5 results found in Venous & Lymphatic
Successful surgical management of Lemierre’s syndrome – a case report
By: Anneke Neumann
Introduction/Aims: Lemierre’s syndrome consists of infectious thrombophlebitis of the internal jugular vein (VJI) combined with recurrent septic emboli. It is a late complication of upper respiratory tract infections, like a peritonsillar abscess. Treatment strategies include the application of intravenous antibiotics and anticoagulation. If these fail, surgical thrombectomy or resection of the VJI are the last therapeutic options. Case Report (Methods & Results): We present the case of a 23-year-old woman, who had had her wisdom teeth extracted and developed a peritonsillar abscess a few weeks later. She was admitted to our hospital with sepsis and multi-organ failure. Development of severe respiratory failure necessitated implantation of a veno-venous ECMO. However, she suffered recurrent septic episodes with hemodynamic instability requiring high doses of catecholamines. Imaging showed no source for these suspected septic emboli other than thrombosis of the left VJI. As her condition got worse despite intravenous antibiotics and therapeutic anticoagulation, we performed thrombectomy of the left VJI. In the following days, the patient’s hemodynamic and respiratory condition stabilized and the ECMO could be removed. Conclusions: The Lemierre Syndrome is a rare but life-threatening complication of oral and pharyngeal infections, which can safely be treated by thrombectomy or removal of the VJI if conservative treatment strategies fail.
Venous & LymphaticComputer-Assisted Vacuum Thrombectomy for Proximal Lower and Upper Limb Deep Venous Thrombosis: A Single-Centre Australian Experience
By: Michael Na
Background: Catheter-directed mechanical thrombectomy (CDMT) is an effective treatment for acute deep venous thrombosis (DVT), offering rapid symptom relief without thrombolysis and risk reduction of acute and chronic complications. One new evolution in CDMT technology is the integration of computer-assisted vacuum thrombectomy (CAVT) for effective large-vessel thrombus removal. Methods: This single-centre prospective observational study reviewed patients undergoing CAVT for acute or subacute DVT between March 2025 and March 2026. Data were extracted from a prospectively maintained registry. The primary outcome was technical success (>75% thrombus removal on venography without adjunctive thrombolysis), and secondary outcomes were for assisted technical success, device-related complications, major bleeding, clinically significant pulmonary embolism, and intraoperative blood loss. Results: 34 patients with venous thrombosis were included, with a median age of 49 years (range 21-79). 20 were for lower limb deep venous thrombosis (59%), compared to 14 for upper limb. Initial technical success was achieved in 29 cases (85%), with assisted success in all cases. 4 patients (15%) required high-dependency unit or intensive care admission post-operatively (2 with preoperative pulmonary embolus, 2 requiring further catheter directed thrombolysis). No mortalities, device-related complications, major bleeding, or new clinically significant pulmonary embolism occurred. Mean intraoperative blood loss was 477mL (range 100-1500ml). Conclusions: Early results suggest that CAVT is a safe and effective treatment for proximal upper and lower limb DVT, with high technical success rate and low associated morbidity. This is the first Australian real-world experience with a CAVT system, supporting its use and future prospective evaluation.
Venous & LymphaticLong-term clinical outcomes of self-expandable closed-cell and open-cell stents for endovascular reconstruction of the inferior vena cava
By: Gabor Forgo
Background: Inferior vena cava (IVC) obstruction may cause acute descending thrombosis, post-thrombotic syndrome, or chronic venous insufficiency. Endovascular IVC stent reconstruction may improve clinical outcomes but the risk of patency loss is considerable. Currently, data comparing the performance of open-cell versus closed-cell IVC stents are lacking. Patients and Methods: We investigated long-term clinical outcomes of 130 patients (median age 39 years, 26% women) who underwent endovascular reconstruction of an IVC obstruction with self-expandable nitinol stents of whom 52 (40%) received closed-cell stents and 78 (60%) open-cell stents between 2012 and 2024 in two Swiss university hospitals. At baseline, 41 (32%) patients presented with acute iliocaval thrombosis, 84 (65%) with post-thrombotic syndrome, and 5 (4%) with non-thrombotic IVC compression. Overall, kissing iliocaval Y-stent reconstruction was performed in 106 patients (82%). Clinical outcomes included patency rates and sustained clinical success defined as Villalta score <5 points and absence of venous stent occlusion or any re-intervention. Results: Median follow-up after endovascular stent reconstruction was 37 months (Q1-Q3: 18 to 68). Primary and secondary patency rates at 24 months were 62.1% (95%CI 50.0-77.2) and 93.8 (95%CI 87.1-100) for closed-cell stents and 79.6% (95%CI 70.3-90.0) and 100% (95%CI 100-100) for open-cell stents, respectively. Sustained clinical success was observed in 22 (42%) patients from the closed-cell group and in 55 (71%) patients from the open-cell stent group. Conclusion: In patients with endovascular IVC reconstruction, self-expandable open-cell nitinol stents appear to offer favorable long-term patency and sustained clinical success as compared with closed-cell stents.
Venous & LymphaticMid-term clinical outcomes of mechanical versus rheolytic thrombectomy for ilio-femoral or ilio-caval deep vein thrombosis
By: Gabor Forgo
Objective: In patients with ilio-femoral deep vein thrombosis (DVT), early thrombus removal reduces the risk of post-thrombotic syndrome (PTS). It remains uncertain if mechanical thrombectomy (MT) using the ClotTriever™ system may offer advantages as compared to rheolytic thrombectomy (RT) using the AngioJet ZelanteDVT™. Methods: In our multicenter, retrospective, observational study, we included 122 patients (mean age 48 years, 57% women) with ilio-femoral (78%) or ilio-caval DVT (22%). All underwent early thrombus removal with either MT (n=40) or RT (n=82) and had a minimum of 3-month follow-up. Periprocedural outcomes included periprocedural thrombolytic use, access complications, and stent placement rate. Clinical outcomes included stent patency rate and freedom from PTS. Results: Median follow-up was 25 months (IQR 11-52). Compared to RT, MT was associated with lower periprocedural thrombolytic use (38% vs 95%, p<0.01) and a lower rate of stent placement (70% vs 98%, p<0.01). Post-procedural access-site thrombosis of the popliteal vein occurred in 5 (13%) MT patients and in none of the RT patients. At one year, primary and secondary patency rates were 80% (95%CI: 67- 95%) and 97% (95%CI: 93-100%) in the MT group, and 88% (95%CI: 81-96%) and 97% (95%CI: 94-100%) in the RT group, respectively. Freedom from PTS at latest follow-up was observed in 98% (95% CI: 93-100%) in the MT group and 94% (95% CI: 87-100%) RT patients. Conclusions: Both MT and RT were associated with high patency rates and freedom from PTS. MT may reduce the need for thrombolysis and venous stent placement. Popliteal vein thrombosis from large-bore access in MT patients requires further investigation.
Venous & LymphaticMechanical Aspiration Thrombectomy in Acute Pulmonary Embolism with the AlphaVac device
By: Michail Tsotsios
Aims Acute intermediate high-risk pulmonary embolism (PE) is a life-threatening condition with an increasing incidence and endovascular mechanical thrombectomy arises as a first-line treatment for selected patients. Three devices are currently available for use in the EU. This study evaluates the safety and efficacy of percutaneous mechanical aspiration thrombectomy with the AlphaVac F18 System (AngioDynamics) a novel device recently approved for use in EU. Methods Patients with acute intermediate high-risk PE and a right to left ventricular (RV/LV) ratio of >0.9 were treated. Perioperative cardiorespiratory parameters, RV/LV ratio, CT thrombus reduction and adverse events (major bleeding, cardiac injury, clinical deterioration or death) were recorded. Results In total, 7 patients were treated in two sites with a mean age of 63 ± 8 years and a median procedure time of 39 minutes (aspiration catheter in and out). No adverse events were experienced. A significant decrease in the on-table mean systolic pulmonary arterial PA pressure was observed from 42 ± 6.2 to 34.5 ± 2.6 mmHg, and a mean decrease in the RV/LV ratio of 0.55 ± 0.22. Three out of the 7 patients required a > 24-hour intensive care unit stay. No major adverse events were recorded. There was a 39 ± 12% mean reduction in clot burden on follow-up CTPA. Conclusions The use of the novel AlphaVac F18 System for percutaneous mechanical aspiration thrombectomy demonstrated a favorable safety and efficacy profile in the treatment of patients with acute intermediate-risk pulmonary embolism.
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