1635_Patel.pdf

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1、Update on Deep Venous Thrombosis and Pulmonary Thromboembolic DiseaseRahul S.Patel MD FSIRAssistant Professor of Radiology and SurgeryVascular and Interventional RadiologyDisclosures SpeakerPenumbra AdvisorBoston ScientificImperative CareGore MedicalMedtronicInnova VascularSumma TherapeuticsScientia

2、 IncDVT:Why do we treat?Obvious:To prevent P.E.Less obvious:To prevent late and devastating consequences of lower extremity venous HTNProlonged swelling,debilitation,pain,leg ulcersLoss of work of a healthy individual3Post Thrombotic SyndromeChronic leg heavinessLeg achingVenous claudicationEdemaVen

3、ous varicositiesChronic skin changesUse:Insert tab Text group Header&Footer dialog to globally edit the footer4Conventional TherapyUnfractionated heparin and warfarinLow molecular weight heparin Decreases risk of recurrent DVT from 30-50%to 5-7%.Decreases risk of fatal PE to 0.4 1.5%Most common risk

4、 is bleeding11%with unfractionated heparin6%with warfarinElastic Compression Stockings Incidences of valvular insufficiency of 23%,28%,and 29%at 2,5,and 8 yrs on adequate anticoagulation therapy.82%of patients on anticoagulation have no clearance or extension of clot on venographyClot propagation ca

5、n occur in as many as 40%of patients while on heparinUse:Insert tab Text group Header&Footer dialog to globally edit the footer5Why Pharmacomechanical Thrombectomy?Thrombolysis alone has drawbacksLong infusion times(mean infusion time during the Venous Registry was 48 hours(30-80hours)Bleeding risks

6、ICU costs($10,000/day)Modern devices allow for near complete clot resolution in a single session+/-TPANo ICU stay?Outpatient procedureCurrent Devices Use:Insert tab Text group Header&Footer dialog to globally edit the footer10AngioJet XelantePenumbra LightningJETI CatheterClottrieverAspirex SVenturi