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: @@
-'''Editors-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]]  '''Associate Editor-In-Chief''': [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
+__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>
-{{Deep vein thrombosis}}
+== 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.<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>
+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>
+* 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)<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===
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class II]]
+|-
+|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>
+|}
-==Overview==
+==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>==
-Percutaneous transcatheter treatment of patients with deep venous thrombosis (DVT) includes:
-*Thrombus removal with catheter-directed thrombolysis,
-*Mechanical thrombectomy,
-*Angioplasty,
-*Stenting of venous obstructions
-===Mechanical thrombectomy===
+===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>===
-It should be considered in patients with proximal occlusive DVT associated with significant swelling and symptoms.
-===Inferior vena cava filter===
+{|class="wikitable"
-{{main|Inferior vena cava filter}}
+|-
-[[Inferior vena cava filter]] reduces 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> and is an option for patients with an absolute contraindication to anticoagulant treatment (e.g., cerebral hemorrhage) or those rare patients who have objectively documented recurrent PEs while on anticoagulation, an [[inferior vena cava filter]] (also referred to as a ''[[Greenfield filter]]'') may prevent pulmonary embolisation of the leg clot.  However these filters are themselves potential foci of thrombosis,<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 filters are viewed as a temporizing measure for preventing life-threatening pulmonary embolism.<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>
+| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
+|-
+|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>
+|}
 ==References==
 {{reflist|2}}
+[[Category:Needs overview]]
+[[Category:Disease]]
+[[Category:Cardiology]]
 [[Category:Hematology]]
-[[Category:Pulmonology]]
+[[Category:Angiology]]
-[[Category:Cardiology]]
 [[Category:Emergency medicine]]
-[[Category:Mature chapter]]
+[[Category:Vascular surgery]]
+[[Category:Up-To-Date]]
+[[Category:Cardiovascular diseases]]
 {{WH}}
 {{WS}}

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]