- Email: [email protected]
A Systematic Review of Stenting in the Management of Acute Deep Venous Thrombosis
Abstracts
413
rate within the first year from 30% to 10% of the patient population. A secondary objective is a non-inferiority of MonoMax suture material (group C) in comparison to MonoPlus (group A). Results: 108 patients were randomized between February 2011 and July 2013. The compare of demographic data, risk factors and co-morbidities did not reveal structural differences between the study groups. After 12 months 4.55% of the patients with an additional implanted mesh in onlay position (group B) had developed an incision hernia versus 21.74% undergoing midline closure using two monofilaments suture loops (group A). In group C 18.18% of patients with 12-months-follow-up had an incision hernia. Non-parametric binomial testing assuming a hernia rate of 20% or 30% after 12 months was performed. For group A and C, herniation significantly differing from 20% (p ¼ 0.499 respectively p ¼ 0.543) or 30% (p ¼ 0.269 respectively p ¼ 0.165) could be refused, while the number of hernias in group B significantly differed from 20% (p ¼ 0.048) and 30% (p ¼ 0.004). Wound healing disorders occurred in15.19%. Notable differences were visible in formation of seromas which were exclusively found in patients of group B (19.23%) but not in group A or C. In total, re-surgery of the abdominal wall was performed in n ¼ 11 patients (10.68%). This number also includes n ¼ 4 non-emergency interventions (revision of the abdominal wall because of persistent seroma or repair of incision hernia). Conclusion: Additional mesh in onlay position after median laparotomy for AAA can reduce hernia rate significantly. Disclosure of Interest: None Declared.
ESVS2016-1455
SESSION 9 e VENOUS/WOUND FRI, 30 SEPT, 08:00e9:00
Endovenous Laser Therapy (ELT) Of Saphenous Vein Reflux Using Thulium Laser (Tm, 1940 nm) with Radial Fiber e One Year Results
ESVS2016-1618 A Systematic Review of Stenting in the Management of Acute Deep Venous Thrombosis M.A.H. Taha
1,*
1
Primary, assisted primary and secondary patency rates 12 months after stent placement were 85.80%, 87.06% and 91.61%, respectively. PTS was assessed in most studies, although recognised tools were only employed in 18 studies (Villalta; 9, Modified Villalta; 1, VCSS; 1 and CEAP; 7). With the overall PTS rate 8.3% of patients in studies that reported PTS as an outcome measure. The incidence of stent re-thrombosis (both early and late) ranged from 5% to 25%. In 98% of the included studies, anticoagulation was administered to all patients who underwent venous stenting and, in 16% of studies, patients received additional antiplatelet therapy consisting of aspirin and/or clopidogrel. The duration of anticoagulation treatment was not guided by the stenting procedure in 75% of studies but guided by the pre-existing predisposing factors 95%. Quality of life questionnaires employed in 22% of included studies and a RCT identified an improvement in VCSS (7.57 0.27 vs. 0.69 0.23) and CIVIQ (22.67 3.01 vs. 39.34 6.66) between both test and control groups, which a high statistical significance for the difference in VCSS and CIVIQ in control and treatment groups (p < 0.001). Conclusion: Venous stenting for an acute DVT of the lower extremity appears to be an effective endovascular option with a high patency rate up to 1 year as well as reducing the incidence of post-thrombotic syndrome and recurrent DVTs. Further studies with longer-term follow-up would allow for a better assessment of this technique and to determine the optimal length of anticoagulation therapy after stent placement and the impact on quality of life. Disclosure of Interest: None Declared.
1
, A. Busuttil , R. Bootun , A.H. Davies
2
1
Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom 2 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, United Kingdom
Introduction: Deep venous thrombosis (DVT) involving the ilio-femoral vein is associated with significant morbidity. Percutaneous endovascular interventions (PEVI) for acute DVT allow for detailed examination of the vein segment in question following thrombus resolution and in most cases unmasks the causative lesion. Treating iliac vein stenosis/compression with venous stenting is thought to reduce the recurrence rate of DVT as well as reduces the severity of symptoms of post thrombotic syndrome (PTS). The aim of this review is to evaluate the impact of venous stenting on the presence of chronic venous insufficiency symptoms, recurrence of thrombosis and stent patency and the optimal duration of anticoagulation following stent placement. Methods: Embase and Medline databases (from 1949 to Feb 2016) were interrogated to identify studies looking at stenting in patients with acute ilio-femoral DVT. Additional references were manually added from reviews and opinion articles included in our initial search. The extracted data was tabulated and descriptive statistics were performed using Excel (Microsoft, Redmond, WA). The inclusion criteria were: (1) Randomised controlled studies for acute venous stenting (2) Case series that included more than 5 stenting patients in their series (3) Lower limb venous stenting (4) Studies published in English (5) Human studies. Results: Seven hundred and eighty-one articles were initially identified from database search. Additional references were obtained by manually checking reviews and original investigations. Following title and abstract screening, 49 articles were included. The 49 studies included 843 patients (850 limbs) stented acutely. Only patients who were stented during the thrombolytic procedure were included in the analysis for stent patency.
C.-G. Schmedt 1,2, A. Esipova 1,*, S. Dikic 1, A. Setia 1, S. Demhasaj 1, T. Dieckmann 1, M.-M. Tipi 1, R. Sroka 2 1
Department for Vascular Surgery, Diakonie-Klinikum Schwaebisch Hall, Schwaebisch Hall, Germany 2 Laser Research Laboratory, LIFE Centre, Ludwig-Maximilians-University, Munich, Germany
Introduction: The use of endovenous laser therapy (ELT) with longer wavelengths (e.g. 1470 nm) is indicated to be advantageous over ELT with shorter wavelengths (e.g. 810e980 nm). The 1940 nm Thulium-Laser is claimed to target and heat water (as opposed to hemoglobin) in the bloodstream. In this clinical study the one-year results of the ELT application of 1940 nm laser with respect to feasibility, effectiveness and safety are reported. Methods: In this single center, prospective observational study, 138 patients with saphenous reflux (great saphenous vein e GSV and small saphenous vein e SSV) were treated with 1940 nm laser (radial fiber) with continuous pullback (1 mm/s). The choice of anesthesia was general, spinal or only tumescent. The tumescent anesthesia was infiltrated in all cases perivenous in the saphenous sheath under ultrasound guidance (USG). Simultaneous miniphlebectomy was performed in all cases additionally ligation of insufficient perforators were performed in selected patients. Clinical evaluation by means of color duplex sonography, clinical examination, standardized questionnaire and pro-forma was done preoperatively and postoperatively after 3 days, 4 weeks, 6 months and 12 months. The data was collected and tabulated with respect to demographics, vein morphology, longitudinal endovenous energy density (LEED), postoperative pain intensity, analgesia requirement, resumption of daily activities and persistent reflux. Results: A total of 138 patients corresponding to 177 saphenous veins were operated (female/male ratio 107/70, mean age 55 years, range 23e 90 years). The 3 day and 4 week follow up rate was 100%. 135 (76.3%) saphenous veins were followed up at 12 months. The mean preoperative maximum diameter of the GSV was 6.9 mm (range 3.3e11.3 mm) and of the SSV was 5.1 mm (range 2.6e10.0 mm). The mean LEED applied was 59.2 Joules/cm (range 30.0e98.2 J/cm) for GSV and 47.3 J/cm (range 30e
413
rate within the first year from 30% to 10% of the patient population. A secondary objective is a non-inferiority of MonoMax suture material (group C) in comparison to MonoPlus (group A). Results: 108 patients were randomized between February 2011 and July 2013. The compare of demographic data, risk factors and co-morbidities did not reveal structural differences between the study groups. After 12 months 4.55% of the patients with an additional implanted mesh in onlay position (group B) had developed an incision hernia versus 21.74% undergoing midline closure using two monofilaments suture loops (group A). In group C 18.18% of patients with 12-months-follow-up had an incision hernia. Non-parametric binomial testing assuming a hernia rate of 20% or 30% after 12 months was performed. For group A and C, herniation significantly differing from 20% (p ¼ 0.499 respectively p ¼ 0.543) or 30% (p ¼ 0.269 respectively p ¼ 0.165) could be refused, while the number of hernias in group B significantly differed from 20% (p ¼ 0.048) and 30% (p ¼ 0.004). Wound healing disorders occurred in15.19%. Notable differences were visible in formation of seromas which were exclusively found in patients of group B (19.23%) but not in group A or C. In total, re-surgery of the abdominal wall was performed in n ¼ 11 patients (10.68%). This number also includes n ¼ 4 non-emergency interventions (revision of the abdominal wall because of persistent seroma or repair of incision hernia). Conclusion: Additional mesh in onlay position after median laparotomy for AAA can reduce hernia rate significantly. Disclosure of Interest: None Declared.
ESVS2016-1455
SESSION 9 e VENOUS/WOUND FRI, 30 SEPT, 08:00e9:00
Endovenous Laser Therapy (ELT) Of Saphenous Vein Reflux Using Thulium Laser (Tm, 1940 nm) with Radial Fiber e One Year Results
ESVS2016-1618 A Systematic Review of Stenting in the Management of Acute Deep Venous Thrombosis M.A.H. Taha
1,*
1
Primary, assisted primary and secondary patency rates 12 months after stent placement were 85.80%, 87.06% and 91.61%, respectively. PTS was assessed in most studies, although recognised tools were only employed in 18 studies (Villalta; 9, Modified Villalta; 1, VCSS; 1 and CEAP; 7). With the overall PTS rate 8.3% of patients in studies that reported PTS as an outcome measure. The incidence of stent re-thrombosis (both early and late) ranged from 5% to 25%. In 98% of the included studies, anticoagulation was administered to all patients who underwent venous stenting and, in 16% of studies, patients received additional antiplatelet therapy consisting of aspirin and/or clopidogrel. The duration of anticoagulation treatment was not guided by the stenting procedure in 75% of studies but guided by the pre-existing predisposing factors 95%. Quality of life questionnaires employed in 22% of included studies and a RCT identified an improvement in VCSS (7.57 0.27 vs. 0.69 0.23) and CIVIQ (22.67 3.01 vs. 39.34 6.66) between both test and control groups, which a high statistical significance for the difference in VCSS and CIVIQ in control and treatment groups (p < 0.001). Conclusion: Venous stenting for an acute DVT of the lower extremity appears to be an effective endovascular option with a high patency rate up to 1 year as well as reducing the incidence of post-thrombotic syndrome and recurrent DVTs. Further studies with longer-term follow-up would allow for a better assessment of this technique and to determine the optimal length of anticoagulation therapy after stent placement and the impact on quality of life. Disclosure of Interest: None Declared.
1
, A. Busuttil , R. Bootun , A.H. Davies
2
1
Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom 2 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, United Kingdom
Introduction: Deep venous thrombosis (DVT) involving the ilio-femoral vein is associated with significant morbidity. Percutaneous endovascular interventions (PEVI) for acute DVT allow for detailed examination of the vein segment in question following thrombus resolution and in most cases unmasks the causative lesion. Treating iliac vein stenosis/compression with venous stenting is thought to reduce the recurrence rate of DVT as well as reduces the severity of symptoms of post thrombotic syndrome (PTS). The aim of this review is to evaluate the impact of venous stenting on the presence of chronic venous insufficiency symptoms, recurrence of thrombosis and stent patency and the optimal duration of anticoagulation following stent placement. Methods: Embase and Medline databases (from 1949 to Feb 2016) were interrogated to identify studies looking at stenting in patients with acute ilio-femoral DVT. Additional references were manually added from reviews and opinion articles included in our initial search. The extracted data was tabulated and descriptive statistics were performed using Excel (Microsoft, Redmond, WA). The inclusion criteria were: (1) Randomised controlled studies for acute venous stenting (2) Case series that included more than 5 stenting patients in their series (3) Lower limb venous stenting (4) Studies published in English (5) Human studies. Results: Seven hundred and eighty-one articles were initially identified from database search. Additional references were obtained by manually checking reviews and original investigations. Following title and abstract screening, 49 articles were included. The 49 studies included 843 patients (850 limbs) stented acutely. Only patients who were stented during the thrombolytic procedure were included in the analysis for stent patency.
C.-G. Schmedt 1,2, A. Esipova 1,*, S. Dikic 1, A. Setia 1, S. Demhasaj 1, T. Dieckmann 1, M.-M. Tipi 1, R. Sroka 2 1
Department for Vascular Surgery, Diakonie-Klinikum Schwaebisch Hall, Schwaebisch Hall, Germany 2 Laser Research Laboratory, LIFE Centre, Ludwig-Maximilians-University, Munich, Germany
Introduction: The use of endovenous laser therapy (ELT) with longer wavelengths (e.g. 1470 nm) is indicated to be advantageous over ELT with shorter wavelengths (e.g. 810e980 nm). The 1940 nm Thulium-Laser is claimed to target and heat water (as opposed to hemoglobin) in the bloodstream. In this clinical study the one-year results of the ELT application of 1940 nm laser with respect to feasibility, effectiveness and safety are reported. Methods: In this single center, prospective observational study, 138 patients with saphenous reflux (great saphenous vein e GSV and small saphenous vein e SSV) were treated with 1940 nm laser (radial fiber) with continuous pullback (1 mm/s). The choice of anesthesia was general, spinal or only tumescent. The tumescent anesthesia was infiltrated in all cases perivenous in the saphenous sheath under ultrasound guidance (USG). Simultaneous miniphlebectomy was performed in all cases additionally ligation of insufficient perforators were performed in selected patients. Clinical evaluation by means of color duplex sonography, clinical examination, standardized questionnaire and pro-forma was done preoperatively and postoperatively after 3 days, 4 weeks, 6 months and 12 months. The data was collected and tabulated with respect to demographics, vein morphology, longitudinal endovenous energy density (LEED), postoperative pain intensity, analgesia requirement, resumption of daily activities and persistent reflux. Results: A total of 138 patients corresponding to 177 saphenous veins were operated (female/male ratio 107/70, mean age 55 years, range 23e 90 years). The 3 day and 4 week follow up rate was 100%. 135 (76.3%) saphenous veins were followed up at 12 months. The mean preoperative maximum diameter of the GSV was 6.9 mm (range 3.3e11.3 mm) and of the SSV was 5.1 mm (range 2.6e10.0 mm). The mean LEED applied was 59.2 Joules/cm (range 30.0e98.2 J/cm) for GSV and 47.3 J/cm (range 30e