1 / 10

Ambulatory Venous Hypertension

Obstruction and valve incompetence. …Highest venous pressure …Most severe morbidity. Ambulatory Venous Hypertension. Components. Obstruction Valve incompetence. Iliofemoral DVT. Contraindication to Lysis. Yes. No. Surgical Thrombectomy + AVF. Catheter-directed Thrombolysis. Success.

kathryn
Download Presentation

Ambulatory Venous Hypertension

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Obstruction and valve incompetence …Highest venous pressure …Most severe morbidity Ambulatory Venous Hypertension Components • Obstruction • Valve incompetence

  2. Iliofemoral DVT Contraindication to Lysis Yes No Surgical Thrombectomy + AVF Catheter-directed Thrombolysis Success No Anticoagulation Yes

  3. Venous Thrombectomy vs. Anticoagulation Randomized Trial • 63 patients: iliofemoral DVT • Thrombectomy + AVF vs. Anticoagulation • Follow-up: 6 mos, 5 yrs, 10 yrs • Patency • Valve function • Venous hemodynamics • Clinical evaluation Plate G et al, J Vasc Surg 1984

  4. Venous Thrombectomy vs. Anticoagulation Results: 5 years (n=41) Thrombectomy Anticoag. Patent iliac* 78% 50% N Valve fct. (fempop) 40% 6% Reflux + obstruction 7% 37% Asymptomatic 37% 18% Severe CVI 11% 27% AVP 43 mmHg 60 mmHg *radionuclide phlebography Plate G et al, Eur J Vasc Endovasc Surg 1990

  5. Acute DVT Thrombolytic Therapy: ACCP 2004 “…There is no evidence that supports the use of thrombolytic agents for the initial treatment of DVT….” Recommend against the routine use of catheter-directed thrombolysis (Grade 1C) …Treatment..[with lytic Rx] .. Be confined to patients requiring limb salvage. (Grade 2C) Buller H, et al Chest 2004;126:401S

  6. Catheter-Directed Lysis Iliofemoral DVT Improvement in Quality of Life • Significantly better QOL with lysis Physical function Stigma Health distress Post thromb Sx • Successful lysis correlated w/QOL • Lytic failures and heparin Rx similar Comerota AJ et al J Vasc Surg 2000

  7. Catheter-Directed Lysis Iliofemoral DVT Improvement in Quality of Life • 35 consecutive patients • Iliofemoral DVT • Randomized • Follow-up 1week/6mos • Clot lysis • Venous reflux • Cath-dir SK (pulse spray) • vs. • Anticoagulation alone Elsharawy M, et al Eur J Vas Surg. 2002; 24:209

  8. Catheter-Directed Lysis Iliofemoral DVT Randomized Trial: Outcome at 6 months Anticoag (n=17) Lysis (n=18) P-valve Patency 12% 72% <0.001 Reflux 41%* 11% 0.04 LOS 6d 7d 0.4 *Underestimate 20 occlusion Elsharawy M, et al Eur J Vas Surg. 2002; 24:209

  9. Postthrombotic Syndrome Elastic Stockings (30-40 mmHg) Postthrombotic Syndrome Control Stocking RRR P-value Brandjes DP 47% 21% 55% <.01 (n=194) Lancet 1997;349:759 Prandoni P 49% 24% 51% <.01 (n=170) Patho Hemst Thromb 2002;32(suppl 2):72

  10. A Strategy of Thrombus Removal for Venous Thromboembolism: We Owe it to Our Patients

More Related