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Abstract No. 63: Oral Contraceptive-Induced Deep Venous Thrombosis: A Correlation with May-Thurner Syndrome
CONCLUSION: Transient, cytokine-mediated viral syndrome after repeated intraarterial NV1020 infusions was well tolerated. When combined with subsequent chemotherapy, antitumor activity was observed in approximately half of treated patients.
Scientific Session 8 Venous Thromboembolic Disease Redux Monday, March 17, 2008 7:30 AM - 9:30 AM Room: 204A 7:30 AM
Abstract No. 63
Oral Contraceptive-Induced Deep Venous Thrombosis: A Correlation with May-Thurner Syndrome. G.A. Tye, J. Rosenberg, W.T. Kuo, N. Kothary, D.Y. Sze, L.V. Hofmann; Interventional Radiology, Stanford University Medical Center, Stanford, CA PURPOSE: There are no published reports of the anatomic distribution of oral contraceptive-induced deep venous thrombosis (DVT). We hypothesized that the combination of oral contraceptive pills (OCP) and left iliac vein compression would be additive and that the majority of OCPinduced DVTs would involve the left lower extremity. MATERIALS AND METHODS: An IRB-approved, single institution, retrospective review was conducted for all women less than 45 years old who were diagnosed at a single institution with DVT between 2002 and 2006. Patients were screened using ICD-9 codes for lower extremity DVT, upper extremity DVT, and pulmonary embolism. Data were collected on anatomical location of the DVTs and use of OCP. When available, cross-sectional imaging was reviewed to determine presence of extrinsic venous compression, and the cross-sectional dimensions of bilateral iliac veins were recorded. RESULTS: Fifty-two women, with a mean age of 31.8 years (range 18 to 44 years), had unilateral DVT. Nineteen patients (37%) developed DVT while on OCP. All 19 patients had lower extremity DVT, and none had upper extremity DVT. Sixteen patients (84%) had left lower extremity DVT, and 3 patients (16%) had right lower extremity DVT (p ⬍ .002). Cross-sectional imaging was available on 11 patients, revealing left common iliac vein diameter of 3.7 ⫾ 1.7 mm (mean ⫾ 1SD) and right common iliac vein diameter of 13.1 ⫾ 3.0 mm (p ⬍ .001). The small diameter of the left common iliac vein was typically due to extrinsic compression of its lumen by the right common iliac artery. CONCLUSION: Upper extremity DVT is rare in young women taking OCP. Left lower extremity DVT is over five times as common as right lower extremity DVT in this population, likely due to significant compression of the left common iliac vein (May-Thurner syndrome). This patient population may benefit from endovascular stenting of the left common iliac vein to decrease their likelihood of recurrent DVT and/or development of post-thrombotic syndrome. S26
7:42 AM
Abstract No. 64
Common Iliac Vein Stent for May-Thurner Syndrome with Acute Thrombosis: Evaluation of Patency with CT Venography. U.B. Jeon, J.W. Chung, H.J. Jae, Y.H. So, H.-C. Kim, J.H. Park; Department of Radiology, Seoul National University Hospital, Seoul, Korea PURPOSE: To evaluate the patency of the stent with CT venography in patients who underwent common iliac vein stent placement for May-Thurner syndrome complicated with acute iliofemoral vein thrombosis. MATERIALS AND METHODS: This study was approved by our institutional review board. During the past 8 years, 30 patients (8 men and 22 women) with May-Thurner syndrome complicated with acute iliofemoral vein thrombosis have been diagnosed with CT venography, managed by endovascular interventions, and followed up with CT venography at our institution. Endovascular interventions were performed via left popliteal vein access. After catheter-directed thrombolysis using urokinase with or without aspiration thrombectomy, the iliac vein obstruction was managed with balloon angioplasty followed by stent placement. Mean stent diameter was 12.6 mm (10-16 mm) and mean stent length was 5.0 cm (4-8 cm). We reviewed medical records and imagings retrospectively. RESULTS: The first follow-up CT venography was performed from 4 days to 2217 days (mean: 331 days) after the procedure in all patients. Five stent occlusions and one stent collapse developed. Mild degree of neointimal thicking within the stent was found in 9 patients. All of the five stent occlusions occurred within 1 year after stent placement (mean 105.8 days). Further sequential follow-up (2 to 5 times) CT venography was done in 18 patients (mean 1062 days follow-up). All of the intimal hyperplasia observed on the first follow-up CT remained stable throughout the follow-up period and new in-stent stenoses or occlusions did not occur. CONCLUSION: In patients who underwent common iliac vein stent placement for May-Thurner syndrome complicated with acute iliofemoral vein thrombosis, stent obstruction or restenosis usually occurs during early follow-up period and initial luminal patency can be well maintained during long-term follow-up. 7:54 AM
Abstract No. 65
Catheter Thrombolysis in Thrombocytopenic Cancer Patients with Deep Vein Thrombosis. A. Chamsuddin, T.A. Kabbani, L.A. Nazzal, L. Martin, B. Kang, C. Lewis, H. Khouri; Emory University, Atlanta, GA PURPOSE: Thrombocytopenia is not an uncommon finding in cancer patients. On the other hand, cancer is a well known risk factor for deep vein thrombosis. In this abstract we study 17 cancer patients with thrombocytopenia who presented with DVT and underwent catheter directed thrombolysis as a treatment. MATERIALS AND METHODS: Between July 2005 and September 2007, seventeen patients with cancer (Twelve with leukemia, four with lymphoma and one with prostate cancer) presented with either upper extremity or lower extremity DVT. Blood analysis revealed thrombocytopenia in all patients (Average platelets count: 32,000 per micro liter). Patients were found by interventional radiology to be good
Scientific Session 8 Venous Thromboembolic Disease Redux Monday, March 17, 2008 7:30 AM - 9:30 AM Room: 204A 7:30 AM
Abstract No. 63
Oral Contraceptive-Induced Deep Venous Thrombosis: A Correlation with May-Thurner Syndrome. G.A. Tye, J. Rosenberg, W.T. Kuo, N. Kothary, D.Y. Sze, L.V. Hofmann; Interventional Radiology, Stanford University Medical Center, Stanford, CA PURPOSE: There are no published reports of the anatomic distribution of oral contraceptive-induced deep venous thrombosis (DVT). We hypothesized that the combination of oral contraceptive pills (OCP) and left iliac vein compression would be additive and that the majority of OCPinduced DVTs would involve the left lower extremity. MATERIALS AND METHODS: An IRB-approved, single institution, retrospective review was conducted for all women less than 45 years old who were diagnosed at a single institution with DVT between 2002 and 2006. Patients were screened using ICD-9 codes for lower extremity DVT, upper extremity DVT, and pulmonary embolism. Data were collected on anatomical location of the DVTs and use of OCP. When available, cross-sectional imaging was reviewed to determine presence of extrinsic venous compression, and the cross-sectional dimensions of bilateral iliac veins were recorded. RESULTS: Fifty-two women, with a mean age of 31.8 years (range 18 to 44 years), had unilateral DVT. Nineteen patients (37%) developed DVT while on OCP. All 19 patients had lower extremity DVT, and none had upper extremity DVT. Sixteen patients (84%) had left lower extremity DVT, and 3 patients (16%) had right lower extremity DVT (p ⬍ .002). Cross-sectional imaging was available on 11 patients, revealing left common iliac vein diameter of 3.7 ⫾ 1.7 mm (mean ⫾ 1SD) and right common iliac vein diameter of 13.1 ⫾ 3.0 mm (p ⬍ .001). The small diameter of the left common iliac vein was typically due to extrinsic compression of its lumen by the right common iliac artery. CONCLUSION: Upper extremity DVT is rare in young women taking OCP. Left lower extremity DVT is over five times as common as right lower extremity DVT in this population, likely due to significant compression of the left common iliac vein (May-Thurner syndrome). This patient population may benefit from endovascular stenting of the left common iliac vein to decrease their likelihood of recurrent DVT and/or development of post-thrombotic syndrome. S26
7:42 AM
Abstract No. 64
Common Iliac Vein Stent for May-Thurner Syndrome with Acute Thrombosis: Evaluation of Patency with CT Venography. U.B. Jeon, J.W. Chung, H.J. Jae, Y.H. So, H.-C. Kim, J.H. Park; Department of Radiology, Seoul National University Hospital, Seoul, Korea PURPOSE: To evaluate the patency of the stent with CT venography in patients who underwent common iliac vein stent placement for May-Thurner syndrome complicated with acute iliofemoral vein thrombosis. MATERIALS AND METHODS: This study was approved by our institutional review board. During the past 8 years, 30 patients (8 men and 22 women) with May-Thurner syndrome complicated with acute iliofemoral vein thrombosis have been diagnosed with CT venography, managed by endovascular interventions, and followed up with CT venography at our institution. Endovascular interventions were performed via left popliteal vein access. After catheter-directed thrombolysis using urokinase with or without aspiration thrombectomy, the iliac vein obstruction was managed with balloon angioplasty followed by stent placement. Mean stent diameter was 12.6 mm (10-16 mm) and mean stent length was 5.0 cm (4-8 cm). We reviewed medical records and imagings retrospectively. RESULTS: The first follow-up CT venography was performed from 4 days to 2217 days (mean: 331 days) after the procedure in all patients. Five stent occlusions and one stent collapse developed. Mild degree of neointimal thicking within the stent was found in 9 patients. All of the five stent occlusions occurred within 1 year after stent placement (mean 105.8 days). Further sequential follow-up (2 to 5 times) CT venography was done in 18 patients (mean 1062 days follow-up). All of the intimal hyperplasia observed on the first follow-up CT remained stable throughout the follow-up period and new in-stent stenoses or occlusions did not occur. CONCLUSION: In patients who underwent common iliac vein stent placement for May-Thurner syndrome complicated with acute iliofemoral vein thrombosis, stent obstruction or restenosis usually occurs during early follow-up period and initial luminal patency can be well maintained during long-term follow-up. 7:54 AM
Abstract No. 65
Catheter Thrombolysis in Thrombocytopenic Cancer Patients with Deep Vein Thrombosis. A. Chamsuddin, T.A. Kabbani, L.A. Nazzal, L. Martin, B. Kang, C. Lewis, H. Khouri; Emory University, Atlanta, GA PURPOSE: Thrombocytopenia is not an uncommon finding in cancer patients. On the other hand, cancer is a well known risk factor for deep vein thrombosis. In this abstract we study 17 cancer patients with thrombocytopenia who presented with DVT and underwent catheter directed thrombolysis as a treatment. MATERIALS AND METHODS: Between July 2005 and September 2007, seventeen patients with cancer (Twelve with leukemia, four with lymphoma and one with prostate cancer) presented with either upper extremity or lower extremity DVT. Blood analysis revealed thrombocytopenia in all patients (Average platelets count: 32,000 per micro liter). Patients were found by interventional radiology to be good