HWN Suggests

Endovascular Treatment for Lower Extremity Deep Vein Thrombosis: An Overview

There is no evidence to indicate that endovascular thrombus removal could help to prevent the propagation of DVT in asymptomatic proximal DVT. In asymptomatic proximal DVT, anticoagulation treatment alone is sufficient to reduce the recurrence rate and prevent PE. There is no need for endovascular thrombus removal in patients with isolated distal DVT. The need for anticoagulation treatment for distal DVT has not been established because isolated distal DVT has a low risk of PE. For isolated distal DVT cases, preference for anticoagulation treatment varies among centers and clinicians.

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Articles of Interest

Deep Venous Thrombosis: An Interventionalist's Approach

Invasive catheter-based therapies that remove thrombus and correct venous outflow obstructions improve outcomes and morbidity in patients with IFDVT. Future trials that address IFDVT specifically will improve our understanding and the proper management of this higher-risk subset of patients with DVT.

Endovascular Intervention for Lower-Extremity Deep Venous Thrombosis

Endovascular options are more effective in reducing long-term morbidity after proximal DVT when compared to anticoagulation alone. These options should be considered for all patients with proximal lower-extremity DVT and a reasonable life expectancy. Percutaneous mechanical thrombectomy is at least as effective as catheter-directed thrombolysis, with reduced ICU and hospital stays and decreased overall costs.

How I use catheter-directed interventional therapy to treat patients with venous thromboembolism

Catheter-based therapies offer the potential for improved clinical outcomes in patients with severe manifestations of DVT and PE. Even as clinical trials continue to establish the appropriate criteria for use of these treatment methods, physicians should continue to individualize care with careful consideration of risks and benefits; close collaboration with colleagues who possess diverse expertise; monitoring of local outcomes including mortality, bleeding, hemodynamic improvement, and long-term function; and implementation of quality improvement interventions to ensure that therapy is targeted to patients most likely to benefit.

Interventional Management of DVT: Top 10 Technical Tips

Advances in noninvasive vascular imaging and endovascular technology, as well as improved endovascular technique, have resulted in an emerging role for interventionists in the management of DVT. Catheter directed thrombolysis (CDT) has several theoretical advantages to traditional systemic thrombolysis, including the ability to attain a high intrathrombus drug concentration while reducing the overall thrombolytic agent dose and treatment times, leading to fewer bleeding complications and decreased hospitalization length.

Interventional Management of Venous Thromboembolism: State of the Art

Catheter-based treatment of VTE is a viable adjunct to anticoagulant therapy and is being rapidly adopted around the United States. Early data suggest that these therapies reduce postthrombotic sequelae and improve quality of life, but bleeding events are still frequent, particularly at low-volume centers. Protocols need to be standardized to improve patient care.

The Role of Venous Interventions in the Contemporary Management of Deep Vein Thromboses

Historically, the mainstays of DVT therapy have been anticoagulation (AC) and venous compressive therapies. However, since the 1990s new interventional tools and techniques have expanded management options, which now include catheter-directed thrombolysis (CDT), pharmacomechanical catheter-directed thrombolysis (PCDT), ultrasound-accelerated thrombolysis, percutaneous aspiration thrombectomy, inferior vena cava (IVC) filters, venous balloon dilatation, and venous stent implantation.