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- Title
Management of proximal deep vein thrombosis.
- Authors
Nyamekye, I.; Merker, L.
- Abstract
Iliofemoral DVT constitutes approximately 20--25% of lower limb DVT and represents a specific subgroup of patients at highest risk for post-thrombotic syndrome (PTS). Anticoagulation alone has no significant thrombolytic activity and has not impact on PTS prevention. Early thrombus removal has reduced PTS in uncontrolled reports and reviews but major trials are awaited. The optimal timing for treatment appear to be thrombus ,2 weeks old and, methods for thrombus removal include direct open or suction thrombectomy, catheter directed thrombolysis (CDT), with or without percutaneous mechanical thrombectomy (PMT) devices. Three principle types of PMT device are in use (rotational, rheolytic and ultrasound enhanced devices) and are combined with CDT in pharmocomechanical thrombolysis (PhMT) to enhance early thrombus removal. These devices have individual device specific attributes and side effects that are additional to the bleeding complications of thrombolysis. A number of additional interventions may be utilised to the improve results of CDT and PhMT. IVC filter deployment to reduce periprocedural PE, is supported by little evidence unless an indication for its use already exists. However, balloon venoplasty and vein stents undoubtedly vein patency after treatment. Early thrombus removal comes with additional upfront costs derived from devices, imaging and critical care bed usage. However, significant potential savings from reduction in PTS and rethrombosis rates may reduce overall societal costs. This review focuses on iliofemoral thrombosis, however, the less commonly encountered but clinically important subclavian vein thrombosis is also discussed.
- Subjects
UNITED Kingdom; VEIN surgery; VENOUS thrombosis treatment; FIBRINOLYTIC agents; ARM; HEALTH services accessibility; LEG; HEALTH outcome assessment; THROMBOLYTIC therapy; VENOUS thrombosis; THROMBOSIS; CATHETERS; TREATMENT effectiveness; PATIENT selection; EQUIPMENT &; supplies; SAFETY
- Publication
Phlebology, 2012, Vol 27, p61
- ISSN
0268-3555
- Publication type
Article
- DOI
10.1258/phleb.2012.012S37