New research was presented at ISET 2012, the annual International Symposium on Endovascular Therapy, on January 15-19 in Miami Beach. The features below highlight just some of the studies that emerged from the meeting.
The Particulars: Studies have shown that DVT is four to six times more common in pregnant women than in non-pregnant women. Research suggests that many pregnant women with DVT often forgo the most effective treatments—surgery or catheter-directed thrombolysis—because they fear that doing so may harm their unborn children.
Data Breakdown: In a study of 11 pregnant women with DVT, two underwent surgery to remove the clot, and nine were treated with a bath of thrombolytic medications delivered directly into the clot. Removal of the clot was successful in all cases, and all but one pregnancy resulted in successful birth. One woman who miscarried 1 week after treatment suffered from antiphospholipid antibody syndrome, which the researchers believe likely caused the miscarriage.
Take Home Pearl: Aggressive treatment with surgery or catheter-directed thrombolysis for pregnant women with DVT appears to be safe. Aggressive treatment was also shown to prevent serious complications and death.
The Particulars: Unstoppable nosebleeds can cause anemia and may lead to other more serious complications, including heart attack. When packing the nose with gauze, inflating a balloon to stop blood flow, or cauterizing the vessels in the nose fail, surgery or embolization are the next treatment options. Embolization in this population can be accomplished via injection of polyvinyl alcohol (PVA) particles into the vessels of the nose.
Data Breakdown: In a study involving 84 patients with unstoppable nosebleeds, embolization was utilized in blood vessels of the participants. Nosebleed recurrence was observed in 25% of patients who had one vessel treated, 14% for those with two vessels treated, 6% for those with three vessels treated, and 0% for those with all four vessels treated. Minor pain and complications increased with the number of vessels treated. These complications, however, were temporary.
Take Home Pearl: As more blood vessels are embolized with PVA particles in patients with unstoppable nosebleeds, the likelihood of successfully ceasing these bleeds appears to increase.
Cryoablation Deemed Effective in Ovarian Cancer [back to top]
The Particulars: Surgery to remove tumors is often used to extend life in women with metastatic ovarian cancer. Depending on location of the tumors and other factors, however, surgery is not an option in approximately 70% of cases. Killing unresectable tumors with cryoablation may be an option for this patient population.
Data Breakdown: An analysis of 48 tumors treated with cryoblation in 21 patients was conducted, and 47 (98%) tumors were killed. Typical survival time for women with metastatic ovarian cancer is 7 months to 2.5 years, but researchers observed an average survival time of more than 4.5 years from the time of diagnosis of metastatic disease for women in the study. The overall major complication rate was 7%, and three major complications were observed, but these were attributed to the cancer rather than the procedure. Cryoablation costs an average of $26,806 per life year saved, compared with the current standard of about $100,000.
Take Home Pearls: Cryoablation appears to effectively kill unresectable ovarian tumors. The procedure also resulted in significant improvements in average survival time.
MS Patients Report Benefits With Angioplasty [back to top]
The Particulars: According to a controversial theory, multiple sclerosis (MS) symptoms may be caused by chronic cerebrospinal venous insufficiency (CCSVI), a narrowing in the veins that can interrupt blood flow between the brain and heart. CCSVI is typically treated with minimally invasive angioplasty to open the narrowed veins.
Data Breakdown: Researchers analyzed 170 patients with MS who, on average, were able to walk slightly more than 300 yards without resting. These patients also had some limitation of activity prior to treatment. After angioplasty, MS patients were able to walk an average of more than 500 yards without resting and were up and about for approximately 12 hours per day when reassessed at 3 months. Quality of life scores on a 112-point scale rose from an average of 64 before treatment with angioplasty to 70 after 1 month and 71 after 3 months.
Take Home Pearl: Patients with MS who are treated for CCSVI appear to experience improved quality of life and improvement in common MS symptoms for up to 3 months after treatment with angioplasty.
Fibromuscular Dysplasia Frequently Undiagnosed [back to top]
The Particulars: Previously published research suggests that nearly 4% of Americans have fibromuscular dysplasia (FMD), an accumulation of fibrous tissue in the arteries that causes them to narrow. Studies have estimated that 20% of patients with FMD will later experience an aneurysm. The disease is frequently undiagnosed because few physicians are aware of the symptoms.
Data Breakdown: A registry review of 339 patients (91% female) with FMD found that 19% had a tear in an artery, most often the carotid artery. Another 17% had suffered an aneurysm. The most common symptoms were high blood pressure (66%) and headache (53%). Other common symptoms included rhythmic ringing in the ears (30%), dizziness (28%), wooshing sound in the ears (24%), and neck pain (22%).
Take Home Pearl: Physicians should screen for FMD, particularly in patients with high blood pressure and headaches.
Readings & Resources (click to view)
For more information on these studies and others presented at the ISET 2012, go to http://iset.org.