Effective endovascular approaches in deep vein thrombosis

Ole Jørgen Grøtta has studied effects of catheter-directed thrombolysis and stent placement following deep vein thrombosis.


MAIN RESULTS:

  1. Catheter-directed thrombolysis reduces post-thrombotic syndrome at long-term follow-up.
  2. Endovenous stent placement is safe and relieves symptoms in patients with chronic vena cava obstruction.
  3. Also patients with iliofemoral post-thrombotic venous obstruction benefit from endovenous stents.

THESIS DEFENCE:

Thesis: Endovascular approaches in the prevention and treatment of chronic deep vein obstruction
Candidate: Ole Jørgen Grøtta
Time: April 5, 2019 at 13:15
Place: Oslo University Hospital, Ullevål, Kreftsenteret: Auditorium 1
Link to university website


SUMMARY:

(1) Additional catheter-directed thrombolysis following deep vein thrombosis reduces the risk of post-thrombotic syndrome over the next five years. The effect is even more pronounced than after two years follow-up, and the results indicate that the treatment prevents one case of post-thrombotic syndrome for every fourth patient treated. However, quality of life did not improve more than with the standard treatment of compression stockings and anticoagulants.

The randomized controlled CaVenT study performed between 2006 and 2009 included 209 patients with a first-time deep vein thrombosis. The five years follow-up study includes data from 176 of these patients. 43 % of those who received catheter-directed thrombolysis on top of standard care developed post-thrombotic syndrome, compared to 71 % in the control group.

(2/3) Placement of endovenous stents is safe and seems to reduce symptoms in patients with chronic vena cava obstruction and in patients with unilateral obstruction with infrainguinal involvement. In both groups, symptoms improved in approximately 70 % of the patients after stent placement, and there were no severe complications.

The first study includes 20 patients with vena cava obstructions, of which stent placement was successful in 19. The patients were followed for a median of two years, and 15 patients had open stents at final follow-up. The second study includes 39 patients with iliofemoral post-thrombotic venous obstruction. Stent placement was successful in all the patients, and 30 of them had open stents at a median follow-up period of nearly four years.


REFERENCES:

(1) Haig, Y., Enden, T., Grøtta, O., Kløw, N. E., Slagsvold, C. E., Ghanima, W., Sandvik, L., Hafsahl, G., Holme, P. A., Holmen, L. O., Njaastad, A. M., Sandbæk, G., & Sandset, P. M. (2016). Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. The Lancet Haematology3(2), e64-e71.

(2) Grøtta, O., Enden, T., Sandbæk, G., Gjerdalen, G. F., Slagsvold, C. E., Bay, D., Kløw, N.-E., & Rosales, A. (2017). Patency and clinical outcome after stent placement for chronic obstruction of the inferior vena cavaEuropean Journal of Vascular and Endovascular Surgery54(5), 620-628.

(3) Grøtta, O., Enden, T., Sandbæk, G., Gjerdalen, G. F., Slagsvold, C. E., Bay, D., Kløw, N.-E., & Rosales, A. (2018). Infrainguinal inflow assessment and endovenous stent placement in iliofemoral post-thrombotic obstructions. CVIR endovascular1(1), 29.