Update on management of deep vein thrombosis

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 
phlegmasia cerulea 
dolens 
May-Thurner Syndrome 
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.