泡沫硬化治疗后胫骨静脉血栓形成:单一机构病例系列。

IF 2.8 2区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Jack K Donohue, Emily Mosher, Michael Knapp, Nuzhat Kabir, Nishant Agrawal, Robert Handzel, Natalie D Sridharan, Eric S Hager
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引用次数: 0

摘要

目的:超声引导泡沫硬化治疗常用于浅表静脉疾病,但深静脉血栓形成(DVT)风险小。硬化治疗后胫静脉血栓形成的管理仍然存在争议,实践范围从抗凝和抗血小板治疗到单独观察。我们试图描述泡沫硬化治疗后确定的胫骨深静脉血栓的自然历史,并评估基于管理策略的结果。方法:我们回顾性分析了2016年1月至2022年1月期间在多机构医疗保健系统接受医师复合泡沫硬化疗法(Asclera)并发展为双重诊断的胫骨深静脉血栓的患者。患者在术后约2周、4周和6周接受标准化随访双重检查。记录血栓的演变(溶解、缩小、稳定、扩大、扩散和栓塞)和临床症状。比较各管理组的结果:抗血小板治疗、抗凝治疗和观察。统计分析采用Kruskal-Wallis检验和卡方检验。结果:在877例泡沫硬化治疗患者中,622例进行了随访成像,54例(55条腿,9%)发生胫骨DVT,形成了研究队列(中位年龄53岁,51%为女性)。在最初的双工超声检查(中位术后14天),所有血栓均在治疗的同侧,5例并发近端DVT(4例腘窝,1例股动脉;9%)。胫骨血栓的初始处理包括抗血小板治疗(55%)、抗凝治疗(26%)或观察(20%)。在最后随访(中位35天)时,53%的患者血栓完全溶解,20%的患者血栓减少,27%的患者血栓保持稳定。没有患者出现肺肿大或肺栓塞。87%的患者症状得到缓解,治疗策略之间无显著差异。结论:在我们的研究中,无论采用何种治疗策略,泡沫硬化治疗后的胫骨深静脉曲张表现为良性临床病程。常规抗凝或抗血小板治疗可能不需要在无症状的患者孤立的远端血栓。需要前瞻性研究来证实这些发现并指导基于证据的建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tibial vein thrombosis after foam sclerotherapy: A single-institution case series.

Objective: Ultrasound-guided foam sclerotherapy is commonly used for superficial venous disease but carries a small risk of deep vein thrombosis (DVT). The management of tibial vein thrombosis after sclerotherapy remains controversial, with practices ranging from anticoagulation and antiplatelet therapy to observation alone. We sought to characterize the natural history of tibial DVTs identified after foam sclerotherapy and evaluate outcomes based on management strategy.

Methods: We retrospectively analyzed patients who underwent physician-compounded foam sclerotherapy (Asclera) at a multi-institutional health care system between January 2016 and January 2022 and developed duplex-diagnosed tibial DVT. Patients underwent standardized follow-up duplex examinations at approximately 2, 4, and 6 weeks after the procedure. Thrombus evolution (resolution, reduction, stability, enlargement, propagation, and embolization) and clinical symptoms were recorded. Outcomes were compared across management groups: antiplatelet therapy, anticoagulation, and observation. Statistical analyses used Kruskal-Wallis and χ2 tests.

Results: Of 877 foam sclerotherapy patients, 622 had follow-up imaging, and 54 patients (55 legs; 9%) developed tibial DVT, forming the study cohort (median age 53 years; 51% female). At initial duplex ultrasound imaging (median 14 days postprocedure), all thrombi were ipsilateral to treatment, with concurrent proximal DVT in 5 cases (4 popliteal and 1 femoral; 9%). Initial management of the tibial thrombus included antiplatelet therapy (55%), anticoagulation (26%), or observation (20%). At final follow-up (median 35 days), thrombus completely resolved in 53%, decreased in 20%, and remained stable in 27%. No patients had enlargement or pulmonary embolism. Symptom resolution was achieved in 87% of patients, with no significant differences between management strategies.

Conclusions: In our series, tibial DVTs after foam sclerotherapy demonstrate a benign clinical course regardless of management strategy. Routine anticoagulation or antiplatelet therapy may not be necessary in asymptomatic patients with isolated distal thrombus. Prospective studies are required to confirm these findings and guide evidence-based recommendations.

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来源期刊
Journal of vascular surgery. Venous and lymphatic disorders
Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE
CiteScore
6.30
自引率
18.80%
发文量
328
审稿时长
71 days
期刊介绍: Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.
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