Mechanical treatment for acute DVT. Laurent Casbas, MD Toulouse, France

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Transcription:

Laurent Casbas, MD Toulouse, France

Disclosure of Interest Speaker name: Laurent Casbas I have the following potential conflicts of interest to report: Consulting Medtronic General Electric

Acute Venous thromboembolism 104-183 per 100,000 person-year Two-year recurrence: 17% 50% of post thrombotic syndrom (inflammatory response) Thromb J. 2018 May 1;16:9. doi: 10.1186/s12959-018-0163-7. ecollection 2018. Design and rationale of the non-interventional, edoxaban treatment in routine clinical practice in patients with venous ThromboEmbolism in Europe (ETNA-VTE-Europe) study. B Eklof M Perrin KT Delis RB Rutherford P. Gloviczki Updated terminology of chronic venous disorders : The VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg 2009 (49) [ SR Kahn I Shrier JA Julian Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008 (149) [

Acute Life threatening at short term And long term effects: Quality of life impaired Chronic disease High costs for public health

Acute How to treat? Antithrombotic Therapy for VTE Disease: CHEST Guideline Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris T, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores CL, Antithrombotic Therapy for VTE Disease: CHEST Guideline, CHEST (2016), doi: 10.1016/j.chest.2015.11.026. The golden average remains anticaogulation therapies Vitamin K antagonists and new oral anticoagulants Rare indications for mechanical treatments

Acute How to treat? Is there any evidence for a mechanical treatment? Will it avoid or reduce acute and long-term consequences?

Open surgery: 1937 Embolectomy probe Invasive, blood loss, need for an AVF 86 % patency Thrombectomie veineuse chirurgicale O. Hartung Service de chirurgie vasculaire, centre hospitalier universitaire Nord, Marseille, France

Catheter Directed thrombolysis: 65,9 % patency (lack of stenting) Reduce by 14 % the PTS No change of QOL Higher risk of bleeding but less than with systemic thrombolysis T ** Enden Y Haig NE Klow Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study) : A randomised controlled trial.. Lancet 2012 (379)

Pharmacomechanical thrombectomy: Rheolytic thrombectomy, Bernoulli effect

Pharmacomechanical thrombectomy: Rotational thrombectomy

Pharmacomechanical thrombectomy: Ultrasonic thrombolysis

Pharmacomechanical thrombectomy: In selected patients Phlegmatia caerula dolens Massive or submassive PE Recurrent Antithrombotic Therapy for VTE Disease: CHEST Guideline Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris T, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores CL, Antithrombotic Therapy for VTE Disease: CHEST Guideline, CHEST (2016), doi: 10.1016/j.chest.2015.11.026.

Pharmacomechanical thrombectomy: In routine Reduce the sevevity of the PTS Increase the risk of bleeding No change of QOL Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis Suresh Vedantham, M.D., Samuel Z. Goldhaber, M.D., Jim A. Julian, M.Math., Susan R. Kahn, M.D., Michael R. Jaff, D.O.,David J. Cohen, M.D., Elizabeth &Al for the ATTRACT Trial Investigators

Pharmacomechanical thrombectomy: FIRST RESULTS More than 90% patency Safe effective Improve QOL Reduce PTS Less bleeding than CDT Cost-effective? J Endovasc Ther. 2018 Feb;25(1):133-139. doi: 10.1177/1526602817714570. Epub 2017 Jun 16. Comparison of Direct Iliofemoral Stenting Following AngioJet Rheolytic Thrombectomy vs Staged Stenting After AngioJet Rheolytic Thrombectomy Plus Catheter-Directed Thrombolysis in Patients With Acute Deep Vein Thrombosis. Phlebology. 2018 Jul;33(6):388-396. doi: 10.1177/0268355517711792. Epub 2017 May 22. The effect of Angiojet rheolytic thrombectomy in the endovascular treatment of lower extremity deep venous thrombosis.

Pharmacomechanical thrombectomy: What about cancer? Life expectancy more than 1 year Ann Vasc Surg. 2018 Mar 5. pii: S0890-5096(18)30204-8. doi: 10.1016/j.avsg.2018.01.081. [Epub ahead of print] Malignancy Does not Affect Outcomes of Pharmacomechanical Thrombolysis in Acute Symptomatic Iliofemoral Deep Vein Thrombosis

Some additionnal treatments are mandatory such as venous stenting and long-term anticoagulant therapy Eur J Vasc Endovasc Surg. 2018 Apr;55(4):537-544. doi: 10.1016/j.ejvs.2018.01.007. Epub 2018 Feb 12. Antithrombotic Therapy Following Venous Stenting: International Delphi Consensus.

PMT is not yet the golden average But it s a very promising way to improve venous therapies

Laurent Casbas, MD Toulouse, France

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