonary embolism]]<ref name="pmid9459643">{{cite journal |author=Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral F, Huet Y, Simonneau G |title=A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis.  Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group |journal=N Engl J Med |volume=338 |issue=7 |pages=409-15 |year=1998 |id=PMID 9459643}}</ref>, but also increase the risk of recurrent [[DVT]]<ref name="pmid16009794">{{cite journal |author= |title=Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study |journal=Circulation |volume=112 |issue=3 |pages=416-22 |year=2005 |id=PMID 16009794}}</ref>.
-* [[IVC filter]] does not effect the combined incidence of recurrent [[VTE]].
-* [[IVC filter]] increases the risk of [[post-thrombotic syndrome]].
-* Retrievable [[IVC filter]]s may be considered in those with an absolute contraindication to anticoagulation, to reduce the risk of [[PE]]<ref name="pmid17636834">{{cite journal |author=Young T, Aukes J, Hughes R, Tang H |title=Vena caval filters for the prevention of pulmonary embolism |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD006212 |year=2007 |pmid=17636834|doi=10.1002/14651858.CD006212.pub2}}</ref>. However, these filters should be removed to prevent long-term complications.<ref name="pmid22315268">{{cite journal |author=Kearon C, Akl EA, Comerota AJ, ''et al.'' |title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e419S–94S |year=2012 |month=February |pmid=22315268 |doi=10.1378/chest.11-2301 |url=}}</ref>
-* Anticoagulation should be started as soon as the bleeding risk resolves.
-'''ACCP recommendations<ref name="pmid22315268">{{cite journal |author=Kearon C, Akl EA, Comerota AJ, ''et al.'' |title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e419S–94S |year=2012 |month=February |pmid=22315268 |doi=10.1378/chest.11-2301 |url=}}</ref>:'''
-{{cquote|
-. In patients with acute DVT of the leg, we recommend against the use of an IVC filter in  addition to anticoagulants (Grade 1B).
-. In patients with acute proximal DVT of the leg and contraindication to anticoagulation, we recommend the use of an IVC fi lter (Grade 1B).
-. In patients with acute proximal DVT of the leg and an IVC filter inserted as an alternative to anticoagulation, we suggest a conventional course of anticoagulant therapy if their risk of bleeding resolves (Grade 2B).}}
+==2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis (DO NOT EDIT)<ref name="pmid22315268">{{cite journal |author=Kearon C, Akl EA, Comerota AJ, ''et al.'' |title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e419S–94S |year=2012 |month=February |pmid=22315268 |doi=10.1378/chest.11-2301 |url=}}</ref>==
+===Treatment of Acute DVT===
-=== Angioplasty ===
-'''Angioplasty''' is the mechanical widening of a narrowed or totally obstructed [[blood vessel]]. These obstructions are often caused by [[atherosclerosis]]. The term ''angioplasty'' is a portmanteau of the words ''angio'' (from the Latin/[[Greek language|Greek]] word meaning "vessel") and ''plasticos'' (Greek: "fit for moulding"). Angioplasty has come to include all manner of [[Blood vessel|vascular]] interventions typically performed in a minimally invasive or ''[[percutaneous]]'' method.
-===ACC/AHA Guidelines- Recommendations for Percutaneous Transluminal Venous Angioplasty and Stenting (DO NOT EDIT)===
 {|class="wikitable"
 |-
-| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
+| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class II]]
 |-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Stent placement in the iliac vein to treat obstructive lesions after CDT, PCDT, or surgical venous thrombectomy is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki>
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with acute proximal DVT of the leg, we suggest anticoagulant therapy alone over operative venous thrombectomy       ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki>
-|-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For isolated obstructive lesions in the common femoral vein, a trial of percutaneous transluminal angioplasty without stenting is reasonable  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki>
-|-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' The placement of iliac vein stents to reduce PTS symptoms and heal venous ulcers in patients with advanced PTS and iliac vein obstruction is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
-|-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' After venous stent placement, the use of therapeutic anticoagulation with similar dosing, monitoring, and duration as for IFDVT patients without stents is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 |}
+==2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)<ref name="pmid21422387">{{cite journal|author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 |pmid=21422387 | doi=10.1161/CIR.0b013e318214914f| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>==
+===Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)<ref name="pmid21422387">{{cite journal|author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 |pmid=21422387 | doi=10.1161/CIR.0b013e318214914f| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>===
 {|class="wikitable"
@@ Line 64: / Line 36: @@
 | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' After venous stent placement, the use of antiplatelet therapy with concomitant anticoagulation in patients perceived to be at high risk of rethrombosis may be considered ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Surgical venous thrombectomy by experienced surgeons may be considered in patients with IFDVT ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.<nowiki>"</nowiki>
 |}
-=== Guidelines Resources ===
-* Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition)<ref name="pmid22315268">{{cite journal |author=Kearon C, Akl EA, Comerota AJ, ''et al.'' |title=Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e419S–94S |year=2012 |month=February |pmid=22315268 |doi=10.1378/chest.11-2301 |url=}}</ref>
-*Guidelines on the management of  Pulmonary embolism: Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension<ref name="pmid21422387">{{cite journal| author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association.| journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 | pmid=21422387 | doi=10.1161/CIR.0b013e318214914f |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387  }} </ref>
 ==References==

Deep vein thrombosis surgery: Difference between revisions

Latest revision as of 16:14, 21 August 2014

Overview

Surgery

2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis (DO NOT EDIT)[1]

Treatment of Acute DVT

2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)[3]

Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)[3]

References

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2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis (DO NOT EDIT)^[1]

2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)^[3]

Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)^[3]