Cập nhật về xử trí huyết khối tĩnh mạch sâu

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 sympto

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