Deep vein thrombosis surgery: Difference between revisions
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'''1.''' In selected patients with extensive proximal DVT (eg, symptoms for < 14 days, good functional status, life expectancy of > 1 year) who have a low risk of bleeding, we suggest that systemic thrombolytic therapy may be used to reduce acute symptoms and postthrombotic morbidity if CDT is not available (Grade 2C)}}. | '''1.''' In selected patients with extensive proximal DVT (eg, symptoms for < 14 days, good functional status, life expectancy of > 1 year) who have a low risk of bleeding, we suggest that systemic thrombolytic therapy may be used to reduce acute symptoms and postthrombotic morbidity if CDT is not available (Grade 2C)}}. | ||
===Recommendation for percutaneous venous Thrombectomy=== | |||
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'''1.''' In patients with acute DVT, we suggest that they should not be treated with percutaneous mechanical thrombectomy alone (Grade 2C)}}. | |||
==References== | ==References== | ||
Revision as of 18:48, 3 January 2012
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
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Deep Vein Thrombosis Microchapters |
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Treatment |
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Deep vein thrombosis surgery On the Web |
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Risk calculators and risk factors for Deep vein thrombosis surgery |
Overview
Percutaneous transcatheter treatment of patients with deep venous thrombosis (DVT) includes:
- Thrombus removal with catheter-directed thrombolysis,
- Mechanical thrombectomy,
- Angioplasty,
- Stenting of venous obstructions
Fibrinolysis
In many patients of arterial and venous thrombosis, fibrinolysis alone is the main mode of treatment. It should not be used in following conditions:
- In patient who have undergone recent surgery or trauma involving central nervous system.
- In patient with extensive or bulk thrombosis.
Mechanical thrombectomy
It should be considered in patients with proximal occlusive DVT, which is associated with significant swelling and symptoms or phlegmasia cerulea dolens. This procedure must be carried out carefully to avoid dislodging the clot or breaking it into small fragments because it may lead to pulmonary embolus.
Inferior vena cava filter
Inferior vena cava filter reduces pulmonary embolism[1] 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,[2] IVC filters are viewed as a temporary measure for preventing life-threatening pulmonary embolism.[3]
ACCP Guidelines Catheter-directed Thrombolysis of Acute DVT of the Leg (DO NOT EDIT)
Class I
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1. In selected patients with extensive acute proximal DVT (eg, iliofemoral DVT, symptoms for <14 days, good functional status, life expectancy of >1 year) who have a low risk of bleeding, we suggest that catheter-directed thrombolysis (CDT) may be used to reduce acute symptoms and postthrombotic morbidity if appropriate expertise and resources are available (Grade 2B). 2. After successful CDT in patients with acute DVT, we suggest correction of underlying venous lesions using balloon angioplasty and stents (Grade 2C). 3. We suggest pharmacomechanical thrombolysis (eg, with inclusion of thrombus fragmentation and/or aspiration) in preference to CDT alone to shorten treatment time if appropriate expertise and resources are available (Grade 2C). 4. After successful CDT in patients with acute DVT, we recommend the same intensity and duration of anticoagulant therapy as for comparable patients who do not undergo CDT (Grade 1C) |
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Recommendation for systemic Thrombolytic therapy
| “ |
1. In selected patients with extensive proximal DVT (eg, symptoms for < 14 days, good functional status, life expectancy of > 1 year) who have a low risk of bleeding, we suggest that systemic thrombolytic therapy may be used to reduce acute symptoms and postthrombotic morbidity if CDT is not available (Grade 2C) |
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.
Recommendation for percutaneous venous Thrombectomy
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1. In patients with acute DVT, we suggest that they should not be treated with percutaneous mechanical thrombectomy alone (Grade 2C) |
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References
- ↑ Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral F, Huet Y, Simonneau G (1998). "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". N Engl J Med. 338 (7): 409–15. PMID 9459643.
- ↑ "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". Circulation. 112 (3): 416–22. 2005. PMID 16009794.
- ↑ Young T, Aukes J, Hughes R, Tang H (2007). "Vena caval filters for the prevention of pulmonary embolism". Cochrane database of systematic reviews (Online) (3): CD006212. doi:10.1002/14651858.CD006212.pub2. PMID 17636834.