RESUMEN

BACKGROUND: A stent with characteristics of a hybrid design may have advantages in improving the patency of symptomatic iliofemoral vein obstruction. This study assessed the safety and effectiveness of the V-Mixtent Venous Stent in treating symptomatic iliofemoral outflow obstruction. METHODS: Eligible patients had a Clinical-Etiologic-Anatomic-Physiologic (CEAP) C classification of ≥ 3 or a Venous Clinical Severity Score (VCSS) pain score of ≥ 2. The primary safety endpoint was the rate of major adverse events within 30 days. The primary effectiveness endpoint was the 12-month primary patency rate. Secondary endpoints included changes in VCSS from baseline to 6 and 12 months, alterations in CEAP C classification, Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-14) scores at 12 months, and stent durability measures. RESULTS: Between December 2020 and November 2021, 171 patients were enrolled across 15 institutions. A total of 185 endovenous stents were placed, with 91.81% of subjects receiving one stent and 8.19% receiving 2 stents. Within 30 days, only two major adverse events occurred (1.17%; 95% confidence interval [CI], 0.14-4.16%), below the literature-defined performance goal of 11% (P < .001). The 12-month primary patency rate (91.36%; 95% CI, 85.93-95.19%; P < .001) exceeded the literature-defined performance goal. VCSS changes from baseline demonstrated clinical improvement at 6 months (- 4.30 ± 3.66) and 12 months (- 4.98 ± 3.67) (P < .001). Significant reduction in symptoms, as measured by CEAP C classification and CIVIQ-14, was observed from pre-procedure to 12 months (P < .001). CONCLUSIONS: The 12-month outcomes confirm the safety and effectiveness of the V-Mixtent Venous Stent in managing symptomatic iliofemoral venous outflow obstruction, including clinical symptom improvement compared to before treatment.

Asunto(s)

Vena Femoral , Vena Ilíaca , Stents , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Vena Femoral/cirugía , Vena Ilíaca/cirugía , Resultado del Tratamiento , Adulto , Anciano , Calidad de Vida

Asunto(s)

Vena Femoral , Humanos , Vena Femoral/cirugía , Masculino , Técnicas de Sutura , Femenino , Persona de Mediana Edad , Suturas , Anciano , Dispositivos de Cierre Vascular

RESUMEN

AIMS: Leadless pacemaker therapy was introduced to overcome lead- and pocket-related complications in conventional transvenous pacemaker systems. Implantation via the femoral vein, however, may not always be feasible. The aim of this study was to evaluate leadless pacemaker implantation using a jugular vein approach and compare it to the standard implantation via the femoral vein. METHODS AND RESULTS: The records of the first consecutive 100 patients undergoing Micra™ leadless pacemaker implantation via the right internal jugular vein from two centres were included in this study. Peri-procedural safety and efficacy of the jugular approach were compared to the first 100 patients using a femoral implantation approach at the University Hospital Zurich. One hundred patients underwent successful implantation of a leadless pacemaker via the internal jugular vein (mean age, 81.18 ± 8.29, 60% males). Mean procedure time was 35.63 ± 10.29 min with a mean fluoroscopy time of 4.66 ± 5.16 min. The device was positioned at the inferior septum in 25 patients, at the high septum in 24 patients, and mid-septum in 51 patients. The mean pacing threshold was 0.56 ± 0.35 V at 0.24 ms pulse width with a sensed amplitude of 10.0 ± 4.4 mV. At follow-up, electrical parameters remained stable in all patients. Compared with femoral implantation, patients undergoing the jugular approach were of similar age and had similar comorbidities. Mean procedure (48.9 ± 21.0 min) and fluoroscopy times (7.7 ± 7.8 min, both P < 0.01) were shorter compared to the femoral approach. Electrical parameters were similar between the two approaches. There were only two complications during jugular veinous implantations (1 pericardial effusion and 1 dislocation), compared to 16 complications using the femoral approach (1 pericardial effusion, 2 femoral artery injuries, and 13 major groin haematomas). CONCLUSION: The jugular approach may represent a safe and efficient alternative to femoral implantation of the Micra leadless pacemaker.

Asunto(s)

Estimulación Cardíaca Artificial , Vena Femoral , Venas Yugulares , Marcapaso Artificial , Humanos , Masculino , Femenino , Anciano de 80 o más Años , Anciano , Estimulación Cardíaca Artificial/métodos , Resultado del Tratamiento , Implantación de Prótesis/métodos , Diseño de Equipo , Estudios Retrospectivos , Arritmias Cardíacas/terapia , Arritmias Cardíacas/fisiopatología , Factores de Tiempo

RESUMEN

Background: Controversy persists concerning the endovascular treatment of the post-thrombotic syndrome (PTS), particularly if femoropopliteal veins are involved. Methods: We screened consecutive patients with PTS who underwent percutaneous transluminal angioplasty (PTA) of femoropopliteal veins using posterior tibial or popliteal vein access who had at least 3-month follow-up. Our assessment included the evaluation of primary and secondary patency of the treated segments by Doppler ultrasound (DUS) and clinical outcomes measured by the change in Villalta score as well as ulcer healing. Results: Among 29 patients, 8 (27.7%) were women and the mean (SD) age was 53.3 (13.6) years. Posterior tibial vein and popliteal access were used in 26 (89.7%) and 3 patients (10.3%), respectively. 13 (44.8%) patients had prior (n = 11, 37.9%) or concomitant (n = 9, 31.0%) endovascular treatment of the iliac or common femoral veins. At a median follow-up of 395 days (Q1: 205-Q3: 756 days), primary patency of femoropopliteal veins was 79.3% (95% CI 64.6-94.1%) and secondary patency was 82.8% (95% CI, 69.0-96.5%). The percentage of patients with moderate or severe PTS according to the Villalta score decreased from baseline to last follow-up from 34.5% to 18.5% and from 31% to 14.8%, respectively (p<0.003). Overall, the mean (SD) Villalta score decreased from 11.5 (1.7) to 8.0 (1.7) (p<0.0001). Postprocedural complete ulcer healing occurred in 4 out of 5 (80%) patients. Two (6.9%) patients developed new ulcers. No major bleeding, pulmonary embolism, stroke, or death occurred. Conclusion: PTA of femoropopliteal veins via posterior tibial or popliteal vein access appears to improve the severity of PTS with acceptable patency rates.

Asunto(s)

Vena Femoral , Vena Poplítea , Síndrome Postrombótico , Grado de Desobstrucción Vascular , Humanos , Femenino , Síndrome Postrombótico/terapia , Síndrome Postrombótico/fisiopatología , Síndrome Postrombótico/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Vena Poplítea/diagnóstico por imagen , Vena Poplítea/fisiopatología , Vena Femoral/diagnóstico por imagen , Vena Femoral/fisiopatología , Factores de Tiempo , Adulto , Anciano , Angioplastia de Balón/efectos adversos , Cicatrización de Heridas , Estudios Retrospectivos , Ultrasonografía Doppler , Úlcera Varicosa/terapia , Úlcera Varicosa/fisiopatología , Úlcera Varicosa/diagnóstico por imagen

RESUMEN

BACKGROUND: Pediatric iliofemoral venous thromboembolism that is resistant to conventional treatments poses significant management challenges. Stent placement represents a potentially underutilized strategy in children when stenosis or thrombosis persists intraprocedurally or recurs postoperatively, despite treatments such as venoplasty, lysis, and thrombectomy. OBJECTIVE: This study aims to report our institutional experience with iliofemoral stenting in 17 pediatric patients with recurrent iliofemoral venous thromboembolism or stenosis. MATERIALS AND METHODS: We performed an IRB-approved retrospective review of pediatric patients (<18 years of age) who underwent iliofemoral venous stenting for recurrent stenosis or thrombosis between January 2012 and December 2022 at a single tertiary care institution. Patient demographics, risk factors for venous thromboembolism, presenting symptoms, and procedural characteristics were recorded. The primary outcome was stent patency rates at interval imaging follow-up. RESULTS: Seventeen patients with mean age of 14.6 years (range 7-17) and mean BMI of 27.7 were stented during the study period. Sixteen of 17 patients presented with evidence of May-Thurner anatomy. 14/17 patients presented with acute iliofemoral venous thromboembolism, 2/17 with chronic venous thromboembolism, and 1/17 with left lower extremity swelling without thrombosis. Seventy-three total angiographic procedures were performed, which included angioplasty, lysis, and thrombectomy, and 23 stent placements. Patients underwent an average of 3 procedures (range 1-9) over a mean of 2.8 months (range 0-17 months) prior to undergoing stent placement. Stents were deployed successfully in all patients. The median follow-up was 18 months (range, 1-77 months). Primary and secondary patency rates were 13/17 (76%) and 14/14 (100%) at 12 months and 12/17 (71%) and 14/14 (100%) at 24 months, respectively. CONCLUSION: In our experience of 17 patients, stent placement appears to be a durable option for children with iliofemoral venous thromboembolism following failure to establish vessel patency or development of recurrent thrombosis/stenosis postoperatively.

Asunto(s)

Vena Femoral , Vena Ilíaca , Stents , Humanos , Niño , Femenino , Masculino , Adolescente , Estudios Retrospectivos , Vena Femoral/cirugía , Vena Femoral/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/cirugía , Tromboembolia Venosa/diagnóstico por imagen , Resultado del Tratamiento , Recurrencia

RESUMEN

PURPOSE: To examine whether there is a significant difference in image quality between the deep learning reconstruction (DLR [AiCE, Advanced Intelligent Clear-IQ Engine]) and hybrid iterative reconstruction (HIR [AIDR 3D, adaptive iterative dose reduction three dimensional]) algorithms on the conventional enhanced and CE-boost (contrast-enhancement-boost) images of indirect computed tomography venography (CTV) of lower extremities. MATERIALS AND METHODS: In this retrospective study, seventy patients who underwent CTV from June 2021 to October 2022 to assess deep vein thrombosis and varicose veins were included. Unenhanced and enhanced images were reconstructed for AIDR 3D and AiCE, AIDR 3D-boost and AiCE-boost images were obtained using subtraction software. Objective and subjective image qualities were assessed, and radiation doses were recorded. RESULTS: The CT values of the inferior vena cava (IVC), femoral vein ( FV), and popliteal vein (PV) in the CE-boost images were approximately 1.3 (1.31-1.36) times higher than in those of the enhanced images. There were no significant differences in mean CT values of IVC, FV, and PV between AIDR 3D and AiCE, AIDR 3D-boost and AiCE-boost images. Noise in AiCE, AiCE-boost images was significantly lower than in AIDR 3D and AIDR 3D-boost images ( P < 0.05). The SNR (signal-to-noise ratio), CNR (contrast-to-noise ratio), and subjective scores of AiCE-boost images were the highest among 4 groups, surpassing AiCE, AIDR 3D, and AIDR 3D-boost images (all P < 0.05). CONCLUSION: In indirect CTV of the lower extremities images, DLR with the CE-boost technique could decrease the image noise and improve the CT values, SNR, CNR, and subjective image scores. AiCE-boost images received the highest subjective image quality score and were more readily accepted by radiologists.

Asunto(s)

Medios de Contraste , Aprendizaje Profundo , Extremidad Inferior , Flebografía , Humanos , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Anciano , Flebografía/métodos , Adulto , Algoritmos , Trombosis de la Vena/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Vena Poplítea/diagnóstico por imagen , Várices/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Vena Femoral/diagnóstico por imagen , Dosis de Radiación , Angiografía por Tomografía Computarizada/métodos , Anciano de 80 o más Años , Intensificación de Imagen Radiográfica/métodos

RESUMEN

OBJECTIVE: To compare the treatment outcomes among percutaneous mechanical thrombectomy (PMT) with AngioJet, Catheter-directed thrombolysis (CDT), and a combination of both. METHODS: One hundred forty nine patients with acute or sub-acute iliac-femoral vein thrombosis accepting CDT and/or PMT were divided into three groups respectively: PMT group, CDT group, PMT + CDT group (PMT followed by CDT). The severity of thrombosis was evaluated by venographic scoring system. Technical success was defined as restored patent deep venous blood flow after CDT and/or PMT. Clinical follow-up were assessed by ultrasound or venography imaging. The primary endpoints were recurrence of DVT, and severity level of post-thrombotic syndrome (PTS) during the follow-up. RESULTS: Technical success and immediate clinical improvements were achieved on all patients. The proportion of sub-acute DVT and the venographic scoring in PMT + CDT group were significantly higher than that in CDT group and PMT group (proportion of sub-acute DVT: p = 0.032 and p = 0.005, respectively; venographic scoring: p < 0.001, respectively). The proportion of May-Thurner Syndrome was lower in PMT group than that in CDT and PMT + CDT group (p = 0.026 and p = 0.005, respectively). The proportion of DVT recurrence/stent thrombosis was significantly higher in CDT group than that in PMT + CDT group (p = 0.04). The severity of PTS was the highest in CDT group ( χ2 = 14.459, p = 0.006) compared to PMT group (p = 0.029) and PMT + CDT group (p = 0.006). CONCLUSION: Patients with sub-acute DVT, high SVS scoring and combined May-Thurner Syndrome were recommended to take PMT + CDT treatment and might have lower rate of DVT recurrence/stent thrombosis and severe PTS. Our study provided evidence detailing of PMT + CDT therapy.

Asunto(s)

Trombectomía , Terapia Trombolítica , Trombosis de la Vena , Humanos , Masculino , Trombosis de la Vena/terapia , Femenino , Persona de Mediana Edad , Terapia Trombolítica/métodos , Trombectomía/métodos , Resultado del Tratamiento , Adulto , Estudios Retrospectivos , Anciano , Vena Ilíaca/cirugía , Vena Ilíaca/diagnóstico por imagen , Terapia Combinada , Vena Femoral , Síndrome Postrombótico , Trombolisis Mecánica/métodos , Flebografía

RESUMEN

INTRODUCTION: Successful implantations of the Aveir VR, have been effectively demonstrated in adults; however, there remain limited reports supporting safe and feasible implantation of the Aveir VR in the young population. METHODS: Retrospective, observational study of Aveir VR implantation of young patients (≦21 years old) at UC Davis Medical Center from November 2022 to January 2024 via the internal jugular or femoral vein implantation approaches. Indications for pacing, patient demographics, pacing thresholds and longevity were reported at the time of implantation and last follow-up. RESULTS: A total of 10 patients received the Aveir VR with a median age of years (IQR 12.5-17) and median weight of 50.8 kg (IQR 44.6-60.9) kg. The majority were male (80%). Aveir VR leadless pacemaker occurred via internal jugular venous (90%) or femoral venous (10%) approaches. Indications for placement were intermittent complete heart block (60%) and sinus pauses (40%). Adequate impedance, sensing and thresholds were maintained from implantation to a median follow-up of 9 months. Predicted pacemaker longevity at follow-up median was 23.8 years. There were no complications in any of the 10 patients. CONCLUSION: Aveir VR implantation via the internal jugular and femoral veins is feasible in the young patient population with stable pacing parameters at follow-up.

Asunto(s)

Vena Femoral , Marcapaso Artificial , Humanos , Masculino , Femenino , Estudios Retrospectivos , Adolescente , Niño , Venas Yugulares , Remoción de Dispositivos , Estimulación Cardíaca Artificial/métodos

RESUMEN

An infant with a corrected gestational age of 38 weeks, weighing 3.1 kg, was referred to our pediatric surgical department because of a fractured peripherally inserted central venous catheter in the left lower limb with the end retracting into the deep venous system. An operation was undertaken to remove the PICC. Because the central venous catheter was, unintentionally, placed in the left small saphenous vein and thus positioned in the left femoral vein, the left great saphenous vein was incised to gain access. Subsequently, the catheter could be removed successfully. Fracturing of a peripherally inserted central venous catheter is a rare occurance. Removal depends on vessel size, location and experertise.

Asunto(s)

Cateterismo Venoso Central , Catéteres Venosos Centrales , Remoción de Dispositivos , Falla de Equipo , Humanos , Recién Nacido , Remoción de Dispositivos/métodos , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/métodos , Masculino , Vena Safena , Femenino , Vena Femoral , Pierna/irrigación sanguínea

RESUMEN

OBJECTIVE: The aim of this study was to study the risk factors influencing the occurrence of moderate to severe post-thrombotic syndrome (PTS) within 2 years in patients with subacute lower extremity deep vein thrombosis (DVT). METHODS: Seventy patients who developed moderate to severe PTS within 2 years after subacute lower extremity DVT from June 2018 to June 2022 were retrospectively selected as the case group. They were matched 1:1 by sex and age (±5 years) with 70 patients who did not develop moderate to severe PTS during the same follow-up period as the control group. Multiple logistic regression, stratified analysis, and interaction analyses were used to explore the risk factors for moderate to severe PTS. RESULTS: The multiple logistic regression model showed that patients with iliofemoral vein thrombosis had a significantly increased risk of developing moderate to severe PTS within 2 years. Patients who underwent intraluminal intervention treatment during hospitalization had a significantly reduced risk. The odds ratios were 4.000 (95% confidence interval, 1.597-10.016) for the femoral-popliteal vein thrombosis and 0.262 (95% confidence interval, 0.106-0.647) for the anticoagulation treatment group. The stratified analysis showed that intraluminal intervention treatment was a protective factor against moderate to severe PTS within 2 years across different strata of hypertension, thrombus type, body mass index, duration of anticoagulation, and wearing compression stockings. Additionally, there was an interaction between thrombus type and treatment method, with intraluminal intervention treatment having a more pronounced effect on preventing moderate to severe PTS in patients with iliofemoral vein thrombosis. CONCLUSIONS: Iliofemoral vein thrombosis is a risk factor for the development of moderate to severe PTS within 2 years in patients with subacute lower extremity DVT. Intraluminal intervention treatment can reduce the risk of moderate to severe PTS, especially in patients with iliofemoral vein thrombosis.

Asunto(s)

Vena Femoral , Síndrome Postrombótico , Índice de Severidad de la Enfermedad , Trombosis de la Vena , Humanos , Síndrome Postrombótico/etiología , Síndrome Postrombótico/prevención & control , Femenino , Masculino , Factores de Riesgo , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Trombosis de la Vena/complicaciones , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Medición de Riesgo , Vena Femoral/diagnóstico por imagen , Adulto , Anciano , Vena Ilíaca/diagnóstico por imagen , Anticoagulantes/uso terapéutico , Estudios de Casos y Controles , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Transvenous lead extractions (TLEs) for cardiac implantable electronic device complications often encounter difficulties with strong adhesions to the myocardium or vessels. In this report, we introduce a novel "Four-Stage Rocket" technique for effective TLE in cases where conventional methods fail. METHODS AND RESULTS: Two challenging cases where conventional TLE methods failed were treated using a combination of four devices: Needle's Eye Snare, Agilis NxT Steerable Introducer, GlideLight Laser sheath, and GORE® DrySeal Flex Introducer sheath, employed via the inferior vena cava. The "Four-Stage Rocket" technique successfully detached firmly adhered leads near the tricuspid valve annulus, where the traditional superior vena cava approach was inadequate. CONCLUSION: The "Four-Stage Rocket" technique offers a potential alternative in complex TLE cases, aligning the laser direction with the adhesion detachment and reducing the tissue damage risk.

Asunto(s)

Desfibriladores Implantables , Remoción de Dispositivos , Vena Femoral , Rayos Láser , Marcapaso Artificial , Humanos , Remoción de Dispositivos/instrumentación , Remoción de Dispositivos/métodos , Masculino , Anciano , Resultado del Tratamiento , Femenino , Persona de Mediana Edad , Cateterismo Periférico/instrumentación

RESUMEN

INTRODUCTION: Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large-scale data comparing clinical outcomes between the two approaches are lacking. METHODS: Two cohorts of patients undergoing AF ablation were identified from 36 healthcare organizations using a global federated research network (TriNetX): those receiving a VCD for femoral hemostasis, and those not receiving a VCD. A 1:1 propensity score matching (PSM) model based on baseline characteristics was used to create two comparable cohorts. The primary outcome was a composite of all-cause mortality, vascular complications, bleeding events, and need for blood transfusion. Outcomes were assessed during early (within 7 days of ablation) and extended follow-up (within 8-30 days of ablation). RESULTS: After PSM, 28 872 patients were included (14 436 in each cohort). The primary composite outcome occurred less frequently in the VCD cohort during early (1.97% vs. 2.60%, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.65-0.88; p < .001) and extended follow-up (1.15% vs. 1.43%, OR 0.80, 95% CI 0.65-0.98; p = .032). This was driven by a lower rate of vascular complications during early follow-up in the VCD cohort (0.83% vs. 1.26%, OR 0.66, 95% CI 0.52-0.83; p < .001), and fewer bleeding events during early (0.90% vs. 1.23%, OR 0.73, 95% CI 0.58-0.92; p = .007) and extended follow-up (0.36% vs. 0.59%, OR 0.61, 95% CI 0.43-0.86; p = .005). CONCLUSION: Following AF ablation, femoral venous hemostasis with a VCD was associated with reduced complications compared with hemostasis without a VCD.

Asunto(s)

Fibrilación Atrial , Ablación por Catéter , Vena Femoral , Técnicas Hemostáticas , Punciones , Dispositivos de Cierre Vascular , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Masculino , Femenino , Ablación por Catéter/efectos adversos , Persona de Mediana Edad , Resultado del Tratamiento , Anciano , Factores de Tiempo , Técnicas Hemostáticas/instrumentación , Técnicas Hemostáticas/efectos adversos , Factores de Riesgo , Estudios Retrospectivos , Cateterismo Periférico/efectos adversos , Medición de Riesgo , Hemorragia/etiología , Hemorragia/prevención & control

Asunto(s)

Cateterismo Venoso Central , Arteria Femoral , Vena Femoral , Humanos , Cateterismo Venoso Central/métodos , Arteria Femoral/diagnóstico por imagen , Masculino

RESUMEN

BACKGROUND: The anticoagulation strategy of switching to rivaroxaban after 1 week of initial low-molecular-weight heparin (LMWH) therapy is recommended by a guideline for the treatment of acute iliofemoral deep vein thrombosis (DVT). However, the initial rivaroxaban dose in the switching strategy, as well as the effectiveness and safety of the early switching (less than 1 week) to rivaroxaban, remain inadequately substantiated. We aimed to evaluate the effectiveness and safety of early switching from LMWH to maintenance therapy of rivaroxaban (20 mg once daily) for acute iliofemoral DVT. METHODS: A retrospective cohort study was conducted using data from patients with acute iliofemoral DVT who received initial LMWH anticoagulation followed by rivaroxaban maintenance therapy. The clinical outcomes were compared between early (LMWH course ≤7 days) and routine (LMWH course >7 days) switching strategies within 3 months of initiating anticoagulation. RESULTS: 217 patients were included, 59 (27.2%) receiving early switching and 158 (72.8%) receiving routine switching. Compared with routine switching, patients with early switching had a significantly shorter hospital stay (7 days vs. 14 days, P < 0.001). The length of hospital stay was significantly positively correlated with the duration of LMWH (r = 0.762, P < 0.001). The incidences of recurrent venous thromboembolism (5.1% vs. 2.5%, P = 0.606), major bleeding (0% vs. 1.9%, P = 0.564), clinically relevant nonmajor bleeding (1.7% vs. 2.5%, P = 1.000) and all-cause mortality (6.8% vs. 2.5%, P = 0.283) were not statistically different between the 2 groups. CONCLUSIONS: Direct early switching from LMWH to maintenance therapy of rivaroxaban is effective and safe for acute iliofemoral DVT.

Asunto(s)

Esquema de Medicación , Sustitución de Medicamentos , Inhibidores del Factor Xa , Vena Femoral , Hemorragia , Heparina de Bajo-Peso-Molecular , Vena Ilíaca , Rivaroxabán , Trombosis de la Vena , Humanos , Rivaroxabán/efectos adversos , Rivaroxabán/administración & dosificación , Estudios Retrospectivos , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/mortalidad , Trombosis de la Vena/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/administración & dosificación , Factores de Tiempo , Anciano , Hemorragia/inducido químicamente , Vena Ilíaca/diagnóstico por imagen , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina de Bajo-Peso-Molecular/administración & dosificación , Factores de Riesgo , Adulto , Enfermedad Aguda , Tiempo de Internación , Recurrencia , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación

RESUMEN

OBJECTIVE: Vascular access is difficult in patients without suitable arm veins and prior graft infections. The use of femoral vein translocation (FVT) to the upper extremity or contralateral lower extremity for hemodialysis access may be associated with low infection rates and high patency rates. FVT is used for patients without central venous occlusion who have failed prior access either owing to graft infection or repetitive graft thrombosis. The largest case series consists of 30 cases. The objective of this study is to determine the infection incidence, primary patency, primary-assisted patency, and secondary patency rates among FVTs. METHODS: A retrospective chart review was performed on all patients who underwent FVT by a single vascular practice over a 10-year period (2013-2023). Study variables included length to last follow-up (months), prior access, prior graft infection, comorbid conditions, primary patency, primary-assisted patency, secondary patency, postoperative steal syndrome, postoperative graft infection, postoperative harvest site complication, and postoperative lower extremity compartment syndrome. RESULTS: A total of 131 FVTs were performed from 2013 to 2023; 126 patients (47% male, 53% female; 76% Black, 24% White) with a mean age of 52 ± 14 years and a mean body mass index of 29 ± 8 had at least 1 month of follow-up and were included for analysis. The median follow-up was 46 months (interqurtile range, 19-72 months). The mean number of prior permanent accesses was 2.5 ± 1.4. Forty-eight percent of patients had prior graft infections. The primary, primary-assisted, and secondary patency rates were 66%, 93%, and 98%, respectively, at 6 months; 43%, 85%, and 96% at 12 months; 25%, 70%, and 92% at 24 months; 16%, 61%, and 88% at 36 months; and 14%, 56%, and 82% at 48 months. Postoperative steal syndrome and postoperative access infection requiring excision was observed 16% and 5% of patients, respectively. Harvest site complications requiring an additional procedure occurred in 19% of cases. Three patients developed lower extremity compartment syndrome postoperatively, requiring fasciotomy. Six patients developed chronic lower extremity edema after femoral vein harvest. The mean procedure time and hospital length of stay were 197 ± 40 minutes and 3.5 ± 2.8 days, respectively. CONCLUSIONS: FVT is associated with low infection rates and high long-term patency rates. Significant postoperative complications include steal syndrome and harvest site complications. FVT remains a viable option for patients who have failed prior access owing to graft infection or repetitive graft thrombosis.

Asunto(s)

Derivación Arteriovenosa Quirúrgica , Implantación de Prótesis Vascular , Vena Femoral , Diálisis Renal , Grado de Desobstrucción Vascular , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Vena Femoral/cirugía , Derivación Arteriovenosa Quirúrgica/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Adulto , Anciano , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Factores de Riesgo , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/etiología , Extremidad Superior/irrigación sanguínea , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/epidemiología

RESUMEN

Femoral vein is increasingly used for venous cannulation procedures. Its anomalies in the femoral triangle could complicate these procedures. We report an extremely rare type of femoral venous ladder observed during routine cadaveric dissections. The variation was found in the left lower limb of an adult male cadaver aged 70 years. The femoral vein was a single vein in initial 3 cm and terminal 4 cm of its course. The middle part of the vein showed a duplication and a complex ladder pattern and encircled the femoral artery in the femoral triangle. This anomaly could predispose the vein for deep vein thrombosis. Knowledge of this anomaly could be useful during radiological procedures, femoral hernia repair and femoral triangle abscess and lymph node clearance.

Asunto(s)

Variación Anatómica , Cadáver , Arteria Femoral , Vena Femoral , Humanos , Masculino , Vena Femoral/anomalías , Vena Femoral/diagnóstico por imagen , Anciano , Arteria Femoral/anomalías , Arteria Femoral/diagnóstico por imagen , Disección

RESUMEN

BACKGROUND: Differences in the efficacy and safety between the preclose and postclose suture-mediated vascular closure systems for femoral vein access have not been adequately studied. OBJECTIVES: This study aimed to evaluate the efficacy and safety of these 2 suturing techniques in femoral vein access. METHODS: Patients subjected to elective catheter ablation via the femoral vein using a sheath of 8- to 13-F inner diameter (n = 282) were randomized to the preclose or postclose groups for the single-suture technique using ProGlide/ProStyle (Abbott Vascular). Duplex ultrasound was performed on days 1 and 90 after the procedure to evaluate vascular complications. The primary efficacy endpoint was rebleeding requiring recompression, and the primary safety endpoint was any major complication occurring within 90 days. The secondary efficacy endpoints included time to hemostasis and time to ambulation, and the secondary safety endpoint was any minor complication occurring within 90 days. RESULTS: The preclose group demonstrated a significantly lower rebleeding rate (5 of 141 [3.5%] vs 15 of 141 [10.6%]; P = 0.03) and shorter time to hemostasis (254.0 ± 120.4 seconds vs 299.8 ± 208.2 seconds; P = 0.02) compared with the postclose group. Five patients in each group were lost to follow-up at 90 days. Incidence of major complications were similar in both groups (1 of 136 [0.7%]; P = 1.00), whereas minor complications were observed in 18 of 136 (13.2%) and 21 of 136 (15.4%) patients in the preclose and postclose groups, respectively, without a significant difference (P = 0.73). CONCLUSIONS: In femoral vein access using the single-suture technique with ProGlide/ProStyle, the preclose technique presented a higher hemostasis rate than the postclose technique, without compromising safety.

Asunto(s)

Ablación por Catéter , Vena Femoral , Técnicas de Sutura , Dispositivos de Cierre Vascular , Humanos , Masculino , Vena Femoral/cirugía , Femenino , Persona de Mediana Edad , Ablación por Catéter/métodos , Ablación por Catéter/efectos adversos , Anciano , Resultado del Tratamiento , Suturas , Adulto , Hemorragia/etiología , Hemorragia/prevención & control

RESUMEN

BACKGROUND: Iliofemoral venous stent placement (IVS) has evolved to a well-established endovascular treatment modality for chronic iliofemoral venous obstruction (CIVO). Dedicated venous stents gained approval from the US Food and Drug Administration in 2019 and solidified IVS as a defined intervention with clear indications, contraindications, risks, benefits, and procedural management principles. This review focuses on the indications, technical aspects and outcomes of stenting for CIVO. Other aspects pertaining to IVS are covered in other articles that are a part of this series. METHODS: This study conducted a literature search limited to English articles. Three search strategies were used, and references were managed in Covidence software. Four investigators screened and evaluated articles independently, excluding meta-analyses, clinical trial protocols, and nonrelevant studies. Eligible studies, focused on clinical outcomes and stent patencies, underwent thorough review. RESULTS: The literature search yielded 1704 studies, with 147 meeting eligibility criteria after screening and evaluation. Exclusions were based on duplicates, irrelevant content, and noniliac vein stent placement. CONCLUSIONS: Successful IVS for CIVO relies on meticulous patient selection, consistent use of intravascular ultrasound examination during procedures and attention to the technical details of IVS.

Asunto(s)

Procedimientos Endovasculares , Vena Femoral , Vena Ilíaca , Stents , Humanos , Vena Ilíaca/diagnóstico por imagen , Vena Femoral/diagnóstico por imagen , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Enfermedad Crónica , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Factores de Riesgo , Selección de Paciente

Asunto(s)

Vena Femoral , Humanos

RESUMEN

During our previous bilateral adrenal vein sampling (AVS) procedure, the authors observed that accessing the left adrenal vein through the antecubital vein was more feasible than the conventional femoral vein. Meanwhile, the femoral vein pathway facilitated access to the right adrenal vein than the antecubital vein pathway. Therefore, the authors hypothesized that simultaneous bilateral AVS via the antecubital combined with the femoral vein pathway could improve the success rate. A total of 94 cases of AVS via the antecubital combined with the femoral vein pathway were performed, while the remaining 20 cases employed the antecubital vein pathway at our center between August 2020 and April 2023. Furthermore, a meta-analysis was conducted in this study using 15 selected articles to determine the success rate of AVS in each center and pathway. The success rate of ACTH-stimulated simultaneous bilateral AVS via the antecubital vein combined with the femoral vein pathway was 92.85% (P = .503) on the right and 95.00% (P < .001) on the left. In the antecubital vein pathway, the success rates were only 25.00% (P < .001) on the right side and 80.00% (P = .289) on the left side. The results of meta-analysis demonstrated a success rate of 78.16% on the right and 94.98% on the left for ACTH-stimulated AVS via the femoral vein pathway. Based on our center's experience, simultaneous bilateral adrenal vein sampling via the combined pathway could improve the success rate of AVS in the short term and shorten the learning curve.

Asunto(s)

Glándulas Suprarrenales , Vena Femoral , Curva de Aprendizaje , Humanos , Glándulas Suprarrenales/irrigación sanguínea , Masculino , Femenino , Persona de Mediana Edad , Adulto , Venas , Hormona Adrenocorticotrópica/sangre , Recolección de Muestras de Sangre/métodos