Endovascular Thrombectomy for Acute Iliofemoral Deep Venous Thrombosis
| Available Online: | May, 2024 |
| Page: | 46-69 |
Author for correspondence:
Tsirigoti Alexandra
Department of Vascular Surgery, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, Athens, Greece
Tel: +30 2810392393 / +30 6948202539
E-mail: alexandratsirigoti@gmail.com
doi: 10.59037/1h40xk83
ISSN 2732-7175 / 2024 Hellenic Society of Vascular and Endovascular Surgery Published by Rotonda Publications
All rights reserved. https://www.heljves.com
Full Text
images
Full Text
Endovascular Thrombectomy for Acute Iliofemoral Deep Venous Thrombosis
1 2nd Department of Vascular Surgery, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
2 Clinic of Vascular and Endovascular Surgery, Athens Medical Group, Athens, Greece
2 Clinic of Vascular and Endovascular Surgery, Athens Medical Group, Athens, Greece
Background: Ilio-femoral deep vein thrombosis has a high rate of long-term morbidity, mainly in the form of postthrombotic syndrome. Endovascular interventions of acute deep vein thrombosis using thrombolysis and mechanical thrombectomy have received increased focus in the literature as a safe and effective therapeutic modality in selected patients.
Aim: To report the use of endovascular thrombectomy in the management of acute iliofemoral venous thrombosis in young patients.
Methods: From October 2022 to January 2024, 6 patients were treated in our department for acute iliofemoral deep vein thrombosis. All patients were treated with endovascular mechanical thrombectomy using the ClotTriever Thrombectomy System (Inari Medical, Irvine, CA, USA) or the Aspirex Mechanical Aspiration Thrombectomy System (BD, Franklin Lakes, NJ, USA).
Results: Four patients were female (66.7%) and the mean age was 33 years (range 24-39). All patients presented within 1 week of symptom onset, whereas an identifiable provoking factors was present in 5 cases (83.3%). May-Thurner syndrome was present in two patients (33.3%). Endovascular mechanical thrombectomy was carried out via popliteal vein access in all cases, wheres as ClotTriever Thrombectomy System was used in 5 cases (83.3%). Technical success was 100%, and venous stenting was performed in 4 cases (66.7%) due to residual stenosis. There were no bleeding events or repeat venous procedures. The median postprocedure hospital stay was 2 days and all patients reported complete symptom relief at postprocedure day one.
Conclusions: Endovascular mechanocal thrombectomy is an effective and safe treatment for selected patients with acute iliofemoral thrombosis. Nonetheless, further research is warranted to determine mid-term and long-term outcomes.
Genetic and Biochemical Thrombophilic Markers in Patients with Chronic Venous Disease (Venous Varicose Veins) and Venous Ulcers
Vascular surgeon-Consultant-General Hospital of Rhodes, Rhodes, Greece
Aim: The aim of this study is to investigate the correlation of biochemical and thrombophilic markers (such as antithrombin, protein C and S deficiency rate, factor V Leiden involvement rate and G20210A prothrombin mutation) with the severity of clinical presentation of CVD, especially those patients with chronic and relapsing limb ulcers.
Methods: The study was performed in 200 individuals with chronic venous disease (varicose veins and / or venous ulcers) and in a corresponding number of control individuals free(100volunteers) of the above or other clinical symptoms referring to a latent venous or thrombophilic pathology, corresponding to sex and age. The classification was made according to the CEAP system developed under the auspices of the American Venous Forum. Doppler color ultrasound and / or duplex ultrasonography was performed to evaluate the effectiveness of the venous system. The ankle-branchial index calculated to determine the effectiveness of the arterial system.
Results: Ιn a first sample of 30 people (15 men and 15 women) in ages from 50 to 70 years with moderate or severe degree chronic venous disease of the lower extremities shows an increase of the factor MTHFR(C677), increase of heterozygous types of Factor V Leiden and a slight rise in Factor V.Willebrand. Also appears a very small rise of IgG and IgM antibodies as well as a slight increase protein C. A specific increase in the CRP index does not occur as well as the WBC.
Conclusions: The polypeptide tissue antigen TPA appears to contribute to the development of chronic venous insufficiency lower extremity disease but not homocysteine (HCY). In this the small sample of patients does not show a particular rise α1 antitrypsin, plasminogen-PLG, Factor IX and Factor XI as well as protein S.
Young Vascular Surgeons Forum – EVST
Use of Rotational Atherectomy-Assisted Balloon Angioplasty in the Treatment of Isolated Below-the-Knee Atherosclerotic Lesions in Patients with Chronic Limb Threatening Ischemia
1 Department of Vascular and Endovascular Surgery, Rhein Main Vascular Center, Asklepios Clinics Langen, Paulinen Wiesbaden, Seligenstadt, Germany
2 Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General
2 Division of Vascular Surgery, 2nd Department of Surgery, Faculty of Medicine, “G. Gennimatas” General
Hospital of Thessaloniki, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Aim:Aim of the study is to evaluate the safety and effectiveness of rotational atherectomy-assisted balloon angioplasty (BTK-RA) for the treatment of isolated below the knee (BTK) atherosclerotic lesions and to compare the outcomes to plain old balloon angioplasty (POBA).
Methods: Between January 2020 and September 2023, 96 consecutive patients with chronic limb threatening ischemia (CTLI) and isolated BTK-lesions underwent POBA (group A) or BTK-RA (group B). The primary outcome measures were: periprocedural technical success, primary patency, postoperative increase of the ankle branchial index(ABI), target lesion revascularization (TLR), limb salvage, minor amputation and death. Both techniques had similar technical success, operative time, intraprocedural complications and bailout stent implantations independent on the operator’s experience.
Results: Group B had significantly higher primary patency rates (93.5% vs 72.0% respectively, p=.006), lower in hospital stay (2.0 – 3.0 vs 4.0 – 6.0 days respectively, p<0.001) and higher postoperative ABI (0.8 – 0.2 vs 0.7 – 0.1 respectively, p=.008), compared to group A, respectively. Significant differences (POBA n: 20, 40%, BTK-RA n=3, 6.5%) were found in minor amputation rates between the 2 groups (p<0.001), while the respective limb salvage rates were similar in both groups (94.0% vs 97.8%, p=.35).
Conclusion: The use of BTK-RA for the treatment of BTK-lesions in patients with CTLI showed significant clinical advantages in comparison to POBA.
Treatment Length, Device Selection and External Iliac Artery Extension are Associated with Increased Aortic Stiffness After Endovascular Aortic Repair: A Prospective, Single-Arm Study
1 Vascular Unit, 1st University Surgery Department, Papageorgiou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
2 Cardiothoracic Surgery Department, Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
3 3rd University Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
2 Cardiothoracic Surgery Department, Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
3 3rd University Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
Background-Aim: Aortic stiffness is a strong independent factor of adverse cardiovascular outcomes. Implantation of stent endografts during endovascular aortic repair(EVAR) increases aortic rigidity, as available commercial endoprostheses are composed of stiffer materials compared to native aortic wall. The aim of this study is to investigate the correlation between endograft properties and aortic stiffness increase.
Methods: This is a prospective, observational and single-arm study. Patients with infrarenal abdominal aortic aneurysms, managed electively with aortobiiliac endografts are consecutively enrolled in our study. Changes in aortic stiffness are calculated by pulse wave velocity(PWV) measurements. Primary endpoint is the correlation of various endograft properties and PWV increase. Statistical analysis is performed by software SPSSv28.0.
Results: 38 patients fulfilling the inclusion criteria were enrolled in this preliminary stage of the study. Patients received Dacron polyester, ePTFE with suprarenal fixation(ePTFESF) and with infrarenal fixation(ePTFEIF) endografts. PWV was significantly increased postoperatively in the total number of patients (10.6 to 11.9 m/s; p<.001), but also in each type of endograft separately. A statistically significant and positive correlation (r=.870; p<.001) of PWV increase and endograft length was found. The observed correlation remained statistically significant in all three endograft categories; Dacron (r=.985; p<.001), ePTFESF (r=.969; p<.001) and ePTFEIF (r=.931; p=.001). Multiple regression analysis showed a statistically significant effect of both endograft type and endograft length on PWV increase, which was higher for ePTFESF endografts comparing to ePTFEIF endografts (p=.038) and the universally observed positive correlation was stronger in the ePTFESF group comparing to the ePTFEIF group (p<.001).
Conclusions: Endoprostheses with infrarenal fixation should be preferred in EVAR. Minimum sealing lengths according to instructions for use should be used, avoiding unnecessary extension of iliac limbs to common iliac bifurcations or even to external iliac arteries. Improvement of endograft properties could minimize the aortic stiffness leading to prevention of adverse cardiovascular events.
Aortic Vascular Graft and Endograft Infection – Outcome Analysis in a Dual Center Cohort
Vascular surgery, Universitätsklinikum TU Dreseden, Germany
Background: Aortic graft infection (AGI) is a serious complication of open and endovascular aortic surgery with significant morbidity and mortality. There is still a low level of evidence regarding diagnostic certainty, comparison of surgical and conservative therapy and procedural outcomes. The aim of this study is a dual center cohort analysis with presentation of the results of both treatment alternatives including a quantitative and qualitative PET-CT analysis for a possible improved risk stratification.
Methods: All Patients with AGI (1/2013 – 12/21) from two university centers were included in a prospective database. Patient characteristics, details of initial surgery, characteristics of surgical treatment and complications during inpatient and follow-up were collected retrospectively. All available PET-CTs were evaluated qualitatively using a visual grading scale and quantitatively using the maximum uptake method. The primary endpoints were mortality during hospitalization and reintervention-free survival at 6 months. Secondary endpoints include survival and complication rates, particularly in the comparison of surgical procedures and the comparison with the conservatively treated group.
Results: 76 patients were treated surgically and 17 conservatively. The diagnosis of AGI was made after 36±49 months. A fistula was present 32 times. Reconstruction was performed with a silver prosthesis (21.3%), hand-sewn bovine pericardium (61.3%) or deep vein (17.3%). With a hospital stay of 45±37 days and 17±34 days in the ICU, the surgical and medical complication rates were 61.8% and 65.8% respectively. In 23.7% of cases there were aortic complications. In-hospital mortality was 19.4%, re-intervention-free survival at 6 months was 50%. The reconstruction material showed no influence on hospital mortality (p=0.18).
Conclusions: Perioperative morbidity and mortality in surgical treatment of AGI remain high. This study shows comparable short- and medium-term mortality in conservatively treated patients, albeit with a small number of patients. Due to the complexity of AGI, a prospective national registry should be established.
e-Poster Presentations
ePP06: Infrainguinal Endovascular Treatment of Peripheral Arterial Occlusive Disease in Diabetic Patients
1 Vascular Surgery Clinic, “Dedinje” Cardiovascular Institue, Belgrade, Serbia
2 Vascular Surgery Clinic, “Dedinje” Cardiovascular Institue, Belgrade, Serbia & Faculty of Medicine University of Belgrade, Belgrade, Serbia
2 Vascular Surgery Clinic, “Dedinje” Cardiovascular Institue, Belgrade, Serbia & Faculty of Medicine University of Belgrade, Belgrade, Serbia
Introduction: Periferal arterial occlusive disease (PAOD) manifests as claudication, ischemic rest pain or tissue loss. The incidence of PAOD is increasing due to the rising prevalence of diabetes and obesity in the general population. The aim of this study is to analyse the outcomes of infrainguinal endovascular treatment of PAOD in patients with diabetes.
Methods: This is a retrospective analysis of patient data from 2018 to 2022 with first time infrainguinal endovascular treatment for PAOD. The primary outcome was to compare amputation free survival between diabetic and non-diabetic group. Endovascular procedures comprised of plain balloon angioplasty with selective use of plain or drug eluting stents.
Results: Study included 228 patients, 157 (68,9%) males and 71 (31,1%) females. Most prevalent comorbidities were congestive heart failure (30,3%) and previous myocardial infraction (14,5%). Claudications was present in 50,9%, rest pain in 15,4% and wound was present in 33,8%. Among 228 procedures the target lesion was the femoropopliteal in 128 (56,1%) and in infrapopliteal segment in 100 (43,9%). Diabetes was present in 158 (69,3%) patients, of whom 52 (32,9%) were women. The mean follow up was 8 months. The mean hospital stay was 3 days. Major amputation occurred in 20,2% in the diabetic group and in 2% in non-diabetic group (OR 12,66 95% CI 1,65 – 97,29; p=0,002). The mean time to major amputation in non-diabetic group was significantly longer (p = 0,016). In the diabetic group men had significantly longer amputation free time (p = 0,004) than women. There were 12 (0,5%) deaths and non of them were due to the revascularisation procedure.
Conclusion: This study shown that the diabetic group displayed a considerably higher rate of major amputations, emphasizing the critical importance of early intervention and close monitoring for diabetic PAOD patients.
ePP09: Percutaneous Endovascular Repair of Abdominal Aortic Aneurysms; A Single-Center Experience
1 Vascular Surgery Department, University Hospital of Larissa, Medical School of Larissa, University of Thessaly, Thessaly, Greece
2 Anesthesiology Department, University Hospital of Larissa, Medical School of Larissa, University of Thessaly, Thessaly, Greece
2 Anesthesiology Department, University Hospital of Larissa, Medical School of Larissa, University of Thessaly, Thessaly, Greece
Background – Aim: Recently, percutaneous endovascular abdominal aortic aneurysm repair (pEVAR) has gained its role in abdominal aortic aneurysm (AAA) treatment. The aim of the study is to report the increase of pEVAR in a tertiary center through years and its impact on clinical outcome.
Methods: A single-center, observational, retrospective study of prospectively collected data was conducted. All patients who underwent elective pEVAR (using the Proglide device) and EVAR with femoral cutdown access between 2017 and 2024 were included [2017-2019 early pEVAR experience (253 patients); 2020-2024 late experience (340 patients)]. Baseline characteristics, intra- and peri-operative data were collected. The main outcomes measured were the rate of pEVAR application, the need for blood transfusion and hospital stay.
Results: A total of 593 patients were treated by endovascular means (20.5% pEVAR vs 79.5% EVAR). Mean age was similar between groups (pEVAR 72.8±4.5 vs EVAR 72.3±7; p=0.68). The mean number of Proglide closure devices used for right and left access was 232 and 205 respectively. There was no difference in terms of type of anaesthesia [pEVAR: local 7% and 93% general anaesthesia (GA) vs EVAR: local 9% and 91% GA, p=0.38].The mean operation time was lower for pEVAR (111±40) vs EVAR 129±45 (p=0.000), while the need for transfusion was similar between groups [pEVAR: 20/122 (16.4%) vs EVAR: 70/434 (16%) p=0.65]. The average hospital stay was significantly lower for patients who underwent pEVAR (1.35±0.8) vs EVAR 3.23±2 (p=0.000). Only 1 death occurred in EVAR group. In the initial period pEVAR was used only in 10% of cases, while it was increased significantly in the later experience to 28.2%.
Conclusions: pEVAR is a growing trend in the treatment of AAA, and compared with femoral cutdown access, it can be considered safe and effective, reducing the operation time and hospital stay.
