Catheter-directed thrombolysis, mechanical thrombectomy, and surgery for the treatment of acute iliofemoral deep venous thrombosis
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
The distal posterior tibial vein is ligated. A small infusion catheter (pediatric feeding tube) is brought into the wound via a separate stab incision in the skin and inserted and fixed in the proximal posterior tibial vein (Figure 20.5i). This catheter is used for post-operative anticoagulation with unfractionated heparin (UFH) and pre-discharge phlebography. Anticoagulation via this catheter ensures maximum heparin concentration in the affected veins during their period of greatest thrombogenicity. A 2–0 monofilament suture is looped around the proximal posterior tibial vein (and catheter) and both ends exit the skin adjacent to the wound. The ends of the suture are passed through the holes of a sterile button, which is secured snugly to the skin when the catheter is removed. Upward tension on the ends of the suture obliterates the proximal posterior tibial vein at the time of catheter removal and eliminates the risk of bleeding; the suture is tied and secured above the skin by the button. As mentioned, before removal of the catheter, an ascending phlebogram is performed through the catheter to assess phlebographic patency.
Venous anatomy and pathophysiology
Helane S Fronek in The Fundamentals of Phlebology: Venous Disease for Clinicians, 2007
In the lower leg, three pairs of deep veins exist: the anterior tibial vein (ATV), draining the dorsum of the foot; the posterior tibial vein (PTV), draining the medial aspect of the foot; and the peroneal vein, draining the lateral aspect of the foot. From the ankle, the anterior tibial vein passes upward anterolateral to the interosseous membrane, the posterior tibial vein passes upward posteromedially beneath the medial edge of the tibia, and the peroneal vein passes upward posteriorly through the calf. Venous sinusoids within the calf muscle coalesce to form soleal and gastrocnemius intramuscular venous plexi, which join the peroneal vein in mid calf. In most patients, each
Venous Thrombosis
Hau C. Kwaan, Meyer M. Samama in Clinical Thrombosis, 2019
A Doppler examination that is falsely negative for the presence of proximal vein thrombosis may be obtained if the observer fails to include the posterior tibial vein examination site.147 Inclusion of the posterior tibial vein site in the Doppler ultrasound examination greatly improves the sensitivity for proximal venous thrombosis, but at the expense of specificity.147 Thus, a Doppler ultrasound examination that is positive only at the posterior tibial vein site requires confirmation by venography.
Central Venous Catheter as a Novel Approach to Postoperative Thrombolysis in Patients with Acute Iliofemoral Deep Venous Thrombosis
Published in Clinical and Experimental Hypertension, 2023
Biyun Teng, Fenghe Li, Xuehu Wang, Hao Tian, Yu Zhao, Qiu Zeng
All venous access was established in the vessels below the knee (BTK), including in the proximal posterior tibial vein (PPTV), anterior tibial vein (ATV), distal posterior tibial vein (DPTV), and peroneal vein (PeV), to sufficiently facilitate thrombi removal during the procedures and maintain patient comfort and ambulatory care after the procedures (Figure 1). Venous access was obtained through four approaches: ultrasound-guided puncture, crossover guidewire- or roadmap-guided puncture, great saphenous vein roadmap-guided puncture, or fluoroscopic image of tibial bone-guided puncture. Twenty-one gauge microneedles with associated microwires and introducers (COOK, USA) were used in all punctures. A 10 French vascular sheath (Cordis, USA) was introduced to accommodate the aspiration catheter, and stents with different sizes were placed to manage iliac vein compression.
Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome
Published in Expert Review of Cardiovascular Therapy, 2021
M Machin, S Salim, M Tan, S Onida, AH Davies, J Shalhoub
Surgical thrombectomy has fallen out of practice with the advancement in catheter-directed therapies, with numbers at rock-bottom in the UK since the early 2000s with as few as 26–45 procedures performed annually [15]; it is likely that even these few open thrombectomy procedures are not exclusively related to primary DVT and include cases for restoring flow within venous bypass grafts. Although no longer routinely practiced, some centers in Europe still undertake surgical thrombectomy; hence, it will be briefly mentioned here. The usual technique is to perform a surgical cut down to the common femoral vein as a minimum, with addition of access to the crural veins such as the posterior tibial vein if required [24]. If there is involvement of the inferior vena cava, a proximal filter is usually placed to avoid pulmonary embolization during thrombectomy. Intra-operative venography is used to visualize the obstruction and aid passage of the Fogarty catheter. The catheter is passed to a cephalad point prior to balloon inflation and thrombectomy undertaken. Intra-operative injection thrombolysis and stenting procedures can also be undertaken as an adjunct to open surgical thrombectomy. A surgical arteriovenous fistula can be created at the femoral vessels to improve venous patency.
Myocardial infarction and factor VIII elevation in a 36-year-old man
Published in Baylor University Medical Center Proceedings, 2022
Amit Alam, Harsh Doshi, Divya N. Patel, Keval Patel, Dreamy James, Jesus Almendral
A year later, he developed pump thrombosis in the setting of Neisseria bacteremia and was treated with antibiotics and LVAD exchange. Aspirin was increased to 325 mg daily and his international normalized ratio goal was increased to 2.5 to 3.5. After 6 months, he had a second episode of pump thrombosis without an associated infection. Chest computed tomography showed no evidence of cannula malposition or obstruction. He underwent another LVAD exchange. Dipyridamole was added to his full-dose aspirin and warfarin. Four years later, he underwent a combined heart-kidney transplant and was discharged on aspirin 81 mg daily. Six weeks posttransplant he developed acute left lower extremity swelling and developed deep vein thrombosis of the left common femoral, femoral, popliteal, and posterior tibial veins requiring thrombolysis with thrombectomy.
Related Knowledge Centers
- Ankle
- Malleolus
- Popliteal Vein
- Vein
- Posterior Tibial Artery
- Artery
- Leg
- Posterior Compartment of Leg
- Foot
- Anterior Tibial Vein