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Article ; Online: Management of iliofemoral deep vein thrombosis with distal involvement.

Rahmani, George / O'Sullivan, Gerard J

2024 Volume 65, Issue 1, Page(s) 32–37

Abstract: Endovascular treatment of iliofemoral deep vein thrombosis (IF DVT) can become more complex when thrombus extends below the knee. This article discusses various techniques that can be used to treat IF DVT with distal involvement. ...

Abstract	Endovascular treatment of iliofemoral deep vein thrombosis (IF DVT) can become more complex when thrombus extends below the knee. This article discusses various techniques that can be used to treat IF DVT with distal involvement.
MeSH term(s)	Humans ; Thrombolytic Therapy/methods ; Femoral Vein/diagnostic imaging ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/therapy ; Catheterization, Peripheral ; Endovascular Procedures/adverse effects ; Iliac Vein/diagnostic imaging ; Treatment Outcome
Language	English
Publishing date	2024-01-23
Publishing country	Italy
Document type	Journal Article
ZDB-ID	80143-4
ISSN	1827-191X ; 0021-9509
ISSN (online)	1827-191X
ISSN	0021-9509
DOI	10.23736/S0021-9509.23.12910-7
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Article ; Online: Lessons Learned With Venous Stenting: In-flow, Outflow, and Beyond.

Rahmani, George / O'Sullivan, Gerard J

Techniques in vascular and interventional radiology

2023 Volume 26, Issue 2, Page(s) 100897

Abstract: Venous stents are being used with increasing frequency, with a multitude of dedicated venous stents now well established or emerging onto the market. This review explores the multifaceted aspects of venous stenting. We discuss the history of venous ... ...

Abstract	Venous stents are being used with increasing frequency, with a multitude of dedicated venous stents now well established or emerging onto the market. This review explores the multifaceted aspects of venous stenting. We discuss the history of venous stents, indications for their use, the imaging required before, during and after stenting, as well as some technical tips and tricks which we have found to be helpful in our own daily practice with a particular focus on iliofemoral venous stenting. Ultimately, this article seeks to enhance the understanding of venous stenting, offering insights into what we feel are best practices, challenges, and prospects for improved patient outcomes.
MeSH term(s)	Humans ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/therapy ; Treatment Outcome ; Iliac Vein/diagnostic imaging ; Stents ; Retrospective Studies ; Vascular Patency
Language	English
Publishing date	2023-08-05
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	2170922-1
ISSN	1557-9808 ; 1089-2516
ISSN (online)	1557-9808
ISSN	1089-2516
DOI	10.1016/j.tvir.2023.100897
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Article ; Online: Acute and chronic venous occlusion.

Rahmani, George / O'Sullivan, Gerard J

The British journal of radiology

2023 Volume 96, Issue 1151, Page(s) 20230242

Abstract: This review article provides an overview of acute and chronic venous occlusion, a condition that can cause significant morbidity and mortality if not diagnosed and treated promptly. The article begins with an introduction to the anatomy of the venous ... ...

Abstract	This review article provides an overview of acute and chronic venous occlusion, a condition that can cause significant morbidity and mortality if not diagnosed and treated promptly. The article begins with an introduction to the anatomy of the venous system, followed by a discussion of the causes and clinical features of venous occlusion. The diagnostic tools available for the assessment of venous occlusion, including imaging modalities such as ultrasound, CT, and MRI, are then discussed, along with their respective advantages and limitations. The article also covers the treatment options for acute and chronic venous occlusion, including anticoagulant therapy and endovascular interventions. This review aims to provide radiologists with an updated understanding of the pathophysiology, diagnosis, and management of acute and chronic venous occlusion.
MeSH term(s)	Humans ; Veins ; Vascular Diseases/diagnostic imaging ; Vascular Diseases/therapy ; Magnetic Resonance Imaging ; Anticoagulants
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-10-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20230242
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Article ; Online: Revisiting the Readability of Online Patient Information in Interventional Radiology.

Rahmani, George / O'Sullivan, Gerard J

Cardiovascular and interventional radiology

2023 Volume 46, Issue 6, Page(s) 809–810

MeSH term(s)	Humans ; Radiology, Interventional/education ; Comprehension ; Radiography, Interventional ; Internet ; Health Literacy
Language	English
Publishing date	2023-03-28
Publishing country	United States
Document type	Letter
ZDB-ID	603082-8
ISSN	1432-086X ; 0342-7196 ; 0174-1551
ISSN (online)	1432-086X
ISSN	0342-7196 ; 0174-1551
DOI	10.1007/s00270-023-03423-z
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Article ; Online: Single-session mechanical thrombectomy for iliofemoral deep vein thrombosis using a dual mechanism of action device combining basket and rotational thrombectomy.

Black, Stephen A / Thulasidasan, Narayanan / Benton, Lily / O'Sullivan, Gerard J / Konteva, Mariana / Petrov, Ivo S / Walsh, Stewart R / Lichtenberg, Michael

Journal of vascular surgery. Venous and lymphatic disorders

2024 , Page(s) 101866

Abstract: Objective: Interventional treatments for acute iliofemoral deep vein thrombosis (DVT) remain controversial after publication of the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) study. Interventions ... ...

Abstract	Objective: Interventional treatments for acute iliofemoral deep vein thrombosis (DVT) remain controversial after publication of the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) study. Interventions have been shown to reduce post-thrombotic syndrome severity and improve quality of life in DVT patients, but have been accompanied by risk of major bleeding from thrombolytics. We describe thrombus removal using a novel combined basket-rotational thrombectomy device that minimizes the need for thrombolytics or repeat procedures. Methods: The aim of this prospective, nonrandomized, multicenter, first-in-human study of 19 patients with acute iliofemoral DVT was to evaluate the safety and performance of the Pounce venous thrombectomy system ≤12 months after treatment. The primary performance end point was defined as procedural success through achievement of Society of Interventional Radiology (SIR) grade II lysis in treated vessels with freedom from procedural adverse events. Secondary end points included venous disease severity assessments using the Villalta scale and the Venous Clinical Severity Score, patient quality-of-life measurement using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life questionnaire, and calf circumference measurements taken at baseline, 24 hours, and 1 month. Results: The primary end point of complete or near-complete thrombus removal (Society of Interventional Radiology grade II or III) was achieved in all patients. All study device-related safety end points were met, with no major bleeding or device-related adverse events. Of the 19 patients treated, 16 (84.2%) did not receive thrombolytics during the procedure. Post-thrombotic syndrome (Villalta scale >4) was identified in 17 of 19 patients (89.5%) at baseline, 4 of 13 patients (30.8%) available for follow-up at 6 months, and 2 of 11 patients (18.2%) at 12 months. The median Venous Clinical Severity Score decreased (P < .001) from 8.5 (interquartile range [IQR], 7-10) at baseline to 4 (IQR, 2-4) at 1 month after the procedure and was similar at 6 months (2; IQR, 2-5) and 12 months (2; IQR, 1.5-3) after the procedure. The median Venous Insufficiency Epidemiological and Economic Study-Quality of Life questionnaire score improved (P < .001) by 39 from baseline (57; IQR, 53.5-74) to 1 month (96; IQR, 86-101) after the procedure, and remained high at 6 months (99; IQR, 75-103) and 12 months (98; IQR, 94.5-100). The median calf circumference decreased (P = .089) from 39 cm (IQR, 35-47.8 cm) at baseline to 36 cm (IQR, 32.5-40.5 cm) at 24 hours after the procedure and was 34.5 cm (IQR, 33.2-38.5 cm) at 1 month. Conclusions: The Pounce device is safe and effective for removal the of thrombus in patients with acute iliofemoral DVT. Initial results demonstrate improvements in venous disease severity and patient quality of life.
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ISSN	2213-3348
ISSN (online)	2213-3348
DOI	10.1016/j.jvsv.2024.101866
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Article ; Online: A review of the incidence, outcome, and management of venous stent migration.

Sayed, Mohamed Hosny / Salem, Murtaza / Desai, Kush R / O'Sullivan, Gerard J / Black, Stephen A

Journal of vascular surgery. Venous and lymphatic disorders

2022 Volume 10, Issue 2, Page(s) 482–490

Abstract: Background: Percutaneous endovenous stenting has emerged during the past decade as the primary method of treating symptomatic venous outflow obstruction. A recognized complication of venous stenting is stent migration. The aim of the present systematic ... ...

Abstract	Background: Percutaneous endovenous stenting has emerged during the past decade as the primary method of treating symptomatic venous outflow obstruction. A recognized complication of venous stenting is stent migration. The aim of the present systematic review was to identify the number of cases of stent migration in reported studies to recognize the risk factors that might be associated with this complication and the outcomes following migration. Methods: A review was conducted in accordance with the MOOSE (meta-analyses of observational studies in epidemiology) and PRIMSA (preferred reporting items for systematic review and meta-analysis) guidelines and registered in the PROSPERO. MEDLINE, EMBASE, and PubMed databases. Key references were searched using specified keywords. All relevant data for the primary procedure and subsequent presentation with stent migration were retrieved. The data were assessed as too low in quality to allow for statistical analysis. Results: Between 1994 and 2020, 31 studies were identified, including 29 case reports and 2 case series, providing data for 54 events of venous stent migration with some data provided regarding the stent used for 47 of the events. The mean age of the 52 patients with stent migration was 50 years (range, 19-88 years) and 30 were men (57.6%). The stents for most of the reported cases were ≤60 mm in length (38 of 46; 82.6%). Only three of the reports were of stents >14 mm in diameter (3 of 47; 3.6%). None of the studies had reported migration of stents >100 mm long. In 85% of the migrated stent events, retrieval was attempted, with 65.2% via an endovascular approach. The immediate outcome was satisfactory for 100% of the reported attempts, whether by an endovascular or open surgical approach. Conclusions: The findings from our literature review suggest that the risk of migration is rare but might be underreported. Most of reported cases had occurred with shorter and smaller diameter stents. The paucity of reported data and the short-term follow-up provided suggest that more formal data collection would provide a truer reflection of the incidence. However, clear strategies to avoid migration should be followed to prevent this complication from occurring.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Device Removal/adverse effects ; Endovascular Procedures/adverse effects ; Endovascular Procedures/instrumentation ; Female ; Foreign-Body Migration/diagnostic imaging ; Foreign-Body Migration/epidemiology ; Foreign-Body Migration/therapy ; Humans ; Incidence ; Male ; Middle Aged ; Risk Assessment ; Risk Factors ; Stents ; Treatment Outcome ; Veins/diagnostic imaging ; Young Adult
Language	English
Publishing date	2022-01-11
Publishing country	United States
Document type	Journal Article ; Systematic Review
ISSN	2213-3348
ISSN (online)	2213-3348
DOI	10.1016/j.jvsv.2021.07.015
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Article ; Online: Endovascular Management of Venous Thromboembolic Disease in the Oncologic Patient Population.

Kishore, Sirish A / Bajwa, Raazi / Van Doren, Layla / Wilkins, Cy / O'Sullivan, Gerard J

Current oncology reports

2022 Volume 24, Issue 3, Page(s) 351–362

Abstract: Purpose of review: Venous thromboembolic disease causes significant mortality and morbidity in the oncologic patient population. Recently, minimally invasive endovascular technologies have been developed as an adjunct to antithrombotic therapy for the ... ...

Abstract	Purpose of review: Venous thromboembolic disease causes significant mortality and morbidity in the oncologic patient population. Recently, minimally invasive endovascular technologies have been developed as an adjunct to antithrombotic therapy for the management of DVT and PE. The current and potential roles for endovascular treatment of cancer-associated venous thromboembolism (VTE) will be reviewed in this article. Recent findings: The recent NCCN guidelines recommend endovascular therapy in patients eligible for therapeutic anticoagulation who present with life-, organ-, or limb-threatening thrombosis. However, symptomatic non-life-threatening VTE can negatively affect QOL and physical function, both of which have prognostic implications in the cancer population. Endovascular therapies have been shown to improve physical function and QOL in prospective trials performed in a non-oncologic patient population as well as small retrospective studies in the cancer population. In addition to treating life- and limb-threatening thrombosis, endovascular therapy for VTE can improve QOL and physical function in comparison to anticoagulation alone. Prospective trials are warranted to assess the benefit of endovascular therapy for quality of life-years, performance status, and overall survival in the oncologic patient population.
MeSH term(s)	Anticoagulants/therapeutic use ; Endovascular Procedures/adverse effects ; Humans ; Neoplasms/drug therapy ; Prospective Studies ; Quality of Life ; Retrospective Studies ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/therapy ; Venous Thrombosis/epidemiology ; Venous Thrombosis/etiology ; Venous Thrombosis/therapy
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-02-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057359-5
ISSN	1534-6269 ; 1523-3790
ISSN (online)	1534-6269
ISSN	1523-3790
DOI	10.1007/s11912-022-01191-6
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Article ; Online: Aiming for the Bottom Corner: How to Score a Field Goal When Landing Venous Stents in May-Thurner Syndrome.

Bajwa, Raazi / Bergin, Diane / O'Sullivan, Gerard J

Journal of vascular and interventional radiology : JVIR

2019 Volume 30, Issue 10, Page(s) 1555–1561

Abstract: Purpose: To report an iliac venous stent landing technique using only fluoroscopy in patients with May-Thurner syndrome (MTS).: Material and methods: Sixty-five patients (69% female) who had self-expanding nitinol stents deployed for symptomatic MTS ... ...

Abstract	Purpose: To report an iliac venous stent landing technique using only fluoroscopy in patients with May-Thurner syndrome (MTS). Material and methods: Sixty-five patients (69% female) who had self-expanding nitinol stents deployed for symptomatic MTS were retrospectively analyzed. Mean age was 50 years (range 18-80). The cephalic stent right lower corner was deployed to the right of the lumbar vertebra spinous process (SP), but not as far to the right as the right pedicle lateral border. Mode stent diameter and length were 14 mm (range 12-18) and 120 cm (range 60-180), determined by venography, respectively. The anatomical positions of the right common iliac artery, inferior vena cava (IVC), and stent were assessed relative to these bony landmarks on computed tomography venography. Results: Position of the proximal right common iliac artery right lateral border lay a mean distance of 12 mm (±8 to the right of the SP and 13 mm (±7) left of the right pedicle lateral border. Mean position of the IVC right lateral wall lay 1 mm (±6) to the right of the right pedicle lateral border. Mean position of the cephalic stent right lower corner was 6 mm (±6) to the left of the right pedicle lateral border and 19 mm (±7) to the right of the SP. The mean space left between the cephalic stent right lower corner and the IVC right lateral wall was 5 mm (±5). Primary patency rate at 1 year was 88%. Conclusions: Important vascular structures lie in predictable locations relative to bony landmarks, facilitating accurate venous stent placement using fluoroscopy only.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alloys ; Anatomic Landmarks ; Computed Tomography Angiography ; Endovascular Procedures/adverse effects ; Endovascular Procedures/instrumentation ; Female ; Fluoroscopy ; Humans ; Iliac Vein/diagnostic imaging ; Iliac Vein/physiopathology ; Male ; May-Thurner Syndrome/diagnostic imaging ; May-Thurner Syndrome/physiopathology ; May-Thurner Syndrome/therapy ; Middle Aged ; Phlebography ; Predictive Value of Tests ; Radiography, Interventional/methods ; Self Expandable Metallic Stents ; Treatment Outcome ; Vascular Patency ; Young Adult
Chemical Substances	Alloys ; nitinol (2EWL73IJ7F)
Language	English
Publishing date	2019-08-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	1137756-2
ISSN	1535-7732 ; 1051-0443
ISSN (online)	1535-7732
ISSN	1051-0443
DOI	10.1016/j.jvir.2019.04.033
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Article ; Online: Comment on "Endovascular Aneurysm Repair With Inferior Mesenteric Artery Embolization for Preventing Type II Endoleak".

Aherne, Thomas Michael / O'Sullivan, Gerard J / Walsh, Stewart R

Annals of surgery

2020 Volume 274, Issue 6, Page(s) e786–e787

MeSH term(s)	Aortic Aneurysm, Abdominal/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Embolization, Therapeutic ; Endoleak/etiology ; Endoleak/prevention & control ; Endovascular Procedures/adverse effects ; Humans ; Mesenteric Artery, Inferior/diagnostic imaging ; Treatment Outcome
Language	English
Publishing date	2020-11-17
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000004386
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Article ; Online: The role of interventional radiology in the management of deep venous thrombosis: advanced therapy.

O'Sullivan, Gerard J

Cardiovascular and interventional radiology

2011 Volume 34, Issue 3, Page(s) 445–461

Abstract: Deep vein thrombosis (DVT) is often managed with a health care pathway that funnels patients to anticoagulation therapy alone. This "usual treatment" is designed to stop propagation and embolisation of venous thrombus but not remove it. Surgical ... ...

Abstract	Deep vein thrombosis (DVT) is often managed with a health care pathway that funnels patients to anticoagulation therapy alone. This "usual treatment" is designed to stop propagation and embolisation of venous thrombus but not remove it. Surgical thrombectomy was once the only option in severe cases in which limbs were threatened, but thrombus removal is no longer restricted to emergency cases. Interventional radiologists are now using advanced endovascular techniques to achieve thrombus removal in a minimally invasive manner in a very short treatment time, thereby quickly restoring patency, relieving acute symptoms, and potentially limiting the subsequent development of postthrombotic syndrome when followed with anticoagulation and compression regimens. This article provides an overview of the interventions available for treating DVT. One of the newer "single-session" techniques is isolated pharmacomechanical thrombolysis, which is described here in detail with supporting cases.
MeSH term(s)	Angioplasty/methods ; Anticoagulants/therapeutic use ; Catheterization ; Diagnostic Imaging ; Humans ; Minimally Invasive Surgical Procedures ; Patient Selection ; Punctures ; Radiography, Interventional ; Stents ; Suction ; Thrombectomy/methods ; Triage ; Ultrasonography, Interventional ; Vena Cava Filters ; Venous Thrombosis/diagnosis ; Venous Thrombosis/therapy
Chemical Substances	Anticoagulants
Keywords	covid19
Language	English
Publishing date	2011-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603082-8
ISSN	1432-086X ; 0342-7196 ; 0174-1551
ISSN (online)	1432-086X
ISSN	0342-7196 ; 0174-1551
DOI	10.1007/s00270-010-9977-9
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