Treatment of Venous Thrombosis

VI21-02

Treatment of Venous Thrombosis

Multisession Courses

Presented on November 30, 2009
Presented as part of VI21: Interventional Radiology Series: Venous Thromboembolic Disease Diagnosis and Treatment

Alan Hiyoshi Matsumoto MD, Presenter: Speakers Bureau, W. L. Gore & Associates, Inc Speakers Bureau, Cook Group Incorporated Speakers Bureau, Medtronic, Inc Speakers Bureau, C. R. Bard, Inc Advisory Board, Boston Scientific Corporation Advisory Board, Crux Biomedical, Inc Research grant, Talecris Biotherapeutics, Inc Research grant, Medtronic, Inc Research grant, W. L. Gore & Associates, Inc Research grant, Cook Group Incorporated Research grant, Siemens AG Data and Safety Monitoring Board, CH-Werfen Consultant, Siemens AG Consultant, C. R. Bard, Inc Consultant, AGA Medical Corp

1) To provide the attendees an overview of the pathophysiology of iliofemoral DVT and its natural history when treated with anticoagulation alone. 2) To review the results of the Venous Registry data and the affects of catheter-directed therapy on quality of life. 3) To give an update on the variety of mechanical devices that have been combined with lytic therapy to enhance the tempo of thrombus removal, while giving the attendees a summary the clinical results from published case series in which these treatment options were employed. 4) To demonstrate some example cases and approaches to the treatment of iliofemoral DVT in order to provide the attendees some insight into case selection and technical considerations.

1. With iliofemoral DVT, > 90% of patients develop venous insufficiency and are the subpopulation of patients with DVT at highest risk for developing the post-thrombotic symptoms (PTS). 2. The volume of thrombus present with iliofemoral DVT is too large to expect in vivo lysis with systemic anticoagulation alone. 3. PTS can be minimized if the thrombus can be removed, venous obstruction relieved, and venous valve function perserved. 4. Venous Registry data has shown that catheter-directed thrombolysis can lead to complete clot lysis in 65% of patients, with 79% one year patency rates and statistically improved quality of life(QOL) when compared to systemic anticoagulation alone. 5. A variety of methods that combine mechanical and pharmacologic techniques are being used with a goal of removing the clot faster and more safely. A large number of case series have shown that these various combination techniques have provided good clinical success and low complication rates. 6. The ATTRACT Trial will be an NIH sponsore, multicenter, randomized trial that will hopefully show that catheter-directed therapy for DVT vs. anticoagulation alone for acute iliofemoral DVT. The hope is that this Study unequivocally shows that catheter-directed therapy for iliofemoral DVT improves clinical outcomes and QOL without signficantly increasing morbidity. The ATTRACT Trial will be discussed in a separate presentation in this session.