Safety and Efficacy of Aspiration Thrombectomy or Pharmacomechanical Thrombectomy after Catheter-Directed Thrombolysis for the Treatment of Acute Iliofemoral Deep Vein Thrombosis

Purpose@#To evaluate the safety and efficacy of additional aspiration thrombectomy (AT) or pharmacomechanical thrombectomy (PMT) after catheter-directed thrombolysis (CDT) for the treatment of acute iliofemoral deep vein thrombosis (AIFDVT). @*Materials and Methods@#Between May 2017 and December 2018, 40 patients with AIFDVT were enrolled. Twenty underwent AT after CDT (CDTAT), while the remaining 20 underwent PMT using an AngioJet TM device after CDT (CDTPMT).Thrombus clearance was assessed using computed tomography venography at 1 week after the procedure, as follows: grade I, ≤50%; grade II, 51% to 75%; grade III, >75%. Grade III was considered a successful outcome. Treatment outcomes (thrombus clearance, thrombolytic therapy duration, urokinase dose, major complications, residual filter thrombosis, and Villalta score) were compared between the groups. @*Results@#Successful thrombus clearance was achieved in 95% of the patients in both groups. Significant decreases in the thrombolytic therapy duration (P=0.018) and urokinase dose (P=0.014) were noted in the CDTPMT group. Major complications were not noted in both groups. Residual filter thrombi >10 mm were found in 6 filters in the CDTAT group and in 1 filter in the CDTPMT group (P=0.038). The Villalta scores at 6 months were 1.47±1.24 and 1.12±0.92 in the CDTAT and CDTPMT groups, respectively (P=0.372). @*Conclusion@#Both methods may be safe and effective management options for patients with AIFDVT. CDTPMT can reduce urokinase dosage, time and remained filter thrombus compared to CDTAT. Studies conducted in the future should compare the effects of overnight CDT followed by PMT with those of single-session PMT on patients with AIFDVT.

Internal hernia through a defect of the broad ligament: a case report

A small bowel obstruction due to an internal hernia through a defect of the broad ligament (called a broad ligament hernia) is rare and accounts for 4-7% of all internal hernias. A 42-year-old woman visited the emergency department of Wonkwang University Hospital with epigastric pain that had lasted for one day. Computed tomography (CT) revealed a closed loop of the small bowel with multiple beak signs at the lower pelvic area, near the uterus and left adnexa. The surgical findings revealed a dilatated small bowel and hernia through a 2×2-cm-sized defect of the left broad ligament. This paper reports a rare case of a broad ligament hernia that was treated successfully via the laparoscopic approach and discusses the characteristics of this disease with reference to the literature.