5 year quality of life data after EKOS treatment in acute DVT
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1 5 year quality of life data after EKOS treatment in acute DVT Jochen Grommes MD European Vascular Center Aachen-Maastricht GxUS-EKO
2 LINC 2016 Disclosure of speaker s interests conflict of interest See below Potentially relevant company relationships in connection with event 1 BTG Sponsorship or research funding 2 Fee or other (financial) payment 3 Shareholder 4 Cook 2 ab medica 2,3 Other relationship, i.e. 5 page 2
3 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
4 New endovascular techniques are becoming more popular US 2013: catheter-directed thrombolysis for DVT New pharmacomechanical devices were developed Most experience derives from small case series addressing patency CaVent-trial is the only PRT who presented long-term results page 4
5 EkoSonic Endovascular System: ultrasound-accelerated catheter-directed thrombolysis (UACDT) Mechanical: high frequency, low energy ultrasound Drug: recombinant tissue plasminogen activator Bolus 5mg, 1mg per hour Heparin PTT seconds Seite 5
6 Angiography Start of UACDT Seite 6
7 Angiography 24 hours 48 hours Seite 7
8 Angiography 72 hours Seite 8
9 Follow-up: Clinical examination Ultrasound Assessment of PTS: Villalta-Score (score 0-33) Quality of life: Generic measures using ShortForm Health Survey-36 (SF36) Physical Component Summary (PCS) Mental Component Summary (MCS) Disease-specific measures using Venous Insufficiency Epidemiological and Economic Study (Veines)-Qol/Sym Veines-Qol 26-items Questionaire Veines Sym subscale of the Veines-Qol measuring venous symptoms Seite 9
10 Our experience Since 2009: 40 patients with iliofemoral DVT (female: 21), 51 legs Recurrent DVT: 17/40 Iliofemoral DVT with involvement of the inferior caval vein: 18/40 Treatment time 79 ± 31 h (min 24 hours; max 120 hours) rtpa dosage 80.2 ± 35.9 mg Seite 10
11 > 90 % reduction of thrombus % <50% No success background methods results conclusion Primary Patency (n=51): 60 >90% reduction of thrombus : % reduction of thrombus: 13 < 50 % reduction of thrombus: 6 no success: 5 success: 79% (40/51) Seite 11
12 > 90 % reduction of thrombus background methods results conclusion n=387 (male=197) Seite 12
13 percentage percentage background methods results conclusion Follow-up Villalta-Score: low incidence of severe PTS after CDT Data percentage 100 no PTS mild 80 moderate severe Data percentage 0 no PTS no PTS mild PTS moderate PTS mild moderate severe PTS severe 0 no PTS mild PTS moderate PTS no PTS mild moderate severe PTS severe successful EKOS/UACDT (n=21) EKOS/UACDT without success (n=7) Kahn SR Determinants of health-related Qol during the 2 years following DVT J Thromb Haemost 2008 (n=387) Seite 13
14 Quality of life I: SF36 PCS and MCS 60 Data 2 PCS MCS PCS MCS 0 1 UACDT Korlaar Ashrani 2010 Roberts Kahn 2008 Seite 14
15 Quality of life II VeinesSym/Qol Data 3 VeinesQol VeinesSym VeinesQol VeinesSym 0 UACDT UACDT Kahn 2008 Kahn SR et.al. Seite 15
16 Follow-up shows improved patency after EKOS/UACDT in comparison to conservative treatment Low incidence of complications Improved Qol after EKOS/UACDT in comparison to the literature We need (more) results of prospective randomized trials Seite 16
17 Thank you for attention! Seite 17
18 5 year quality of life data after EKOS treatment in acute DVT Jochen Grommes MD European Vascular Center Aachen-Maastricht GxUS-EKO
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