The AngioVac Device and Its Anesthetic Implications
2016; Elsevier BV; Volume: 31; Issue: 3 Linguagem: Inglês
10.1053/j.jvca.2016.12.017
ISSN1532-8422
AutoresHarish Ram, Rebecca M. Gerlach, Antonio Hernandez Conte, Danny Ramzy, Ashley Jaramillo-Huff, Neal S. Gerstein,
Tópico(s)Atrial Fibrillation Management and Outcomes
ResumoALTHOUGH THE EXACT incidence of venous thromboembolism (VTE) is not known, about 1 million cases are reported in the United States each year, 1 Anderson Jr, F.A. Wheeler H.B. Goldberg R.J. et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991; 151: 933-938 Crossref PubMed Scopus (2154) Google Scholar and VTE is the third most frequent cardiovascular disease after myocardial infarction and stroke. 2 Goldhaber S.Z. Pulmonary embolism thrombolysis: A clarion call for international collaboration. J Am Coll Cardiol. 1992; 19: 246-247 Abstract Full Text PDF PubMed Scopus (50) Google Scholar The term VTE encompasses both deep venous thrombosis (DVT) and pulmonary embolism (PE). 3 Heit J.A. O’Fallon W.M. Petterson T.M. et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: A population-based study. Arch Intern Med. 2002; 162: 1245-1248 Crossref PubMed Scopus (919) Google Scholar DVT may be found in any location, with the lower extremities being the most common site. Once formed, venous thrombi either remain in the peripheral veins, undergo endogenous fibrinolysis and recanalization, or embolize to the pulmonary arteries and cause PE. VTE remains a significant cause of mortality primarily due to PE; the 1-week survival rate after a PE is 71%, and almost 25% of all PE cases present as sudden death. 3 Heit J.A. O’Fallon W.M. Petterson T.M. et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: A population-based study. Arch Intern Med. 2002; 162: 1245-1248 Crossref PubMed Scopus (919) Google Scholar Increased risk of PE is associated with more proximal and extensive thrombi. 4 Jenkins J.S. Michael P. Deep venous thrombosis: An interventionalist’s approach. Ochsner J. 2014; 14: 633-640 PubMed Google Scholar The more central the DVT, the higher the risk of developing PE. Moreover, thrombus associated with veins of larger caliber (femoral, iliac, inferior vena cava [IVC]) results in a larger PE and is more likely to be fatal. 5 O’Sullivan G.J. The role of interventional radiology in the management of deep venous thrombosis: Advanced therapy. Cardiovasc Intervent Radiol. 2011; 34: 445-461 Crossref PubMed Scopus (32) Google Scholar Once VTE is suspected, anticoagulation should be started immediately unless contraindicated. 6 Lansberg M.G. O’Donnell M.J. Khatri P. et al. American College of Chest Physicians. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012; 141: e601S-e6636 Abstract Full Text Full Text PDF PubMed Scopus (368) Google Scholar VTE treatment goals are to reduce the risk of thrombus propagation and embolism and to restore vascular patency, thereby minimizing complications. 7 Salsamendi J. Doshi M. Bhatia S. et al. Single center experience with the AngioVac aspiration system. Cardiovasc Intervent Radiol. 2015; 38: 998-1004 Crossref PubMed Scopus (33) Google Scholar , 8 Kahn S.R. Ginsberg J.S. The post-thrombotic syndrome: Current knowledge, controversies, and directions for future research. Blood Rev. 2002; 16: 155-165 Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar However, anticoagulation alone does not remove the thrombus, nor does it fully exclude the risk of PE. 5 O’Sullivan G.J. The role of interventional radiology in the management of deep venous thrombosis: Advanced therapy. Cardiovasc Intervent Radiol. 2011; 34: 445-461 Crossref PubMed Scopus (32) Google Scholar Patients with a high risk of PE (defined as the presence of hemodynamic instability, right ventricle [RV] dysfunction, or myocardial injury 9 Cohen A.T. Dobromirski M. Gurwith M.M. Managing pulmonary embolism from presentation to extended treatment. Thromb Res. 2014; 133: 139-148 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar ) should be considered for either systemic thrombolysis or in certain cases surgical embolectomy. 10 Kucher N. Rossi E. DeRosa M. et al. Massive pulmonary embolism. Circulation. 2006; 113: 577-582 Crossref PubMed Scopus (561) Google Scholar , 11 Konstantinides S.V. Torbicki A. Agnelli G. et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014; 35 (69a-69k): 3033-3069 Crossref PubMed Scopus (86) Google Scholar Downsides to systemic thrombolysis include intensive care level monitoring, the thrombolytic agent may not reach the area of thrombus in significant concentration to be effective, and a bleeding risk that may outweigh the benefits. 6 Lansberg M.G. O’Donnell M.J. Khatri P. et al. American College of Chest Physicians. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012; 141: e601S-e6636 Abstract Full Text Full Text PDF PubMed Scopus (368) Google Scholar According to current American College of Chest Physicians guidelines, pulmonary embolectomy for the initial treatment of PE is reserved for patients with massive PE (documented angiographically if possible), shock despite heparin and resuscitation efforts, and failure of thrombolytic therapy or a contraindication to its use. 6 Lansberg M.G. O’Donnell M.J. Khatri P. et al. American College of Chest Physicians. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012; 141: e601S-e6636 Abstract Full Text Full Text PDF PubMed Scopus (368) Google Scholar Pooled data published from 1985 to 2005 by Stein et al 12 Stein P.D. Alnas M. Beemath A. et al. Outcome of pulmonary embolectomy. Am J Cardiol. 2007; 99: 421-423 Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar reported a 20% surgical mortality rate in patients undergoing pulmonary embolectomy.
Referência(s)