scholarly journals May–Thurner Syndrome: A Consideration for Deep Vein Thrombosis in Males

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Tay Tian En Jason ◽  
Tay Jia Sheng ◽  
Tieng Chek Edward Choke ◽  
Pooja Sachdeva
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Vena Cava ◽  
Postthrombotic Syndrome ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
Left Lower Limb ◽  
Deep Vein

May–Thurner syndrome (MTS) is an underdiagnosed cause of lower limb deep vein thrombosis (DVT). The clinical prevalence of MTS-related DVT is likely underestimated, particularly in patients with other more recognisable risk factors. MTS is classically described in females between the age group of 20–50 years. In patients with acute iliofemoral thrombosis, medical treatment with anticoagulation alone has been associated with higher risk of postthrombotic syndrome (PTS) and lower iliofemoral patency rates, as compared to endovascular correction. We describe a case of MTS-related extensive iliofemoral DVT occurring in a middle age male who presented with acute onset of left lower limb swelling and pain, complicated by pulmonary embolism. Doppler compression ultrasonography of the left lower limb showed partial DVT extending from the left external iliac to the popliteal veins, and contrasted computed tomography (CT) of the thorax abdomen and pelvis established features of MTS, together with right pulmonary embolism. He was started on low molecular weight heparin (LMWH) and then underwent left lower limb AngioJet pharmacomechanical thrombolysis/thrombectomy, iliac vein stenting, and temporary inferior vena cava (IVC) filter insertion. After the procedure, the patient recovered and improved symptomatically with rapid resolution of this left lower limb swelling and pain. He was switched to an oral Factor Xa inhibitor and was subsequently discharged. After 1-month follow-up, he remained well with stent patency visualised on repeat ultrasound and underwent an uneventful elective IVC filter retrieval with subsequent plans for a 1-year follow-up.

scholarly journals Acute pulmonary embolism complicating deep vein thrombosis in a young patient with stroke

2021 ◽  
Vol 11 (2) ◽  
pp. 142-144
Author(s):  
Mohammed Mirazur Rahman ◽  
Farjana Binte Habib ◽  
Ahmed Imran Kabir ◽  
Samprity Islam ◽  
Rajashish Chakrabortty ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Acute Pulmonary Embolism ◽  
Successful Outcome ◽  
Shortness Of Breath ◽  
Vein Thrombosis ◽  
Doppler Study ◽  
Left Lower Limb ◽  
Deep Vein

Acute pulmonary embolism is one of the most common causes of vascular death after myocardial infarction and cerebrovascular accidents. It usually presents with severe chest pain and shortness of breath and occasionally occurs in the background of deep vein thrombosis. A 32-year-old male presented with swelling of left lower limb and shortness of breath. Subsequent investigations revealed that he developed DVT of left lower limb and pulmonary embolism. However, in general, if left untreated, pulmonary embolism is associated with an overall mortality of up to 30 percent compared with 2 to 11 percent in those treated with anticoagulation. Early diagnosis by D-dimer, computed tomograpgy pulmonary angiogram and doppler study of the left lower limb and prompt intervention through low molecular weight heparin and rivaroxaban led to a successful outcome in our case. Birdem Med J 2021; 11(2): 142-144

Retroperitoneal Laparoscopic-Assisted Retrieval of Wall-Penetrating Inferior Vena Cava Filter After Endovascular Techniques Failed: An Initial Clinical Outcome

2021 ◽  
pp. 153857442110225
Author(s):  
Haidong Wang ◽  
Zhenhua Liu ◽  
Xiaofei Zhu ◽  
Jianlong Liu ◽  
Libo Man
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Endovascular Techniques ◽  
Vein Thrombosis ◽  
Ivc Filters ◽  
Laparoscopic Assisted ◽  
Deep Vein

Background: Inferior vena cava (IVC) filters are commonly used in China to prevent pulmonary embolisms in patients with deep vein thrombosis. However, IVC filter removal is complicated when the filter has penetrated the IVC wall and endovascular techniques usually fail. The purpose of this study was to evaluate the effectiveness and safety of retroperitoneal laparoscopic-assisted retrieval of wall-penetrating IVC filters after endovascular techniques have failed. Patients and Methods: We retrospectively evaluated a series of 8 patients who underwent retroperitoneal laparoscopic-assisted retrieval of a wall-penetrating IVC filter between December 2017 and November 2019. All patients had experienced at least 1 failure with endovascular retrieval before the study. The filters were slanted and the proximal retrieval hooks penetrated the posterior lateral IVC wall in all patients on computed tomography. Demographic information, operation parameters, and complications were recorded and analyzed. All patients were followed up for at least 12 months. Results: The procedure was successful in all patients. The median surgery time was 53.6 ± 12.7 min and the average blood loss was 45.0 ± 13.5 ml. No serious complication occurred during the patients’ hospitalization, which was an average of 6.4 days. The median follow-up time was 15.1 months, and no patient had deep vein thrombosis recurrence. Conclusions: Retroperitoneal laparoscopic-assisted retrieval is a feasible and effective technique, particularly when proximal retrieval hooks penetrate the posterior lateral wall of the IVC after endovascular techniques have failed. To some extent, the development of this technique at our institution has increased the success rate of filter removal and improved patient satisfaction.

Deep venous thrombosis and postthrombotic syndrome: Invasive management

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 59-66 ◽  
Author(s):  
AJ Comerota
Keyword(s):  
Deep Vein Thrombosis ◽  
Vena Cava ◽  
Venous Drainage ◽  
Percutaneous Treatment ◽  
Postthrombotic Syndrome ◽  
Venous Outflow ◽  
Vein Thrombosis ◽  
Valvular Function ◽  
Deep Vein ◽  
Invasive Management

Invasive management of postthrombotic syndrome encompasses the two ends of the deep vein thrombosis spectrum, patients with acute iliofemoral deep vein thrombosis and those with chronic postthrombotic iliofemoral venous obstruction. Of all patients with acute deep vein thrombosis, those with involvement of the iliofemoral segments have the most severe chronic postthrombotic morbidity. Catheter-based techniques now permit percutaneous treatment to eliminate thrombus, restore patency, potentially maintain valvular function, and improve quality of life. Randomized trial data support an initial treatment strategy of thrombus removal. Failure to eliminate acute thrombus from the iliofemoral system leads to chronic postthrombotic obstruction of venous outflow. Debilitating chronic postthrombotic symptoms of the long-standing obstruction of venous outflow can be reduced by restoring unobstructed venous drainage from the profunda femoris vein to the vena cava.

Role of Anticoagulation in Patients with Inferior Vena Cava Filter but with No Risk Factor or History of DVT/PE

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4317-4317
Author(s):  
Mustapha A. Khalife ◽  
Vrushali S. Dabak ◽  
Marwa Hammoud ◽  
Karim Arnaout
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
History Of ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Abstract Abstract 4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Detection of Deep Vein Thrombosis by Follow-up Indirect Computed Tomography Venography after Pulmonary Embolism

2018 ◽  
Vol 81 (1) ◽  
pp. 49
Author(s):  
Hye Jin Lee ◽  
Seung-Ick Cha ◽  
Kyung-Min Shin ◽  
Jae-Kwang Lim ◽  
Seung-Soo Yoo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Computed Tomography Venography
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