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Michael D Dake - One of the best experts on this subject based on the ideXlab platform.
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chronically occluded inferior venae cavae endovascular treatment
Radiology, 2000Co-Authors: Mahmood K Razavi, Ernst Hansch, Charles P Semba, Michael D DakeAbstract:PURPOSE: To report the results of endoluminal recanalization and stent placement in patients with chronic occlusions of the inferior vena cava (IVC). MATERIALS AND METHODS: Seventeen consecutive patients (12 male, five female patients; mean age, 40.6 years; age range, 15–77 years) with chronic IVC occlusions were treated during a 6-year period. The mean duration of symptoms was 32 months. Underlying active malignancy was the cause of occlusion in four patients. Five patients with superimposed acute thrombus underwent catheter-directed thrombolysis prior to IVC recanalization. Clinical patency was defined as absence or improvement of symptoms. Clinical follow-up was supplemented with ultrasonography, vena Cavography, or both in 10 patients. RESULTS: Technical success was achieved in 15 (88%) patients. Additional thrombolytic therapy and stent placement was needed in two patients to maintain patency at 4 and 6 months after the procedure. Twelve patients had IVCs that remained patent after a mean follow-up o...
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chronically occluded inferior venae cavae endovascular treatment
Radiology, 2000Co-Authors: Mahmood K Razavi, Ernst Hansch, Charles P Semba, Michael D DakeAbstract:PURPOSE: To report the results of endoluminal recanalization and stent placement in patients with chronic occlusions of the inferior vena cava (IVC). MATERIALS AND METHODS: Seventeen consecutive patients (12 male, five female patients; mean age, 40.6 years; age range, 15–77 years) with chronic IVC occlusions were treated during a 6-year period. The mean duration of symptoms was 32 months. Underlying active malignancy was the cause of occlusion in four patients. Five patients with superimposed acute thrombus underwent catheter-directed thrombolysis prior to IVC recanalization. Clinical patency was defined as absence or improvement of symptoms. Clinical follow-up was supplemented with ultrasonography, vena Cavography, or both in 10 patients. RESULTS: Technical success was achieved in 15 (88%) patients. Additional thrombolytic therapy and stent placement was needed in two patients to maintain patency at 4 and 6 months after the procedure. Twelve patients had IVCs that remained patent after a mean follow-up o...
Mahmood K Razavi - One of the best experts on this subject based on the ideXlab platform.
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chronically occluded inferior venae cavae endovascular treatment
Radiology, 2000Co-Authors: Mahmood K Razavi, Ernst Hansch, Charles P Semba, Michael D DakeAbstract:PURPOSE: To report the results of endoluminal recanalization and stent placement in patients with chronic occlusions of the inferior vena cava (IVC). MATERIALS AND METHODS: Seventeen consecutive patients (12 male, five female patients; mean age, 40.6 years; age range, 15–77 years) with chronic IVC occlusions were treated during a 6-year period. The mean duration of symptoms was 32 months. Underlying active malignancy was the cause of occlusion in four patients. Five patients with superimposed acute thrombus underwent catheter-directed thrombolysis prior to IVC recanalization. Clinical patency was defined as absence or improvement of symptoms. Clinical follow-up was supplemented with ultrasonography, vena Cavography, or both in 10 patients. RESULTS: Technical success was achieved in 15 (88%) patients. Additional thrombolytic therapy and stent placement was needed in two patients to maintain patency at 4 and 6 months after the procedure. Twelve patients had IVCs that remained patent after a mean follow-up o...
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chronically occluded inferior venae cavae endovascular treatment
Radiology, 2000Co-Authors: Mahmood K Razavi, Ernst Hansch, Charles P Semba, Michael D DakeAbstract:PURPOSE: To report the results of endoluminal recanalization and stent placement in patients with chronic occlusions of the inferior vena cava (IVC). MATERIALS AND METHODS: Seventeen consecutive patients (12 male, five female patients; mean age, 40.6 years; age range, 15–77 years) with chronic IVC occlusions were treated during a 6-year period. The mean duration of symptoms was 32 months. Underlying active malignancy was the cause of occlusion in four patients. Five patients with superimposed acute thrombus underwent catheter-directed thrombolysis prior to IVC recanalization. Clinical patency was defined as absence or improvement of symptoms. Clinical follow-up was supplemented with ultrasonography, vena Cavography, or both in 10 patients. RESULTS: Technical success was achieved in 15 (88%) patients. Additional thrombolytic therapy and stent placement was needed in two patients to maintain patency at 4 and 6 months after the procedure. Twelve patients had IVCs that remained patent after a mean follow-up o...
David Rosenthal - One of the best experts on this subject based on the ideXlab platform.
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¤CLINICAL INVESTIGATION ¤ Retrievability of the Günther Tulip Vena Cava Filter After Dwell Times Longer Than 180 Days in Patients With Multiple Trauma
2016Co-Authors: David Rosenthal, Md Eric, D. Wellons, Md Susan, M. Hancock, Allison B BurkettAbstract:Purpose: To evaluate the retrieval feasibility of the Günther Tulip inferior vena cava filter (IVCF) after dwell times.180 days in patients with multiple trauma. Methods: A retrospective study was conducted of 117 multiple-trauma patients (70 men; mean age 36 years, range 17 to 64) who underwent prophylactic placement of Günther Tulip retrievable IVCFs between December 1, 2003 and October 1, 2006. Prior to IVCF retrieval, all patients had vena Cavography to identify possible IVCF thrombus entrapment. Filter retrieval was performed in the catheterization laboratory under sterile conditions from a right internal jugular vein approach. After IVCF retrieval, repeat vena Cavography was performed to evaluate the IVC for contrast extravasation, intraluminal defects, or IVC narrowing. Results: Twelve (10.3%) filters were not retrieved as the patients died of their injuries (no deaths related to IVCF placement or retrieval). Forty-one (35.0%) filters had dwell times.180 days (mean 261.5 days, range 182–403). Of these, 31 (76%) were uneventfully retrieved; 10 were left in place permanently. Pre-retrieval vena Cavography identified filter tilting in 13 filters: 9 had a mild tilt #10u, and 4 had severe tilting $25u. All of the 10 filters that could not be retrieved were tilted (4 severe and 6 mild). In comparison to the 64 (54.7%) filters in place for,180 days (mean 51 days, range 42–180), 4 (6.2%) could not be retrieved (p50.367). No filter had trapped thrombus identified by vena Cavography at the time of retrieval. None of the retrieved filters had structural fracture or collapse, and none had migrated. Post-retrieval vena cavograms demonstrated no contrast extravasation, intraluminal defects, or impingement on adjacent organs. Conclusion: If retrieval of a Gunther Tulip filter with an dwell time.180 days is considered, the patient should be ambulatory and a candidate for anticoagulation if indicated; notably, the filter should have a,25u tilt. Under these circumstances, retrieval of the Günther Tulip filter after 180 days of dwell time appears justified and safe
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retrievability of the gunther tulip vena cava filter after dwell times longer than 180 days in patients with multiple trauma
Journal of Endovascular Therapy, 2007Co-Authors: David Rosenthal, Susan M Hancock, Eric D. Wellons, Allison B BurkettAbstract:PURPOSE: To evaluate the retrieval feasibility of the Gunther Tulip inferior vena cava filter (IVCF) after dwell times >180 days in patients with multiple trauma. METHODS: A retrospective study was conducted of 117 multiple-trauma patients (70 men; mean age 36 years, range 17 to 64) who underwent prophylactic placement of Gunther Tulip retrievable IVCFs between December 1, 2003 and October 1, 2006. Prior to IVCF retrieval, all patients had vena Cavography to identify possible IVCF thrombus entrapment. Filter retrieval was performed in the catheterization laboratory under sterile conditions from a right internal jugular vein approach. After IVCF retrieval, repeat vena Cavography was performed to evaluate the IVC for contrast extravasation, intraluminal defects, or IVC narrowing. RESULTS: Twelve (10.3%) filters were not retrieved as the patients died of their injuries (no deaths related to IVCF placement or retrieval). Forty-one (35.0%) filters had dwell times >180 days (mean 261.5 days, range 182-403). Of these, 31 (76%) were uneventfully retrieved; 10 were left in place permanently. Pre-retrieval vena Cavography identified filter tilting in 13 filters: 9 had a mild tilt or =25 degrees. All of the 10 filters that could not be retrieved were tilted (4 severe and 6 mild). In comparison to the 64 (54.7%) filters in place for 180 days is considered, the patient should be ambulatory and a candidate for anticoagulation if indicated; notably, the filter should have a <25 degrees tilt. Under these circumstances, retrieval of the Gunther Tulip filter after 180 days of dwell time appears justified and safe.
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role of prophylactic temporary inferior vena cava filters placed at the icu bedside under intravascular ultrasound guidance in patients with multiple trauma
Journal of Vascular Surgery, 2004Co-Authors: David Rosenthal, Eric D. Wellons, Adam B Levitt, Frederick W Shuler, Robert E Oconner, Vernon J HendersonAbstract:Objective Patients with multiple trauma often have injuries that preclude the use of anticoagulation therapy or sequential compression device prophylaxis. Temporary inferior vena cava (IVC) filters (IVCFs) offer protection against pulmonary embolism during the early immediate injury and perioperative period, when risk is highest, while averting potential long-term sequelae of permanent IVCFs. The objective of this study was to evaluate the efficacy of prophylactic, temporary IVCF placement at the intensive care unit bedside under real-time intravascular ultrasound (IVUS) guidance in patients with multiple trauma. Interventions Ninety-four patients with multiple trauma seen between July 1, 2002, and November 1, 2003, underwent placement of OptEase (Cordis Endovascular) retrievable IVCFs under real-time IVUS guidance. Mean (±SD) Injury Severity Score was 25.1 ± 2.2). Abdominal x-ray films were obtained in all patients to verify filter location. Before IVCF retrieval all patients underwent femoral vein color-flow ultrasound scanning to rule out deep vein thrombosis (DVT), and pre-procedure and post-procedure vena Cavography to identify possible IVCF thrombus entrapment and post-retrieval inferior vena cava injury. Results Nineteen patients died of their injuries; no deaths were related to IVCF placement. One pulmonary embolism occurred during follow-up after filter retrieval, and 1 insertion site femoral vein DVT occurred. As verified on abdominal x-ray films, 96.8% (91 of 94) of IVCFs were placed without complications at the L2-3 level. Filter-related complications included 2 groin hematomas (2.1%) and 3 IVCFs misplaced in the right iliac vein (3.2%), early in our experience; the filters were uneventfully retrieved and replaced in the inferior vena cava within 24 hours. Thirty-one patients underwent uneventful retrieval of IVCFs after DVT or pulmonary embolism anticoagulation prophylaxis was initiated. Forty-four filters were not removed, 41 because severity of injury prevented DVT or pulmonary embolism prophylaxis and 3 because of thrombus trapped within the filter. Conclusions Prophylactic, temporary IVCF placement at the intensive care unit bedside under IVUS guidance in patients with multiple trauma is simple and safe, and serves as an effective "bridge" to anticoagulation therapy until venous thromboembolism prophylaxis can be initiated. Further investigation of this bedside technique and the role of temporary IVCFs in patients with multiple trauma is warranted.
L Garciagarcia - One of the best experts on this subject based on the ideXlab platform.
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stenting as first option for endovascular treatment of malignant superior vena cava syndrome
American Journal of Roentgenology, 2001Co-Authors: C Lanciego, J L Chacon, A Julian, J Andrade, L Lopez, B Martinez, Miguel A Cruz, L GarciagarciaAbstract:OBJECTIVE: Endoprostheses were inserted in cancer patients with superior vena cava syndrome to assess their effectiveness as first-choice, initial treatment for relief of symptoms. SUBJECTS AND METHODS: Wallstent prostheses (n = 73) of various lengths (5-14 cm; median, 7 cm) and diameters (10-16 mm; median, 16 mm) were inserted in 52 cancer patients (51 men, 1 woman; age range, 44-78 years; mean, 63 years) who were diagnosed and confirmed by Cavography or phlebography as having superior vena cava syndrome. A single stent was sufficient in 37 patients, two stents were required in 11, three stents in two, and four stents in another two patients. Contraindications for the procedure were severe cardiopathy or coagulopathy. RESULTS: Resolution of symptoms was achieved in all patients within 72 hr. At follow-up, six obstructions, one partial migration to the right atrium, two incorrect placements, and four stent "shortenings" were noted. All were successfully resolved by repeated stenting. Symptom-free survival ranged from 2 days to 17 months (mean, 6.4 months). At the time of this writing, eight patients are alive and have patent stents. The rest have died from their cancer. CONCLUSION: The Wallstent vascular endoprosthesis is an effective initial treatment in superior vena cava syndrome of neoplastic origin. Morbidity and complications are minimal. Clinical relief of symptoms is rapid; therefore, the Wallstent endoprosthesis is highly recommended as the first choice for palliative treatment of superior vena cava syndrome, especially because the clinical decision for subsequent chemotherapy or radiotherapy or surgery is not in any way prejudiced.
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stenting as first option for endovascular treatment of malignant superior vena cava syndrome
American Journal of Roentgenology, 2001Co-Authors: C Lanciego, J L Chacon, A Julian, J Andrade, L Lopez, B Martinez, Miguel A Cruz, L GarciagarciaAbstract:OBJECTIVE. Endoprostheses were inserted in cancer patients with superior vena cava syndrome to assess their effectiveness as first-choice, initial treatment for relief of symptoms.SUBJECTS AND METHODS. Wallstent prostheses (n = 73) of various lengths (5-14 cm; median, 7 cm) and diameters (10-16 mm; median, 16 mm) were inserted in 52 cancer patients (51 men, 1 woman; age range, 44-78 years; mean, 63 years) who were diagnosed and confirmed by Cavography or phlebography as having superior vena cava syndrome. A single stent was sufficient in 37 patients, two stents were required in 11, three stents in two, and four stents in another two patients. Contraindications for the procedure were severe cardiopathy or coagulopathy.RESULTS. Resolution of symptoms was achieved in all patients within 72 hr. At follow-up, six obstructions, one partial migration to the right atrium, two incorrect placements, and four stent “shortenings” were noted. All were successfully resolved by repeated stenting. Symptom-free survival r...
Ernst Hansch - One of the best experts on this subject based on the ideXlab platform.
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chronically occluded inferior venae cavae endovascular treatment
Radiology, 2000Co-Authors: Mahmood K Razavi, Ernst Hansch, Charles P Semba, Michael D DakeAbstract:PURPOSE: To report the results of endoluminal recanalization and stent placement in patients with chronic occlusions of the inferior vena cava (IVC). MATERIALS AND METHODS: Seventeen consecutive patients (12 male, five female patients; mean age, 40.6 years; age range, 15–77 years) with chronic IVC occlusions were treated during a 6-year period. The mean duration of symptoms was 32 months. Underlying active malignancy was the cause of occlusion in four patients. Five patients with superimposed acute thrombus underwent catheter-directed thrombolysis prior to IVC recanalization. Clinical patency was defined as absence or improvement of symptoms. Clinical follow-up was supplemented with ultrasonography, vena Cavography, or both in 10 patients. RESULTS: Technical success was achieved in 15 (88%) patients. Additional thrombolytic therapy and stent placement was needed in two patients to maintain patency at 4 and 6 months after the procedure. Twelve patients had IVCs that remained patent after a mean follow-up o...
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chronically occluded inferior venae cavae endovascular treatment
Radiology, 2000Co-Authors: Mahmood K Razavi, Ernst Hansch, Charles P Semba, Michael D DakeAbstract:PURPOSE: To report the results of endoluminal recanalization and stent placement in patients with chronic occlusions of the inferior vena cava (IVC). MATERIALS AND METHODS: Seventeen consecutive patients (12 male, five female patients; mean age, 40.6 years; age range, 15–77 years) with chronic IVC occlusions were treated during a 6-year period. The mean duration of symptoms was 32 months. Underlying active malignancy was the cause of occlusion in four patients. Five patients with superimposed acute thrombus underwent catheter-directed thrombolysis prior to IVC recanalization. Clinical patency was defined as absence or improvement of symptoms. Clinical follow-up was supplemented with ultrasonography, vena Cavography, or both in 10 patients. RESULTS: Technical success was achieved in 15 (88%) patients. Additional thrombolytic therapy and stent placement was needed in two patients to maintain patency at 4 and 6 months after the procedure. Twelve patients had IVCs that remained patent after a mean follow-up o...