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Update on Management of
Deep vein thrombosis
Vietnam Heart Association Meeting
October 10th 2016
8:17AM – 8:32 AM Dong Do 2
Thach Nguyen, M.D. FACC FSCAI


Complications of extensive DVT

May-Thurner Syndrome

phlegmasia cerulea

dolens


Post-thrombotic Syndrome:
Chronic pain, swelling, skin ulceration


1) Prevention of clot propagation
2) Prevention of PE and recurrent thrombosis
3) Restoration of venous patency and flow
4) Preservation of valvular function
5) Elimination of clinical symptoms associated with PTS


Endovascular Rx for DVT:
A Contemporary Approach
Pharmaco-mechanical treatment (PMT): function to both

dissolve (lytic assisted) and mechanically remove clot


EKOS


TRELLIS


ANGIOJET


Ultrasound Accelerated
Thrombolysis


Indications
1. Acute limb threat

2. Caval thrombus
3. Iliac DVT

4. Femoral-Popliteal DVT in symptomatic, low risk
of bleeding, good life expectancy may be considered
5. Patient must have no absolute contraindications
Recent surgery is a relative contraindication.


Technique
1. Access POPLITEAL VEIN OF AFFECTED LIMB

under ultrasound guidance (most common approach)
2. Perform pharmaco-mechanical thrombolysis of
choice (individualize per pt) and per local expertise
3. Can be done on full dose anticoagulation (no reason
to hold coumadin and therefore eliminate bridging
issues)
4. 6 french sheath


THROMBUS- PRE and POST EKOS


IVC Filter for prevention of PE


EKOS thombolysis then Balloon Angioplasty of
left common iliac vein (8x60-evercross)


Self Expanding Stent to left common iliac vein
residual stenosis (May Thurner) with Protégé
12x80 stent; post-dilated with 10x40 evercross



DVT of upper extremities


Thrombolysis is best accomplished with
local administration of the thrombolytic

agent directly at the thrombus. After
completion of a venographic study, a
catheter is floated up to the site of the clot,
and the thrombolytic agent is administered
as a direct infusion.


Venographic assessment for clot lysis is
repeated every 4-6 hours until venous
patency is restored. Heparin is usually
given concurrently to prevent
rethrombosis.


1. Thrombolytic therapy is the treatment

of choice for axillary/subclavian
venous thrombosis.
2. Restoration of venous patency is more

critical for the prevention of chronic
venous insufficiency in the upper
extremity.