Midterm Outcomes of Pharmacomechanical Thrombectomy in the Treatment of Lower Extremity Deep Vein Thrombosis With a Rotational Thrombectomy Device.

BACKGROUND: The purpose of this study was to assess the safety and efficacy with midterm outcomes of pharmacomechanical thrombectomy (PMT) performed by using a relatively new thrombectomy device in the treatment of lower extremity deep vein thrombosis (DVT). METHODS: Between February 2014 and February 2016, a total of 46 patients with lower extremity DVT were treated with PMT by using Cleaner rotational thrombectomy system. Preprocedural, intraprocedural, postprocedural, and follow-up records of patients were collected and retrospectively analyzed. RESULTS: Mean age of patients was 50.5 (14.8) years, and 58.7% of them were female. Technical success rate of procedure was 91.3%. Mean procedure time was 81.8 (40.3) minutes. Early clinical improvement was observed in all patients with successful treatment. No serious adverse event related to procedure and mortality was observed. Mean follow-up time was 16.0 (7.9) months. Reocclusion was observed in 7 (17.5%) patients during the follow-up period. Venous patency rates of patients at 1-, 3-, 6-, and 12-month follow-up visits were 95%, 92.5%, 89.7%, and 79.5%, respectively. Mild, moderate, and severe postthrombotic syndrome were observed in 8 (20%) patients, 4 (10%) patients, and 1 (2.5%) patient, respectively. Postthrombotic syndrome-free survival rate was 67.5%. CONCLUSION: Cleaner rotational thrombectomy system appears to be safe and effective in the treatment of lower extremity DVT. Further larger randomized studies are needed to determine the long-term outcomes of this treatment modality.

Early-Term Outcomes for Treatment of Saphenous Vein Insufficiency with N-Butyl Cyanoacrylate: A Novel, Non-Thermal, and Non-Tumescent Percutaneous Embolization Technique.

BACKGROUND: The purpose of this study was to present early-term outcomes of VariClose® Vein Sealing System, which is a novel, non-thermal, and non-tumescent percutaneous embolization technique for treatment of saphenous vein insufficiency. METHODS: Between March 2014 and July 2015, 189 saphenous veins in 141 patients were treated with Variclose Vein Sealing System containing n-butyl cyanoacrylate. Pre-, intra-, post-procedural, and follow-up data of patients were collected and retrospectively reviewed. RESULTS: Mean age of patients was 42.5 ± 14.0 years, of which 53% were female. Technical success rate of intervention was 98.9%. Mean procedure time was 14.3 ± 7.5 minutes. Eighty-nine percent of patients (n = 126/141) were available at mean follow-up time of 6.7 months. Mean Venous Clinical Severity Score was significantly improved from 8.3 ± 2.2 at pre-procedure period to 3.3 ± 1.8 at follow-up. No complete recanalization was observed, but 2 patients were presented with partial recanalization during follow-up. The complete occlusion rate was 98.4%. No serious adverse event related to procedure was observed. CONCLUSION: Variclose Vein Sealing System appears to be safe and effective in treatment of saphenous vein insufficiency. Further randomized studies with long-term outcomes are required for determining optimal treatment modality in patients with saphenous vein insufficiency.

Vascular complications of intra-aortic balloon pump usage in coronary bypass surgery: 18 years of experience.

OBJECTIVE: To evaluate the vascular complication incidence related to intra-aortic balloon pump usage during coronary bypass surgery and possible risk factors. METHODS: The retrospective study was conducted at Uludog University Hospital, Turkey, and comprised 147 cases in which intra-aortic balloon pump was used during coronary artery bypass surgery between January 1994 and December 2011. Data was examined in terms of age, gender, diabetes mellitus, hypertension, smoking, peripheral vascular disease, pre-operative serum creatinine, history of congestive heart failure, left ventricular ejection fraction, previous infarction and cardiac functional capacity. Time, indication, treatment duration, technique of insertion and complications were recorded about the balloon insertion. Patients in whom peripheral vascular complication developed were evaluated with pulse examination, Doppler ultrasound and angiography. Logistic regression analyses were carried out with the purpose of determining the relation between pre-operative clinical variables and vascular complications and mortality. RESULTS: Of the total, 105 (71%) were males and 42 (28%) were females. The overall mean age was 62.4 +/- 10.1 years. Besides, 16 (41%) cases had diabetes mellitus and 30 (20%) had peripheral artery disease. The mean Euroscore was 7.6 +/- 4.8. Intra-aortic balloon pump was inserted in 16 (10.8%) due to pre-operative high risk and in 75 (51%) cases due to hypotension being non-responsive to inotropes. Balloon catheter was placed with percutaneous technique in 141 (96%) cases and sheath wasn't used in 44 (29%). The balloon stayed for 2.9 +/- 2.1 days on average. Balloon rupture developed in 1 (0.6%) case. Mortality resulted in 58 (39%) cases. Euroscore (p=0.012), staying in hospital (p=0.005), low ejection fraction (p=0.018), hypertension existence (p=0.003) in multivariate logistic regression analyses were found significant in terms of affecting mortality. Duration of therapy (p<0.001), existence of sheath (p=0.002), and existence of peripheral vascular disease (p<0.001) were found significant as factors affecting the development of vascular complication. CONCLUSION: Intra-aortic balloon pump provides mechanical circulation assistance during coronary artery surgery, but peripheral vascular system should be well evaluated in order to avoid vascular complications and the balloon catheter should be placed without the sheath if necessary. The duration of the therapy is a risk factor for the development of vascular complication.

Spontaneous deep vein thrombosis in hemophilia A: a case report.

Venous thromboembolus is an important cause of hospital acquired morbidity and mortality. Venous thrombosis is a very rare occurrence in patients with haemophilia A. The thrombosis originated from the right main and external iliac veins, and effects the cranial segments of the main, deep and superficial femoral veins as an acute phase thrombus. Neither any local anatomic compression nor any predisposing thrombophilic risk factors were identified. We treated the patient with enoxaparine 1 mg/kg twice a day subcutaneously and then started oral anticoagulation with warfarin.