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      Flegmasia cerúlea dolorosa en paciente con trombocitopenia inmune primaria: un gran reto terapéutico Translated title: Phlegmasia cerulea dolorosa and primary immune thrombocytopenia: a therapeutic challenge

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          Abstract

          Resumen Introducción: la flegmasia cerúlea dolorosa resulta de una trombosis venosa masiva aguda que provoca una obstrucción del drenaje venoso de una extremidad y se asocia con un alto grado de morbilidad. Caso clínico: presentamos el caso de un paciente con flegmasia cerúlea dolorosa y múltiples factores de riesgo para desarrollarla, quien fue llevado a trombólisis dirigida por catéter, con lo que se logró salvar la extremidad. Discusión: la flegmasia cerúlea dolorosa es una entidad poco frecuente que puede progresar de manera rápida y comprometer la vitalidad de la extremidad afectada o llevar a desenlaces fatales, por lo que requiere una pronta sospecha y una intervención emergente. La terapia antitrombótica sigue siendo el manejo de elección.

          Translated abstract

          Abstract Introduction: phlegmasia cerulea dolorosa results from acute massive venous thrombosis that causes obstruction of the venous drainage of an extremity, and it's associated with a high morbidity. Case report: we present the case of a patient with phlegmasia cerulea dolorosa and multiple risk factors for developing it, who was taken to catheter-directed thrombolysis successfully. Discussion: phlegmasia cerulea dolorosathis is a rare entity that can progress rapidly and compromise the vitality of the limb or lead to fatal outcomes, which requires early suspicion and emergency intervention. Antithrombotic therapy continues to be the ideal treatment.

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          Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis

          The post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter "pharmacomechanical thrombolysis") rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome.
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            Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial.

            Post-thrombotic syndrome is a common complication after acute proximal deep vein thrombosis (DVT) and is associated with reduced quality of life and a substantial cost burden. In the 2-year results of the CaVenT study, additional catheter-directed thrombolysis reduced the risk of post-thrombotic syndrome by 14% compared with conventional therapy, but did not affect quality of life. In this study we report results at the 5-year follow-up, aiming to assess whether findings for post-thrombotic syndrome and quality of life have persisted.
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              Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis.

              Rheolytic mechanical thrombectomy using the AngioJet catheter (Possis Medical, Minneapolis, MN) has been shown to be effective in the treatment of deep venous thrombosis (DVT). Additional infusion of thrombolytic agents via the device creates a novel treatment strategy of pharmacomechanical thrombectomy (PMT), which further enhances thrombectomy efficacy. The purpose of the current study was to compare the treatment outcome in patients with symptomatic DVT who underwent either catheter-directed thrombolysis (CDT) or PMT intervention. During a recent 8-year period, clinical records of all patients with symptomatic lower leg DVT undergoing catheter-directed interventions were evaluated. Patients were divided into 2 treatment groups: CDT or PMT. Comparisons were made with regards to the treatment outcome between the 2 groups. A total of 93 patients who underwent 98 catheter-directed interventions for DVT were included in the study. Among them, CDT or PMT was performed in 46 (47%) and 52 (53%) procedures, respectively. In the CDT group, complete or partial thrombus removal was accomplished in 32 (70%) and 14 (30%) cases, respectively. In the PMT cohort, complete or partial thrombus removal was accomplished in 39 (75%) and 13 (25%) cases, respectively. Venous balloon angioplasty and/or stenting in the CDT or PMT groups was necessary in 36 (78%) and 43 (82%), respectively (difference not significant [NS]). Patients in the CDT groups underwent a mean of 2.5 venograms during the hospital course, in contrast to 0.4 venograms per patient in PMT cohorts (P < .001). Immediate (<24 hours) improvement in clinical symptoms in CDT and PMT groups was achieved in 33 (72%) and 42 (81%) cases, respectively (NS). Significant reductions in the intensive care unit (ICU) and hospital lengths of stay was noted in the PMT group (0.6 and 4.6 days) when compared to the CDT group (2.4 and 8.4 days). During follow-up visits, the primary patency rates at 1 year of CDT and PMT groups were 64% and 68%, respectively (NS). Hospital cost analysis showed significant cost reduction in the PMT group compared to the CDT group (P < .01). PMT with adjunctive thrombolytic therapy is an effective treatment modality in patients with significant DVT. When compared to CDT, this treatment provides similar treatment success with reduced ICU, total hospital length of stay, and hospital costs.
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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                August 2023
                : 75
                : 4
                : 264-267
                Affiliations
                [1] Neiva Huila orgnameUniversidad Surcolombiana orgdiv1Hospital Universitario Hernando Moncaleano Perdomo Colombia
                Article
                S0003-31702023000400008 S0003-3170(23)07500400008
                10.20960/angiologia.00503
                782437b4-1fa1-45ae-8296-de21c63dd06f

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 06 February 2023
                : 11 March 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 4
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                Phlegmasia cerulea dolorosa,Anticoagulación,Trombosis venosa profunda,Catheterdirected thrombolysis,Anticoagulation,Deep vein thrombosis,Flegmasia cerúlea dolorosa,Trombólisis dirigida por catéter

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