Deep Vein Deep Vein Thrombosis Thrombosis DVT facts, statistics, DVT facts, statistics, and therapeutic options and therapeutic options MICHAEL A ARATA MD MICHAEL A ARATA MD INTERVENTIONAL RADIOLOGY INTERVENTIONAL RADIOLOGY MEMORIAL UNIVERSITY MEDICAL CENTER MEMORIAL UNIVERSITY MEDICAL CENTER SAVANNAH, GEORGIA SAVANNAH, GEORGIA
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Deep Vein Thrombosis Deep Vein Thrombosis DVT facts, statistics, and therapeutic options MICHAEL A ARATA MD INTERVENTIONAL RADIOLOGY INTERVENTIONAL RADIOLOGY.
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The Problem of DVT: StatisticsThe Problem of DVT: Statistics
• DVT occurs in approx. 2 million Americans DVT occurs in approx. 2 million Americans each year. Approx 1/3 develop PEeach year. Approx 1/3 develop PE
• The combined annual incidence for DVT is The combined annual incidence for DVT is approximately 2.5%-5% of the adult populationapproximately 2.5%-5% of the adult population
• DVT recurs in 5-10% of patients the year after DVT recurs in 5-10% of patients the year after anticoagulationanticoagulation
• DVT recurs in 30% of patients eight years after DVT recurs in 30% of patients eight years after anticoagulationanticoagulation
1996 American Heart Association Scientific Statement on DVT1996 American Heart Association Scientific Statement on DVT
Risk Factors for DVTRisk Factors for DVT Age >40 years Age >40 years Cancer Cancer Obesity Obesity Previous or family history of DVT/PE Previous or family history of DVT/PE Recent surgeryRecent surgery Paralysis or immobilityParalysis or immobility Contraceptives/Hormone replacement therapy Contraceptives/Hormone replacement therapy Pregnancy Pregnancy Serious illness: CHF, MI, sepsis Serious illness: CHF, MI, sepsis Coagulation disordersCoagulation disorders
Calf pain/tenderness Calf pain/tenderness SwellingSwelling Calor, rubor Calor, rubor Cyanosis or pallorCyanosis or pallor Superficial venous dilatation Superficial venous dilatation Loss of pulses in severe DVTLoss of pulses in severe DVT
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Causes of Limb Swelling: Causes of Limb Swelling: Acute Acute
< 3 Weeks Good < 3 Weeks Good < 1 Week Better < 1 Week Better < 3 Days Best< 3 Days Best
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Rationale for Early Treatment Rationale for Early Treatment of DVTof DVT
Early treatment increases probability of Early treatment increases probability of maintaining normal valve functionmaintaining normal valve function– Damaged valves lead to venous insufficiencyDamaged valves lead to venous insufficiency
Decrease recurrent DVT riskDecrease recurrent DVT risk– Restore normal venous flowRestore normal venous flow– Clear thrombogenic substrateClear thrombogenic substrate
Decrease risk for PEDecrease risk for PE– Asymptomatic PE occurs in majority of patients Asymptomatic PE occurs in majority of patients
Post-Phlebitic Syndrome -- spectrum Post-Phlebitic Syndrome -- spectrum symptoms seen after DVTsymptoms seen after DVT– painpain– edemaedema– pigmentationpigmentation– ulcerulcer
Occurs in 50 to 70% cases proximal DVTOccurs in 50 to 70% cases proximal DVT Prevalence estimated to be as high as 2 Prevalence estimated to be as high as 2
percent in the general populationpercent in the general population
New treatments to rapidly remove thrombus: New treatments to rapidly remove thrombus:
Mechanical ThrombectomyMechanical Thrombectomy– Physical removal of clot burdenPhysical removal of clot burden– Often used in combination with lyticsOften used in combination with lytics
Power Pulse Spray Power Pulse Spray – Accelerated thrombolysis delivered by AngioJet Accelerated thrombolysis delivered by AngioJet
systemsystem
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Clinical Experience: Mechanical Clinical Experience: Mechanical Thrombectomy for DVTThrombectomy for DVT
Experience as reported by K. Kasirajan, MDExperience as reported by K. Kasirajan, MD– 17 patients with extensive DVT treated with AngioJet17 patients with extensive DVT treated with AngioJet
» 7 of 17 patients had <50% thrombus removal 7 of 17 patients had <50% thrombus removal
» 9 patients thrombolytics used achieving <90% thrombus 9 patients thrombolytics used achieving <90% thrombus removal removal
Conclusion: PMT with adjunctive thrombolytic is less Conclusion: PMT with adjunctive thrombolytic is less invasive, low risk option in patients with extensive DVTinvasive, low risk option in patients with extensive DVT
Clinical Experience: Mechanical Clinical Experience: Mechanical Thrombectomy for DVTThrombectomy for DVT
44 patient retrospective study 44 patient retrospective study – DVT- mechanical thrombectomy using AngioJetDVT- mechanical thrombectomy using AngioJet
Key Findings Key Findings – 54.5% of patients received thrombolysis 54.5% of patients received thrombolysis
administered pre-AngioJet administered pre-AngioJet – 56.8% of patients received adjunctive 56.8% of patients received adjunctive
thrombolysis thrombolysis – No major complications were related to the use of No major complications were related to the use of
AngioJetAngioJet
Kasirajan K, Arata M, Swischuk S, Hunter D, Cazenave C, Rheolytic thrombectomy for management of venous thrombosis: Results of a multicenter venous registry. J Vasc Interven Radiol 2003: 14: S1617
Clinical Experience: Mechanical Clinical Experience: Mechanical Thrombectomy for DVTThrombectomy for DVT
Complete (> 90% of initial thrombus removed)
Substantial (> 50% -- 90% of initial thrombus removed)
Partial (> 50% of initial thrombus removed)
No Response
Response to AngioJet TreatmentResponse to AngioJet Treatment
18Kasirajan K, Arata M, Swischuk S, Hunter D, Cazenave C, Rheolytic thrombectomy for management of venous thrombosis: Results of a multicenter venous registry. J Vasc Interven Radiol 2003: 14: S16
9%16%
25%
50%
Clinical Experience: Mechanical Clinical Experience: Mechanical Thrombectomy for DVTThrombectomy for DVT
ReportedReported Conclusions:Conclusions:
– AngioJet Mechanical thrombectomy is a AngioJet Mechanical thrombectomy is a safe adjunct or alternative to safe adjunct or alternative to thrombolysis for DVTthrombolysis for DVT
– Debulking with AngioJet may result in Debulking with AngioJet may result in elimination or reduction of lytic doseelimination or reduction of lytic dose
– A sufficiently powered study is A sufficiently powered study is warranted to assess effectswarranted to assess effects
19Kasirajan K, Arata M, Swischuk S, Hunter D, Cazenave C, Rheolytic thrombectomy for management of venous thrombosis: Results of a multicenter venous registry. J Vasc Interven Radiol 2003: 14: S16