Percutaneous Mechanical Thrombectomy for Acute Iliofemoral DVT with the Aspirex Catheter: The Dijon Experience

Size: px
Start display at page:

Download "Percutaneous Mechanical Thrombectomy for Acute Iliofemoral DVT with the Aspirex Catheter: The Dijon Experience"

Transcription

1 JFICV 2018, Beaune Percutaneous Mechanical Thrombectomy for Acute Iliofemoral DVT with the Aspirex Catheter: The Dijon Experience Prof. Romaric LOFFROY, MD, PhD, FCIRSE Chief, Department of Vascular and Interventional Radiology Image-Guided Therapy Center François ois-mitterrand University Hospital Dijon, France

2 Endovascular therapeutic options Thrombolysis Local CDT Manual aspiration Thrombus fragmentation Trerotola PMT or lysis-assisted MT EKOS = US-enhanced lysis Trellis = pharmaco-mt Angiojet = rheolytic pharmaco-mt Pure MT Indigo = aspiration MT Aspirex S = rotational MT

3 Thrombectomy devices for DVT treatment Aspirex Pure mechanical thrombectomy No thrombolytics Age of thrombus not so relevant Chance to finish in the angio- room No RCT data EKOS / Trellis / Angiojet Time consuming Additional thrombolytics Bleeding risks Re-angio after finishing treatment for stent placement (EKOS) Organized thrombus > 4 weeks = possible ineffectiveness Additional ICU stay with EKOS No RCT data, only registry data

4 The perfect system? Minimally invasive Easy to use Reduced procedural time Treat all veins Reduces thrombus burden Lowest complication rate No vessel wall damage Successful in restoring vein patency Preserves valvular function Unmask underlying lesion Targeted treatment No need for lysis drug Overall cost-effective Pure Rotational Mechanical Thrombectomy?

5 Purpose To assess the safety and efficacy of percutaneous mechanical thrombectomy (PMT) for acute symptomatic iliofemoral deep vein thrombosis (DVT) using the Aspirex S device (Straub Medical AG, Wangs, Switzerland)

6 Study population Retrospective study Period of inclusion December 2015-January patients 19F/6M Mean age yrs (range, 17-76) History DVT history: 13/25 (52%) Thrombophilic abnormality: 5/25 (20%) Cancer: 4/25 (16%) IVC surgery: 1/25 (4%) Treatment before diagnosis Anticoagulants=6/20 Antiplatelets=3/20 Symptomatic ilio-femoral DVT Oedema/pain in all patients PE in 2 patients

7 DVT characteristics Localisation Left=21/right=4 Bilateral=1 Extension LET 3=21/25 Involvement of popliteal vein=5/21 LET 4=4/25 Duration of symptoms before treatment 5.5 days (range, 2-11) May-Thurner syndrome 15/25 (60%) Pre-operative CT scan in all patients

8 Procedural data Under local anesthesia Cook Flexor 10-Fr long sheath Endovascular approach Jugular: 7 Popliteal: 17 Both: 1 Aspirex S 10-Fr 110 cm Self-expandable stents (10-16 mm) Sinus-XL Flex Stent or Sinus Superflex-635 Optimed, Ettlingen, Germany Protégé GPS ev3-covidien, Plymouth, MN Bolus of 100IU/kg of heparin every 45 min «ALN» IVC temporary filter 9/25 Systematic exams at day 1 Chest CT scan Duplex US Post-operative medication for 3 months Anticoagulants Antiplatelets 1 mo: LMWH 2 mo: NOAC 3 mo

9 Aspirex S technical data Size matters!

10

11 Key concepts Age of thrombus Coagulation Infusion mix Flow Guidewire Correct movement Motor

12 Age of thrombus Optimal moment to treat proximal vein occlusion Goal: safe valve function Age of thrombus is key of success Best results achieved with really fresh thrombus: 10 days: National Venous Registry 14 days: ATTRACT trial 21 days: CaVent trial < 14 days is optimal but as early as possible is better

13 Coagulation Always consider the coagulation Bolus of 100UI/kg of heparin every 45 min If a proper anticoagulation is not achieved The helix may be blocked Guidewire could be stuck in the catheter

14 Infusion mix Technique 250ml saline + 250ml contrast UI heparin Put the mix in a pressure bag Adjust the flow To avoid collapse of the vein during the aspiration Start the infusion until visualization of the vein Start the aspiration Stop the flow when the motor is off Benefits Get real-time information during the procedure about Status of the vein Vessel wall behavior Thrombus status Efficiency of the aspiration Vessel patency Contrast: no systemic effect because permanently aspirated by the Aspirex

15 Flow If the vein is collapsing on the Aspirex head, it means that the flow is not enough Pull back the catheter and wait for the vein to fill up again Stop the motor and wait for the vein to fill up again Keep in mind during run of catheter System is cooled by blood flow: warming of catheter indicates insufficient blood flow/cooling Consider saline infusion in occluded venous segments High aspiration capacity: keep an eye on collecting bag Flush catheter after usage

16 Guidewire Aspirex 10-Fr guidewire is always fine Aspirex 8-Fr / 6-Fr guidewire is not always fine Keep it straight Don t hesitate to take another one

17 Correct movement How to reach eccentric thrombus Used long angled 10/12-Fr sheath to increase the radius of catheter

18 Motor

19 Immediate results Technical success=100% Restoration of proximal iliofemoral blood flow Residual thrombus < 20% No lytic therapy infusion Additional IV bolus of Actilyse in 5 of 25 patients Stenting rate 100% Iliac and/or femoral Implanted stents Mean = 2.3/patient Range: 1-4 Number of runs=2-4 (mean = 2.6/patient) Amount of blood/thrombus aspirated Mean = ml Range: ml Mean procedural time PMT run min ( ) Total procedure min (70-180) Mean scopy time min (8-44)

20 Outcomes Complications No MAE (bleeding, PE) 3 minor 1 wire lost: snared 1 helix broken outside the patient Hospital stay Mean = 2.6 days Discharge 2 days in 84% No ICU stay Follow-up Mean: mo Range: 6-30 mo Relief of acute symptoms within 3 days 23/25 = 92% Patency rate at 6 months Primary: 23/25 = 92% Early in-stent rethrombosis within 1 week in 2 patients Secondary: 22/24 (88%) Failure of recanalization: 2 PTS at 6 months 4/25 = 16% Moderate ++

21

22

23

24

25 Why is pure MT cost-effective? Fast thrombus removal No ICU stay No angiographic control No lytics required No bleeding complications Outpatient procedure? Catheter cost

26 LET 4 DVT: outpatient procedure 9:20 am: angiologist call 1:30 pm: CT scan 2:10 pm: angio-suite entrance 3:20 pm: angio-suite exit 5:15 pm: go home 10:40 pm (day 1): US

27 Technical limitations Subintimal position of the guidewire Chronic venous occlusion Proper anticoagulation not achieved Impossibility to pass the lesion completely with the guidewire Undersized or oversized vessel diameter With radius of curvature less than 2 cm If the catheter, the guidewire or the sheath are damaged, kinked or present unsolved resistance

28 IVUS role?

29 Study limitations

30 On-going P-Max study

31 Conclusion Thrombectomy using the Aspirex S device is a safe, fast and effective therapeutic option in patients presenting with acute symptomatic iliofemoral DVT: Effective in venous thrombus removal +++ Fast relief of acute symptoms Restores vein patency in lower limb +++ Has low risk and less side effects +++ No ICU stay End it in the angiolab No need for lytic infusion No bleeding complications Prevention of PTS ++ Preserves valve function?

32 Still debated Jugular/popliteal approach? IVC filter? Necessity of 100% thrombus removal? Landing zone of stenting? Treatment of superficial femoral/popliteal vein? Type/duration of post-operative medication?

Technique de recanalisation: mon expérience avec Aspirex

Technique de recanalisation: mon expérience avec Aspirex JFICV 2017, Deauville Thrombose veineuse profonde aiguë en 2017 Technique de recanalisation: mon expérience avec Aspirex Romaric LOFFROY Département de Radiologie Diagnostique et Thérapeutique CHU Hôpital

More information

Venous interventions in DVT

Venous interventions in DVT Venous interventions in DVT Sriram Narayanan Chief of Vascular and Endovascular Surgery, Tan Tock Seng Hospital A/Prof of Surgery, National University of Singapore ANTI-COAGULATION LMWH Warfarin x 6m Acute

More information

Successful recanalisation of venous thrombotic occlusions with Aspirex mechanical thrombectomy. Michael K. W. Lichtenberg

Successful recanalisation of venous thrombotic occlusions with Aspirex mechanical thrombectomy. Michael K. W. Lichtenberg Successful recanalisation of venous thrombotic occlusions with Aspirex mechanical thrombectomy Michael K. W. Lichtenberg Disclosure Speaker name: Michael Lichtenberg... I have the following potential conflicts

More information

Techniques for thrombus removal in acute DVT Benefits of an Endovascular Approach for Rapid Flow Restoration in DVT

Techniques for thrombus removal in acute DVT Benefits of an Endovascular Approach for Rapid Flow Restoration in DVT Techniques for thrombus removal in acute DVT Benefits of an Endovascular Approach for Rapid Flow Restoration in DVT Michael K. W. Lichtenberg, MD, FESC Vascular Centre Arnsberg, Germany Disclosure Speaker

More information

Pharmaco-mechanical techniques stand alone procedures? Peter Neglén, MD, PhD SP Vascular Center Limassol Cyprus

Pharmaco-mechanical techniques stand alone procedures? Peter Neglén, MD, PhD SP Vascular Center Limassol Cyprus Pharmaco-mechanical techniques stand alone procedures? Peter Neglén, MD, PhD SP Vascular Center Limassol Cyprus Faculty Disclosure Peter Neglén, M.D., Ph.D Stockholder/Founder of Veniti, Inc. Member, Medical

More information

THERE IS NO ROLE FOR SURGICAL THERAPY FOR DVT

THERE IS NO ROLE FOR SURGICAL THERAPY FOR DVT THERE IS NO ROLE FOR SURGICAL THERAPY FOR DVT Tara D. Balint, MD FACS Sentara RMH Thursday, June 14, 2018 1 Objectives of treatment for DVT Prevent death from PE Prevent recurrent VTE Prevent post-thrombotic

More information

Not all Leg DVT s are the Same: Which Patients Benefit from Interventional Therapy? Case 1:

Not all Leg DVT s are the Same: Which Patients Benefit from Interventional Therapy? Case 1: 12/16/2015 Not all Leg DVT s are the Same: Which Patients Benefit from Interventional Therapy? Constantino S.Peña, FSIR, FSCCT, FAHA Interventional Radiologist Medical Director, Vascular Imaging Miami

More information

Aggressive endovascular management of ilio-femoral DVT. thrombotic syndrome. is the key in preventing post

Aggressive endovascular management of ilio-femoral DVT. thrombotic syndrome. is the key in preventing post CACVS 2017 Aggressive endovascular management of ilio-femoral DVT is the key in preventing post thrombotic syndrome ALI AMIN MD, FACS,FACC, RVT CHIEF OF ENDOVASCULAR INTERVENTIONS READING HEALTH SYSTEM

More information

Straub Endovascular System &

Straub Endovascular System & Straub Endovascular System & S t r a u b E n d o v a s c u l a r To o l s Straub Endovascular System Effective debulking in occluded arteries and veins Effective debulking in many indications Rotarex

More information

Improved clinical outcomes Evidence on venous thrombectomy followed by stenting

Improved clinical outcomes Evidence on venous thrombectomy followed by stenting Improved clinical outcomes Evidence on venous thrombectomy followed by stenting Michael K. W. Lichtenberg, MD, FESC Vascular Centre Arnsberg, Germany Venous Centre Arnsberg, Germany Disclosure Speaker

More information

Surgical approach for DVT. Division of Vascular Surgery Department of Surgery Seoul National University College of Medicine

Surgical approach for DVT. Division of Vascular Surgery Department of Surgery Seoul National University College of Medicine Surgical approach for DVT Seung-Kee Min Division of Vascular Surgery Department of Surgery Seoul National University College of Medicine Treatment Options for Venous Thrombosis Unfractionated heparin &

More information

Implications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach

Implications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach Implications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach Prof. I. Baumgartner Head Clinical and Interventional Angiology About the ACCP guidelines Widely

More information

Interventional Treatment VTE: Radiologic Approach

Interventional Treatment VTE: Radiologic Approach Interventional Treatment VTE: Radiologic Approach Hae Giu Lee, MD Professor, Dept of Radiology Seoul St. Mary s Hospital The Catholic University of Korea Introduction Incidence High incidence: 250,000-1,000,000/year

More information

Innovative Endovascular Approach to Pulmonary Embolism by Ultrasound Enhanced Thrombolysis. Prof. Ralf R.Kolvenbach MD,PhD,FEBVS

Innovative Endovascular Approach to Pulmonary Embolism by Ultrasound Enhanced Thrombolysis. Prof. Ralf R.Kolvenbach MD,PhD,FEBVS Innovative Endovascular Approach to Pulmonary Embolism by Ultrasound Enhanced Thrombolysis Prof. Ralf R.Kolvenbach MD,PhD,FEBVS Catheter-based thrombolysis Local administration of lytic agent Higher local

More information

Intervention for Deep Venous Thrombosis and Pulmonary Embolus

Intervention for Deep Venous Thrombosis and Pulmonary Embolus Intervention for Deep Venous Thrombosis and Pulmonary Embolus Michael R. Jaff, DO Paul and Phyllis Fireman Endowed Chair in Vascular Medicine Massachusetts General Hospital Professor of Medicine Harvard

More information

Improved clinical outcomes Evidence on venous mechanical thrombectomy followed by stenting

Improved clinical outcomes Evidence on venous mechanical thrombectomy followed by stenting Improved clinical outcomes Evidence on venous mechanical thrombectomy followed by stenting Michael K. W. Lichtenberg, MD, FESC Vascular Centre Arnsberg, Germany German Venous Centre Arnsberg, Germany Disclosure

More information

- Our patients with iliofemoral DVT - Effective thrombus removal with purely mechanical thrombectomy can lead to better outcomes

- Our patients with iliofemoral DVT - Effective thrombus removal with purely mechanical thrombectomy can lead to better outcomes - Our patients with iliofemoral DVT - Effective thrombus removal with purely mechanical thrombectomy can lead to better outcomes Michael K. W. Lichtenberg, FESC Conflict of Interest - Disclosure Within

More information

Optimal Utilization of Thrombolytics

Optimal Utilization of Thrombolytics April 8-9, 2011 New York LaGuardia Marriott COMPLETE MANAGEMENT OF VENOUS DISEASE Optimal Utilization of Thrombolytics Anthony J. Comerota, MD, FACS, FACC Director, Jobst Vascular Institute Adjunct Professor

More information

Methods of Thrombus Fragmentation & Extraction. Methods of Thrombus Extraction

Methods of Thrombus Fragmentation & Extraction. Methods of Thrombus Extraction Thrombus Fragmentation and Extraction: Clinical Evidence and Practical Application No Relevant Disclosures Venita Chandra, MD Clinical Assistant Professor of Surgery Division of Stanford Medical School,

More information

Venous Thrombosis. Magnitude of the Problem. DVT 2 Million PE 600,000. Death 60,000. Estimated Cost of VTE Care $1.5 Billion/year.

Venous Thrombosis. Magnitude of the Problem. DVT 2 Million PE 600,000. Death 60,000. Estimated Cost of VTE Care $1.5 Billion/year. Venous Thrombosis Magnitude of the Problem DVT 2 Million Postthrombotic Syndrome 800,000 PE 600,000 Death 60,000 Silent PE 1 Million Pulmonary Hypertension 30,000 Estimated Cost of VTE Care $1.5 Billion/year

More information

PEARL Registry Update Overview Venous Arterial AV Access

PEARL Registry Update Overview Venous Arterial AV Access PEARL Registry Update Overview Venous Arterial AV Access PEARL Registry Overview (as of 10 Sep12*) Overview Venous Arterial AV Access HOME Topic Data Support Comments Study Design Prospective, non-randomized,

More information

Should We Be More Aggressive in the Treatment of Acute DVT?

Should We Be More Aggressive in the Treatment of Acute DVT? DISCLOSURES Consultant Penumbra, Inc. UCSF Vascular Surgery Symposium April 6, 2017 K. Pallav Kolli, MD Assistant Professor of Clinical Radiology University of California, San Francisco 17 yo male, DVT

More information

4/23/2009. September 15, 2008

4/23/2009. September 15, 2008 The Current Treatment of Deep Venous Thrombosis: Are We Doing Enough? George H. Meier, MD Professor and Chief Division of Vascular Surgery University of Cincinnati College of Medicine Cincinnati, Ohio

More information

A Dedicated Venous Self-expanding Oblique Hybrid Nitinol Stent (Sinus-Obliquus Stent)

A Dedicated Venous Self-expanding Oblique Hybrid Nitinol Stent (Sinus-Obliquus Stent) A Dedicated Venous Self-expanding Oblique Hybrid Nitinol Stent (Sinus-Obliquus Stent) Anna Stuck, Rolf P. Engelberger, Nils Kucher Division of Angiology Cantonal Hospital Fribourg & Bern University Hospital

More information

Innovative Endovascular Approach to Pulmonary Embolism by Ultrasound Enhanced Thrombolysis. Prof. Ralf R.Kolvenbach MD,PhD,FEBVS

Innovative Endovascular Approach to Pulmonary Embolism by Ultrasound Enhanced Thrombolysis. Prof. Ralf R.Kolvenbach MD,PhD,FEBVS Innovative Endovascular Approach to Pulmonary Embolism by Ultrasound Enhanced Thrombolysis Prof. Ralf R.Kolvenbach MD,PhD,FEBVS Conflict of Interest BTG Standard PE therapy ANTICOAGULATION (AC) HEPARIN

More information

Venous stenting in Marseille

Venous stenting in Marseille Venous stenting in Marseille Olivier HARTUNG, MD, MSc CHU Nord, Marseille, FRANCE Disclosure Speaker name: Olivier HARTUNG I have the following potential conflicts of interest to report: x Consulting :

More information

Ultrasound-assisted catheter-directed thrombolysis: Does it really work? The BERNUTIFUL trial

Ultrasound-assisted catheter-directed thrombolysis: Does it really work? The BERNUTIFUL trial Ultrasound-assisted catheter-directed thrombolysis: Does it really work? The BERNUTIFUL trial Rolf P. Engelberger Division of Angiology CHUV, Lausanne & Inselspital, Bern Switzerland Disclosure Speaker

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of Interventional procedure overview of ultrasound-enhanced, catheterdirected thrombolysis

More information

Emerging Tools for Lytic-Free, Single-Session Treatment of Venous Thromboembolic Disease

Emerging Tools for Lytic-Free, Single-Session Treatment of Venous Thromboembolic Disease FEATURED TECHNOLOGY THE CLOTTRIEVER AND FLOWTRIEVER SYSTEMS Emerging Tools for Lytic-Free, Single-Session Treatment of Venous Thromboembolic Disease The ClotTriever Outcomes (CLOUT) registry principal

More information

Chronic Iliocaval Venous Occlusive Disease

Chronic Iliocaval Venous Occlusive Disease none Chronic Iliocaval Venous Occlusive Disease David Rigberg, M.D. Clinical Professor of Surgery Division of Vascular Surgery University of California Los Angeles Chronic Venous Occlusive Disease Chronic

More information

Percutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related. Iliocaval Thrombosis

Percutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related. Iliocaval Thrombosis Percutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related Iliocaval Thrombosis Faiz D. Francis, DO; Gianvito Salerno, MD; Sabbah D. Butty, MD Abstract In the setting of

More information

Anticoagulation therapy following endovascular treatment of iliofemoral deep vein thrombosis

Anticoagulation therapy following endovascular treatment of iliofemoral deep vein thrombosis Anticoagulation therapy following endovascular treatment of iliofemoral deep vein thrombosis Tim Sebastian, M.D. University Hospital Zurich Clinic for Angiology Disclosure Speaker name: Tim Sebastian I

More information

Copy Here. The Easy One.. What is the Role of Thrombus Removal in Acute Proximal DVT after ATTRACT? Deep Venous Thrombosis Spectrum

Copy Here. The Easy One.. What is the Role of Thrombus Removal in Acute Proximal DVT after ATTRACT? Deep Venous Thrombosis Spectrum What is the Role of Thrombus Removal in Acute Proximal DVT after ATTRACT? Mitchell J. Silver DO FACC FSVM RPVI Director, Center for Critical Limb Care Riverside Methodist Hospital Ohio Health Heart and

More information

The hallmark of percutaneous thrombus management

The hallmark of percutaneous thrombus management Treating Venous Thromboembolism Without Lytic Medications What the present and the near future will bring in terms of techniques and devices to remove venous thrombus. BY CONSTANTINO S. PEÑA, MD; RIPAL

More information

Iliofemoral DVT: Miminizing Post-Thrombotic Syndrome

Iliofemoral DVT: Miminizing Post-Thrombotic Syndrome Iliofemoral DVT: Miminizing Post-Thrombotic Syndrome Catherine K. Chang, MD FACS Vascular Surgery San Diego Southern California Permanente Medical Group Acute Deep Venous Thrombosis Incidence & Outcomes

More information

Reducing Thrombotic Burden in Arterial Interventions. Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy

Reducing Thrombotic Burden in Arterial Interventions. Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy Reducing Thrombotic Burden in Arterial Interventions Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy Disclosure Speaker name: Mario Galli... I have the following potential

More information

The hallmark of percutaneous thrombus management

The hallmark of percutaneous thrombus management Treating Venous Thromboembolism Without Lytic Medications What the present and the near future will bring in terms of techniques and devices to remove venous thrombus. BY CONSTANTINO S. PEÑA, MD; RIPAL

More information

Complex Iliocaval Reconstruction PNEC. Seattle WA. Bill Marston MD Professor, Div of Vascular Surgery University of N.

Complex Iliocaval Reconstruction PNEC. Seattle WA. Bill Marston MD Professor, Div of Vascular Surgery University of N. Complex Iliocaval Reconstruction 2017 PNEC. Seattle WA Bill Marston MD Professor, Div of Vascular Surgery University of N. Carolina DISCLOSURES William Marston, MD Consultant/Advisory Board: Veniti, Cardinal

More information

Expanding Horizons: AngioVac Suction Thrombectomy at UTHealth

Expanding Horizons: AngioVac Suction Thrombectomy at UTHealth Expanding Horizons: AngioVac Suction Thrombectomy at UTHealth Naveed Saqib, MD Assistant Professor Department of Cardiothoracic and Vascular Surgery McGovern Medical School The University of Texas Science

More information

Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT Trial)

Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT Trial) Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT Trial) N Engl J Med. Volume 377(23):2240-2252. December 7, 2017 Wednesday, July 11, 2018, 1:00pm ET Guest

More information

VIVO-EU Results: Prospective European Study of the Zilver Vena TM Venous Stent in the Treatment of Symptomatic Iliofemoral Venous Outflow Obstruction

VIVO-EU Results: Prospective European Study of the Zilver Vena TM Venous Stent in the Treatment of Symptomatic Iliofemoral Venous Outflow Obstruction VIVO-EU Results: Prospective European Study of the Zilver Vena TM Venous Stent in the Treatment of Symptomatic Iliofemoral Venous Outflow Obstruction Gerard J O Sullivan, M.D. and Jennifer McCann-Brown,

More information

Aspirex for Upper and Lower Extremity DVT

Aspirex for Upper and Lower Extremity DVT Aspirex for Upper and Lower Extremity DVT Steven Kum MD Vascular & Endovascular Surgeon Director of Vascular Service Changi General Hospital Singapore Disclosure Speaker name:... I have the following potential

More information

The Evidence Base for Treating Acute DVT

The Evidence Base for Treating Acute DVT The Evidence Base for Treating Acute DVT Mr Chung Sim Lim Consultant Vascular Surgeon and Honorary Lecturer Royal Free London NHS Foundation Trust and University College London NIHR UCLH Biomedical Research

More information

Acoustic Pulse Thrombolysis Treatment

Acoustic Pulse Thrombolysis Treatment Acoustic Pulse Thrombolysis Treatment BTGVascular.com SETTING THE STANDARD FOR VASCULAR THERAPIES Quickly & safely dissolve thrombus with the EKOS System. The Acoustic Pulse Difference Acoustic Pulse Thrombolysis

More information

NOTE: Deep Vein Thrombosis (DVT) Risk Factors

NOTE: Deep Vein Thrombosis (DVT) Risk Factors Deep Vein Thrombosis (DVT) Deep Vein Thrombosis (DVT) is the formation of a blood clot, known as a thrombus, in the deep leg vein. It is a very serious condition that can cause permanent damage to the

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of Interventional procedure overview of ultrasound-enhanced, catheterdirected thrombolysis

More information

BC Vascular Day. Contents. November 3, Abdominal Aortic Aneurysm 2 3. Peripheral Arterial Disease 4 6. Deep Venous Thrombosis 7 8

BC Vascular Day. Contents. November 3, Abdominal Aortic Aneurysm 2 3. Peripheral Arterial Disease 4 6. Deep Venous Thrombosis 7 8 BC Vascular Day Contents Abdominal Aortic Aneurysm 2 3 November 3, 2018 Peripheral Arterial Disease 4 6 Deep Venous Thrombosis 7 8 Abdominal Aortic Aneurysm Conservative Management Risk factor modification

More information

Use of EKOS Catheter in the management of Venous Mr. Manoj Niverthi, Mr. Sarang Pujari, and Ms. Nupur Dandavate, The GTF Group

Use of EKOS Catheter in the management of Venous Mr. Manoj Niverthi, Mr. Sarang Pujari, and Ms. Nupur Dandavate, The GTF Group Use of EKOS Catheter in the management of Venous Thromboembolism @ Mr. Manoj Niverthi, Mr. Sarang Pujari, and Ms. Nupur Dandavate, The GTF Group Introduction Georgia Thrombosis Forum (GTF, www.gtfonline.net)

More information

Meissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, et al. J Vasc Surg. 2012;55:

Meissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, et al. J Vasc Surg. 2012;55: Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum Meissner MH, Gloviczki P, Comerota AJ,

More information

What is the optimal time window for treating deep venous thrombosis? Acute vs subacute vs chronic

What is the optimal time window for treating deep venous thrombosis? Acute vs subacute vs chronic What is the optimal time window for treating deep venous thrombosis? Acute vs subacute vs chronic Peter A. Schneider, MD Chief of Vascular Therapy Kaiser Foundation Hospital Honolulu, Hawaii Disclosure

More information

On Which Criteria Do You Select Your Stent for Ilio-femoral Venous Obstruction? North American Point of View

On Which Criteria Do You Select Your Stent for Ilio-femoral Venous Obstruction? North American Point of View On Which Criteria Do You Select Your Stent for Ilio-femoral Venous Obstruction? North American Point of View Peter Gloviczki, MD Ying Huang, MD, PhD Division of Vascular and Endovascular Surgery, Mayo

More information

ENHANCING YOUR OPTIONS

ENHANCING YOUR OPTIONS ANGIOJET ULTRA Thrombectomy System ENHANCING YOUR OPTIONS FOR RESTORING FLOW When you need the versatility and power to restore flow Refined from experience in over 700,000 cases worldwide, today s AngioJet

More information

Sinus Venous Thrombosis

Sinus Venous Thrombosis Sinus Venous Thrombosis Joseph J Gemmete, MD FACR, FSIR, FAHA Professor Departments of Radiology and Neurosurgery University of Michigan Hospitals Ann Arbor, MI Outline Introduction Medical Treatment Options

More information

How to best approach chronic venous occlusions?

How to best approach chronic venous occlusions? How to best approach chronic venous occlusions? Prof. Nils Kucher Director Venous Thromboembolism Reseach Group University Hospital Bern nilskucher.com Disclosure Speaker name: Nils Kucher X X I have the

More information

EKOS. Interventional Vascular 3 February, Imagine where we can go.

EKOS. Interventional Vascular 3 February, Imagine where we can go. EKOS Interventional Vascular 3 February, 2015 Imagine where we can go. Forward-looking statement This presentation and information communicated verbally to you may contain certain projections and other

More information

Outcomes Of Combined Rheolytic And Rotational Mechanical Thrombectomy For Total Access Circuit Thrombosis In Hemodialysis Patients

Outcomes Of Combined Rheolytic And Rotational Mechanical Thrombectomy For Total Access Circuit Thrombosis In Hemodialysis Patients Outcomes Of Combined Rheolytic And Rotational Mechanical Thrombectomy For Total Access Circuit Thrombosis In Hemodialysis Patients Nicholas Petruzzi, MD Raphael Cohen, MD Mark Mantell, MD Timothy W. Clark,

More information

Image-Guided Approach to Treatment of Patients with Nonthrombotic

Image-Guided Approach to Treatment of Patients with Nonthrombotic Image-Guided Approach to Treatment of Patients with Nonthrombotic May Thurner Syndrome Brian DeRubertis, MD, FACS Associate Professor of Surgery Division of Vascular Surgery UCLA School of Medicine Los

More information

TEACHING CASE # 5. Reocclusion Of Transverse And Sigmoid Venous Sinuses Mechanical and Chemical Thrombectomy

TEACHING CASE # 5. Reocclusion Of Transverse And Sigmoid Venous Sinuses Mechanical and Chemical Thrombectomy TEACHING CASE # 5 Reocclusion Of Transverse And Sigmoid Venous Sinuses Mechanical and Chemical Thrombectomy CASE PRESENTATION 22M with right transverse and sigmoid venous sinuses occlusion s/p transvenous

More information

Management of Acute DVT Extending From the Tibial Veins to the Common Iliac Vein Using the AngioJet Thrombectomy System

Management of Acute DVT Extending From the Tibial Veins to the Common Iliac Vein Using the AngioJet Thrombectomy System FEATURED TECHNOLOGY: ANGIOJET THROMBECTOMY SYSTEM Sponsored by Boston Scientific Corporation Management of Acute DVT Extending From the Tibial Veins to the Common Iliac Vein Using the AngioJet Thrombectomy

More information

Tom Eisele, Benedikt M. Muenz, and Grigorios Korosoglou. Department of Cardiology & Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany

Tom Eisele, Benedikt M. Muenz, and Grigorios Korosoglou. Department of Cardiology & Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany Case Reports in Vascular Medicine Volume 2016, Article ID 7376457, 4 pages http://dx.doi.org/10.1155/2016/7376457 Case Report Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial

More information

Treatment of Chronic DVT with EKOS: Reproducing ACCESS PTS Data in Every Day Clinical Practice

Treatment of Chronic DVT with EKOS: Reproducing ACCESS PTS Data in Every Day Clinical Practice Treatment of Chronic DVT with EKOS: Reproducing ACCESS PTS Data in Every Day Clinical Practice Mert Dumantepe, MD Acibadem Altunizade Hospital, Istanbul, Turkey Department of Cardiovascular Surgery Disclosure

More information

Ileo Femoral DVT Review and Update

Ileo Femoral DVT Review and Update Ileo Femoral DVT Review and Update Ammar Safar, MD, FSCAI, FACC, FACP, RPVI Interventional Cardiology & Endovascular Medicine Deep Vein Thrombosis Venous thromboembolism is a major national health problem,

More information

Canadian Society of Internal Medicine Annual Meeting 2017 Toronto, ON

Canadian Society of Internal Medicine Annual Meeting 2017 Toronto, ON Canadian Society of Internal Medicine Annual Meeting 2017 Toronto, ON How to Prevent and Manage the Post-Thrombotic Syndrome? Jean-Philippe Galanaud Clinical Thromboembolism & Division of GIM Sunnybrook,

More information

DEEP VENOUS THROMBOSIS A PRACTICAL APPROACH TO IMPROVING CLINICAL OUTCOMES

DEEP VENOUS THROMBOSIS A PRACTICAL APPROACH TO IMPROVING CLINICAL OUTCOMES DEEP VENOUS THROMBOSIS A PRACTICAL APPROACH TO IMPROVING CLINICAL OUTCOMES Jose M. Borromeo M.D. Vascular Surgeon Iowa Heart Center Disclosures: AstraZeneca Pharmaceuticals Cook CVRx LeMaitre Vascular,

More information

Catheter Interventions for pulmonary embolism:

Catheter Interventions for pulmonary embolism: Catheter Interventions for pulmonary embolism: From Directed tpa Drips to Suction Thrombectomy Efthymios Avgerinos, MD Associate Professor of Surgery Division of Vascular Surgery University of Pittsburgh

More information

Clinical results of venous stents. Michael K. W. Lichtenberg MD, FESC

Clinical results of venous stents. Michael K. W. Lichtenberg MD, FESC Clinical results of venous stents Michael K. W. Lichtenberg MD, FESC Conflict of Interest - Disclosure Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation

More information

PEARL REGISTRY Post Market Registry

PEARL REGISTRY Post Market Registry PEARL REGISTRY Post Market Registry Real World Use of the AngioJet Thrombectomy System in the Peripheral Vascular System PI-315422-AA JUN2015 Objectives AngioJet Action Enrollment General Indications &

More information

Venous stent experience in Arnsberg Michael K. W. Lichtenberg MD, FESC

Venous stent experience in Arnsberg Michael K. W. Lichtenberg MD, FESC Venous stent experience in Arnsberg Michael K. W. Lichtenberg MD, FESC IMPORTANT INFORMATION: These materials are intended to describe common clinical considerations and procedural steps for the on-label

More information

PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM

PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM International Consensus Statement 2013 Guidelines According to Scientific Evidence Developed under the auspices of the: Cardiovascular Disease Educational

More information

Michael Meuse, M.D. Vascular and Interventional Radiology

Michael Meuse, M.D. Vascular and Interventional Radiology Michael Meuse, M.D. Vascular and Interventional Radiology Iliac Vein Compression Syndrome Left CIV compressed by right CIA Virchow 1851: DVT L>R May and Thurner 1954: venous spurs Cockett and Thomas 1965:

More information

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved. Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of October 29, 2018 Mesenteric Arteriogram & Thrombectomy/Thrombolysis

More information

Future Devices of Venous Interventions

Future Devices of Venous Interventions Future Devices of Venous Interventions Director of Peripheral Vascular Medicine Department of Shin Kong Wu Ho-Su Memorial Hospital, Taiwan Interventional Cardiologist Tien-Yu Wu MD Disclosure Speaker name:...

More information

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved. Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of June 4, 2018 Thrombolysis, Thrombectomy & Angioplasty

More information

ACUTE LIMB ISCHEMIA Table of Contents

ACUTE LIMB ISCHEMIA Table of Contents ACUTE LIMB ISCHEMIA Table of Contents PERIPHERAL ARTERIAL DISEASE (PAD)... 1 INTERMITTENT CLAUDICATION (IC)... 1 CRITICAL LIMB ISCHEMIA (CLI)... 1 ACUTE LIMB ISCHEMIA (ALI)... 2 Risk Factors...2 Associated

More information

Single Center 4 year series of 114 consecutive patients treated for massive and submassive PE. Mark Goodwin, MD

Single Center 4 year series of 114 consecutive patients treated for massive and submassive PE. Mark Goodwin, MD Single Center 4 year series of 114 consecutive patients treated for massive and submassive PE Mark Goodwin, MD Disclosure Speaker name:... I have the following potential conflicts of interest to report:

More information

2017 Cardiology Survival Guide

2017 Cardiology Survival Guide 2017 Cardiology Survival Guide Chapter 2: Angioplasty/Atherectomy/Stent The term angioplasty literally means "blood vessel repair." During an angioplasty procedure, the physician inserts a catheter, with

More information

PERFORMANCE YOU CAN TRUST. EverFlex Self-expanding Peripheral Stent with Entrust Delivery System

PERFORMANCE YOU CAN TRUST. EverFlex Self-expanding Peripheral Stent with Entrust Delivery System PERFORMANCE YOU CAN TRUST EverFlex Self-expanding Peripheral Stent with Entrust Delivery System The Entrust Delivery System is designed to provide improved patient outcomes and procedural efficiency. The

More information

4/30/2018 CLOT+ In patients with an acute proximal deep vein thrombosis, pharmacomechanical catheter-directed thrombolysis does not reduce t

4/30/2018 CLOT+ In patients with an acute proximal deep vein thrombosis, pharmacomechanical catheter-directed thrombolysis does not reduce t In patients with an acute proximal deep vein thrombosis, pharmacomechanical catheter-directed thrombolysis does not reduce the rate of post-thrombotic syndrome Question In patients who have symptomatic

More information

VERNACULAR Trial & Clinical Experience with the VENOVO Venous Stent

VERNACULAR Trial & Clinical Experience with the VENOVO Venous Stent Stephen Black, MD VERNACULAR Trial & Clinical Experience with the VENOVO Venous Stent 1 Speaker Disclaimers The speakers presentation today is on behalf of Bard Peripheral Vascular, Inc. Any discussion

More information

Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully

Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully Physician Training Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully supported by self-expanding z-stents H&L-B

More information

Mechanical Thrombectomy Devices. Thomas M. Vesely, MD Vascular Access Services, LLC Saint Louis, Missouri

Mechanical Thrombectomy Devices. Thomas M. Vesely, MD Vascular Access Services, LLC Saint Louis, Missouri Mechanical Thrombectomy Devices Thomas M. Vesely, MD Vascular Access Services, LLC Saint Louis, Missouri No conflicts of interest relevant to thrombolysis / mechanical thrombectomy Number and Type of Hemodialysis

More information

Case Study of Implantation of a VICI VENOUS STENT - Combined NIVL and PTS Stenting

Case Study of Implantation of a VICI VENOUS STENT - Combined NIVL and PTS Stenting Case Study of Implantation of a VICI VENOUS STENT - Combined NIVL and PTS Stenting Courtesy of Mr. Stephen Black United kingdom Patient History 25 y/o female 2011: Conservatively treated ilio-femoral DVT

More information

Mechanical thrombectomy in peripheral interventions: A multitask and effective tool in a widening scenario. Current evidence and technical tips.

Mechanical thrombectomy in peripheral interventions: A multitask and effective tool in a widening scenario. Current evidence and technical tips. Mechanical thrombectomy in peripheral interventions: A multitask and effective tool in a widening scenario. Current evidence and technical tips. Dr. Bruno Freitas, Prof., MD Department of Interventional

More information

Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC

Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC 1 st workshop: update to VTE guidelines in 2016 2 nd workshop: VTE controversies + new horizons André Roussin MD, FRCP, CSPQ CHUM

More information

J Jpn Coll Angiol, 2009, 49:

J Jpn Coll Angiol, 2009, 49: Online publication August 27, 2009 1 2 J Jpn Coll Angiol, 2009, 49: 247 254 deep vein thrombosis, thrombolytic therapy, catheter-directed thrombolysis, inferior vena cava filter, pulmonary thromboembolism

More information

MAXIMIZE RADIAL SOLUTIONS TO PERIPHERAL CHALLENGES

MAXIMIZE RADIAL SOLUTIONS TO PERIPHERAL CHALLENGES MAXIMIZE RADIAL SOLUTIONS TO PERIPHERAL CHALLENGES PUSHING BOUNDARIES Terumo Interventional Systems is committed to your success with innovative procedural solutions and ongoing support for your most challenging

More information

Iliocaval Reconstruc0on in an OIS. William Julien, MD South Florida Vascular Associates Coconut Creek, FL

Iliocaval Reconstruc0on in an OIS. William Julien, MD South Florida Vascular Associates Coconut Creek, FL Iliocaval Reconstruc0on in an OIS William Julien, MD South Florida Vascular Associates Coconut Creek, FL Disclosures Consultant Cardiovascular Systems Inc Cook Outline Background Our Data Efficacy, Safety

More information

VIRTUS: Trial Design and Primary Endpoint Results

VIRTUS: Trial Design and Primary Endpoint Results VIRTUS: Trial Design and Primary Endpoint Results Mahmood K. Razavi, MD St. Joseph Cardiac and Vascular Center Orange, CA, USA IMPORTANT INFORMATION: These materials are intended to describe common clinical

More information

The evidence for venous interventions is evolving- many patients do actually benefit. Nils Kucher University Hospital Bern Switzerland

The evidence for venous interventions is evolving- many patients do actually benefit. Nils Kucher University Hospital Bern Switzerland The evidence for venous interventions is evolving- many patients do actually benefit Nils Kucher University Hospital Bern Switzerland Disclosure Speaker name: Nils Kucher X X I have the following potential

More information

5 year quality of life data after EKOS treatment in acute DVT

5 year quality of life data after EKOS treatment in acute DVT 5 year quality of life data after EKOS treatment in acute DVT Jochen Grommes MD European Vascular Center Aachen-Maastricht GxUS-EKO-2016-0006 LINC 2016 Disclosure of speaker s interests conflict of interest

More information

Disclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None

Disclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)

More information

IVC FILTERS: A CASE REPORT REVIEWING THE INDICATIONS FOR PLACEMENT, RETRIEVAL AND ANTICOAGULATION

IVC FILTERS: A CASE REPORT REVIEWING THE INDICATIONS FOR PLACEMENT, RETRIEVAL AND ANTICOAGULATION IVC FILTERS: A CASE REPORT REVIEWING THE INDICATIONS FOR PLACEMENT, RETRIEVAL AND ANTICOAGULATION Resident(s): George Athanasatos Attending(s): Daniel Golwyn Program/Dept: Interventional Radiology CHIEF

More information

What is New in Acute Pulmonary Embolism? Interventional Treatment. Prof. Nils Kucher University Hospital Bern Switzerland

What is New in Acute Pulmonary Embolism? Interventional Treatment. Prof. Nils Kucher University Hospital Bern Switzerland What is New in Acute Pulmonary Embolism? Interventional Treatment Prof. Nils Kucher University Hospital Bern Switzerland nils.kucher@insel.ch Disclosure of Interest Dr. Kucher received research grants

More information

Algorithm for Managing Acute Lower Extremity Ischemia. Peter A. Schneider, MD Honolulu, Hawaii

Algorithm for Managing Acute Lower Extremity Ischemia. Peter A. Schneider, MD Honolulu, Hawaii Algorithm for Managing Acute Lower Extremity Ischemia Peter A. Schneider, MD Honolulu, Hawaii Disclosure Peter A. Schneider, MD... I have the following potential conflicts of interest to report: Consulting:

More information

IVUS Guided Case Review Case Performed by Frank R. Arko III, MD Charlotte, NC

IVUS Guided Case Review Case Performed by Frank R. Arko III, MD Charlotte, NC IVUS Guided Case Review Case Performed by Frank R. Arko III, MD Charlotte, NC The opinions and clinical experiences presented herein are for informational purposes only. Dr. Arko is a paid consultant for

More information

CHALLENGING ILIAC ACCESSES AND THROMBOSIS PREVENTION

CHALLENGING ILIAC ACCESSES AND THROMBOSIS PREVENTION CHALLENGING ILIAC ACCESSES AND THROMBOSIS PREVENTION ARMANDO MANSILHA MD, PhD, FEBVS UNIVERSITY HOSPITAL - PORTO Disclosure of Interest Speaker name: ARMANDO MANSILHA I have the following potential conflicts

More information

Rotarex mechanical debulking: The Leipzig experience in patients

Rotarex mechanical debulking: The Leipzig experience in patients Rotarex mechanical debulking: The Leipzig experience in 1.200+ patients Dierk Scheinert, MD Division of Interventional Angiology University-Hospital Leipzig, Germany Disclosure Speaker name: Dierk Scheinert

More information

Appropriate Device Selection for Endovascular Procedures

Appropriate Device Selection for Endovascular Procedures Appropriate Device Selection for Endovascular Procedures Thomas M. Shimshak, MD Florida Hospital Heartland Medical Center Sebring, Florida Disclosures Speaker s Bureau: Abbott Vascular Boston Scientific

More information

Chronic deep venous occlusions: Case planning, recanalization and stent technique

Chronic deep venous occlusions: Case planning, recanalization and stent technique Chronic deep venous occlusions: Case planning, recanalization and stent technique Michael K. W. Lichtenberg, FESC German Venous Center Arnsberg, Germany Conflict of Interest - Disclosure Within the past

More information

Clinical Guide - Inferior Vena Cava Filters (Reviewed 2006)

Clinical Guide - Inferior Vena Cava Filters (Reviewed 2006) Clinical Guide - Inferior Vena Cava Filters (Reviewed 2006) Principal Developer: V. Oliva Secondary Developers: W. Geerts Background The treatment of choice for deep venous thrombosis (DVT) and pulmonary

More information