Vascular Surgery

Biography

Ahmet Akgul has graduated from Ankara University Medical School in 1997. He had completed his Postdoctoral residence and fellowship in the Michael E DeBakey Department of Surgery at Baylor College of Medicine in Houston, Texas. In 2004 in addition to his Chief Assistant position, he also served as an Editor in Turkiye Klinikleri Journal of Medical Sciences. In 2009 he was charged with establishing Heart and Vascular Surgery clinic at Istanbul Bakirkoy Dr. Sadi Konuk Hospital where he performed his works as founding clinic chief. Due to the increasing aging population in Turkey and this senior group being the majority of the heart and vascular diseases patients, he has established the Department of Gerontology in Istanbul University. In doing so he had received his Professorship and the title of Founding Department Head. 

Abstract

Statement of the Problem: Chronic post-thrombotic syndrome (CPTS) refers to chronic clinical manifestations of venous insufficiency after deep venous thrombosis.  CPTS is the most important consequence of CDVT, which develops in 20% to 50% of patients after proximal CDVT (popliteal and above CDVT) despite optimal anticoagulation therapy. Methodology & Theoretical Orientation: We report the successful percutaneous management of extensive lower-extremity deep venous thrombosis (DVT) in 70 lower limbs (68 of them acute/ subacute DVT and 2 CDVT) of consecutive 69 patients using pharmaco-mechanical thrombectomy. A 14F introducer sheath was inserted through the popliteal vein followed by rotational and aspiration thrombectomy. Balloon angioplasty was performed when needed. No stent insertion was added. Routine percutaneous pharmaco-mechanical treatment was performed in acute and/or subacute DVT and atherectomy with pharmacologic treatment were performed in CDVT. Findings: From 2014 to 2017, single-session percutaneous endovenous pharmaco-mechanic thrombectomy was performed in 70 lower limbs of 69 patients (42 men; mean age: 41.8 years) with DVT. DVT was in subacute forms in 20 patients, and in chronic (1 patient with two limbs). Technical success rate was 97.1% (68 of 70 limbs). Among the 68 limbs, thrombectomy alone was performed in 62 (91.1%) limbs; additional balloon angioplasty of the femoral vein was performed in 6 patients. One patient with two limbs (chronic DVT) was performed thrombectomy with arterial atherectomy device with aspiration as well as balloon angioplasty. Conclusion & Significance: Percutaneous endovenous thrombectomy is feasible and effective for patients with acute and subacute deep vein thrombosis. More patients with chronic DVT could be treated by revised-atherectomy device in the near future.