the aachen-maastricht approach for the endovascular...
TRANSCRIPT
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The Aachen-Maastricht approach for the
endovascular recanalization of deep vein
thrombosis (DVT)
H. Jalaie European Vascular Center Aachen-Maastricht
Department of vascular and Endovascular Surgery
University Hospital Aachen
Germany
6th MUNIC VASCULAR CONFERENCE 2016
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Introduction
Kahn et al, Ann Intern Med 2008
• 20-55% of pt’s develop PTS after DVT
• PTS due to deep venous Thrombosis
• Calf: rare
• Popliteal: rare
• Femoral: common
• Iliac/caval: common
• 20 % of thrombosed iliac veins completely recanalize with
anticoagulant therapy
• 44% claudication 5 years post iliac DVT
• 15% ulcers 5 years post iliac DVT
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Reason for early clot removal
• Relief of acute symptoms
• Swelling
• Pain
• Edema
• Risk reduction for posthrombotic syndrome (PTS)
• residual venous obstruction
• residual thrombus
• valve incomptence
page 3
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EkoSonic® Endovascular System: ultrasound-accelerated catheter-
directed thrombolysis (UACDT)
• Mechanical: high frequency, low energy ultrasound
• Drug: recombinant tissue plasminogen activator (rTPA)• Bolus 5mg, 1mg per hour
• Heparin PTT 40-60 seconds
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Roadmap before the lysis
Visualize extend and localization of thrombi and potential stenotic or obstructive
lesions
• Ultrasound imaging
• MR venography
• CT venography
• Lower extremtity thrombosis
classification (LET)
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Start of the lysis
Case 1
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Angiography
24 hours 48 hours
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Angiography
72 hours
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Case 2
• 20y. male
• Leg-pain and severe swelling right-sided 3 days
• No risc-factors
• Duplex and CT-scan : DVT iliofemoral and caval
• Ultrasoud accelerated catheter-lysis for 2 days
• Stenting of the underlying pathology
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Case 2
Ultrasound accelerated
catheter
After 2 days of lysis
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Dedicated venous stent
(before dilatation)
IVC
CVO
Completion angiogram
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Case 3
• 57 y. male
• Swelling of the left leg 1 week
• No risc-factors
• Duplex and CT-scan : DVT iliofemoral and caval
with compression of the left iliac vein
• Ultrasoud accelerated catheter-lysis for 3 days
• Stenting of the underlying pathology
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Phlebogram before lysis Placement of ultrasound
accelerated lysis catheter
CTV
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After Stentimplantation
(before dilatation of the stent)
Result after 3 days of
lysis
Result after 1 day of lysis
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Evaluation after
1 year
(multiplane
X-Ray)
Compression of left iliac vein
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No. of patients
(2010-2014)
79
Sex 54 (64,5%) female
Age 41 (19-71)
Thrombophilia 15 (18,9%)
Therapy duration 71,6 h
Point of access popliteal 68%, femoral 32%
Left sided DVT 50 (63,1%)
Right sided DVT 21 (26,6%)
Bilateral DVT 8 (10,1%)
Compression (May Thurner Syndrom) 26 (32,9%)
Demographics
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• Therapeutic success (reduction of Thrombus > 50%) in 80,5%
• Stent-PTA in 58,2%
• minor bleeding (puncture side) in 15,2%
• No major bleeding
• No PE
• No catheter related complications
• No mortality
Results
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• CDT for patients with an acute DVT ( 1g/L during thrombolysis
• CDT schould not exceed more than 72 hours (better 48 h)
• Stenting of residual obstruction with dedicated venous stents
• Accurate anticoagulation
• Regular follow-up
Summary
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Seite 19
Thank you for your attention