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Thromboembolic Risk of Endovascular Intervention for Lower Extremity Deep Venous Thrombosis
Volume 43, August 2017
Southern California Vascular Surgical Society 35th Annual Meeting 53
wide variation, the incidence is new post-operative MI is exceptionally low. Further studies should evaluate the cost-effectiveness of the PCST practices and future quality improvement efforts should focus on standardization of indications for PCST.
Table Registry
n
Stress test (%)
% normal stress
# new MI
PVI CEA CAS TEVAR Infra EVAR Supra OAAA
1197 902 108 150 263 294 86 63
206 261 33 46 84 151 49 39
87 87 70 93 83 87 88 92
0 0 1 4 1 4 1 1
(17) (29) (31) (31) (32) (52) (57) (62)
http://dx.doi.org/10.1016/j.avsg.2017.06.025
THROMBOEMBOLIC RISK OF ENDOVASCULAR INTERVENTION FOR LOWER EXTREMITY DEEP VENOUS THROMBOSIS Philip Lindsey, Angela Echeverria, Mun J. Poi, Elias Kfoury, Carlos F. Bechara, and Peter H. Lin Baylor College of Medicine, Houston, TX. Houston Methodist Hospital, Houston, TX. University Vascular Associates, Los Angeles, CA. Sponsored by: Samuel S. Ahn, MD Introduction: This study evaluated the risk of thromboembolism during endovascular interventions in patients with symptomatic lower extremity deep vein thrombosis (DVT). Methods: Clinical records of all patients who underwent endovascular interventions for symptomatic lower extremity DVT from 2003 to 2015 were retrospectively analyzed using a prospectively maintained database. Only patients who received an IVC filter were included in the analysis. Tapped intra-filter thrombus was assessed for procedural-related thromboembolism. Clinical outcomes of thrombus management and risk for thromboembolism risk were analyzed. Results: A total 136 patients (mean age 52.4 years, 65 females) who underwent 154 endovascular DVT interventions were included in the analysis. Treatment strategies included thrombolytic therapy (n¼97, 63%), mechanical thrombectomy (n¼88, 57%), pharmacomechanical thrombectomy (n¼66, 43%), balloon angioplasty (n¼46, 95%), and stent placement (n¼62, 40%). Thrombectomy device used included AngioJet (65%), Trellis (31%), and Aspire (4%). Trapped thrombus was identified in the IVC filter in 38%
(n¼59) of patients based on the IVC venogram. No patient developed clinically-evident pulmonary embolism. IVC filter retrieval was performed in 103 patients (67%, mean 11 months after implantation). Pre-retrieval IVC venogram identified thrombus in 25 patients (24%). Multivariate analysis showed prolonged AngioJet run time (>200 seconds, p < 0.04)) and iliac vein occlusion (P < 0.03) wee risk factors for procedural-related thromboembolism. Conclusions: Percutaneous AngioJet thrombectomy with prolonged run time and iliac vein occlusion are associated with an increased thromboembolic risk in DVT intervention. Retrievable IVC filter should be considered to prevent pulmonary embolism when performing percutaneous thrombectomy in patients with iliofemoral DVT. http://dx.doi.org/10.1016/j.avsg.2017.06.026
UNDERUTILIZATION OF THROMBOLYTIC THERAPY FOR PATIENTS DIAGNOSED WITH ACUTE DEEP VENOUS THROMBOSIS IN THE OUTPATIENT SETTING Mark Archie, Meena Archie, Jessica O’Connell, and Brian DeRubertis UCLA Gonda (Goldschmied) Vascular Center. Objective: Catheter-directed thrombolysis (CDT) has been shown to be a safe and effective treatment for the management of acute iliofemoral DVT. The potential benefits of this therapy include more rapid resolution of symptoms and possible reduction in the long-term sequelae. Many patients diagnosed with DVT in the inpatient setting have contraindications to lytic therapy, but less is known regarding the suitability of thrombolysis for outpatients diagnosed with acute DVT. We sought to determine the proportion of patients who were candidates for thrombolytic therapy and were referred to a vascular specialist for evaluation. Methods: A manual search of an outpatient vascular laboratory associated with a tertiary medical center was performed to identify all patients referred for the purpose of ruling out DVT between Jan 2013 and December 2014. Vascular lab studies conducted for evaluation of venous insufficiency were excluded. The electronic medical records were reviewed to evaluate for contraindications for thrombolysis. Results: Over a 2-year period, there were 689 referrals to the outpatient vascular laboratory for the evaluation of patients with suspected DVT. Of the 689 referrals, 47 (6.8%) were found to have acute and 66 (9%) were found to have chronic DVT. Of the 47 patients with acute DVT, 41 involved the lower extremities. Fifteen of the 41 patients (36%) with extensive acute iliofemoral DVT had no absolute or major contraindications for CDT. Of these 15 patients, only 33% were referred to a vascular specialist
Southern California Vascular Surgical Society 35th Annual Meeting 53
wide variation, the incidence is new post-operative MI is exceptionally low. Further studies should evaluate the cost-effectiveness of the PCST practices and future quality improvement efforts should focus on standardization of indications for PCST.
Table Registry
n
Stress test (%)
% normal stress
# new MI
PVI CEA CAS TEVAR Infra EVAR Supra OAAA
1197 902 108 150 263 294 86 63
206 261 33 46 84 151 49 39
87 87 70 93 83 87 88 92
0 0 1 4 1 4 1 1
(17) (29) (31) (31) (32) (52) (57) (62)
http://dx.doi.org/10.1016/j.avsg.2017.06.025
THROMBOEMBOLIC RISK OF ENDOVASCULAR INTERVENTION FOR LOWER EXTREMITY DEEP VENOUS THROMBOSIS Philip Lindsey, Angela Echeverria, Mun J. Poi, Elias Kfoury, Carlos F. Bechara, and Peter H. Lin Baylor College of Medicine, Houston, TX. Houston Methodist Hospital, Houston, TX. University Vascular Associates, Los Angeles, CA. Sponsored by: Samuel S. Ahn, MD Introduction: This study evaluated the risk of thromboembolism during endovascular interventions in patients with symptomatic lower extremity deep vein thrombosis (DVT). Methods: Clinical records of all patients who underwent endovascular interventions for symptomatic lower extremity DVT from 2003 to 2015 were retrospectively analyzed using a prospectively maintained database. Only patients who received an IVC filter were included in the analysis. Tapped intra-filter thrombus was assessed for procedural-related thromboembolism. Clinical outcomes of thrombus management and risk for thromboembolism risk were analyzed. Results: A total 136 patients (mean age 52.4 years, 65 females) who underwent 154 endovascular DVT interventions were included in the analysis. Treatment strategies included thrombolytic therapy (n¼97, 63%), mechanical thrombectomy (n¼88, 57%), pharmacomechanical thrombectomy (n¼66, 43%), balloon angioplasty (n¼46, 95%), and stent placement (n¼62, 40%). Thrombectomy device used included AngioJet (65%), Trellis (31%), and Aspire (4%). Trapped thrombus was identified in the IVC filter in 38%
(n¼59) of patients based on the IVC venogram. No patient developed clinically-evident pulmonary embolism. IVC filter retrieval was performed in 103 patients (67%, mean 11 months after implantation). Pre-retrieval IVC venogram identified thrombus in 25 patients (24%). Multivariate analysis showed prolonged AngioJet run time (>200 seconds, p < 0.04)) and iliac vein occlusion (P < 0.03) wee risk factors for procedural-related thromboembolism. Conclusions: Percutaneous AngioJet thrombectomy with prolonged run time and iliac vein occlusion are associated with an increased thromboembolic risk in DVT intervention. Retrievable IVC filter should be considered to prevent pulmonary embolism when performing percutaneous thrombectomy in patients with iliofemoral DVT. http://dx.doi.org/10.1016/j.avsg.2017.06.026
UNDERUTILIZATION OF THROMBOLYTIC THERAPY FOR PATIENTS DIAGNOSED WITH ACUTE DEEP VENOUS THROMBOSIS IN THE OUTPATIENT SETTING Mark Archie, Meena Archie, Jessica O’Connell, and Brian DeRubertis UCLA Gonda (Goldschmied) Vascular Center. Objective: Catheter-directed thrombolysis (CDT) has been shown to be a safe and effective treatment for the management of acute iliofemoral DVT. The potential benefits of this therapy include more rapid resolution of symptoms and possible reduction in the long-term sequelae. Many patients diagnosed with DVT in the inpatient setting have contraindications to lytic therapy, but less is known regarding the suitability of thrombolysis for outpatients diagnosed with acute DVT. We sought to determine the proportion of patients who were candidates for thrombolytic therapy and were referred to a vascular specialist for evaluation. Methods: A manual search of an outpatient vascular laboratory associated with a tertiary medical center was performed to identify all patients referred for the purpose of ruling out DVT between Jan 2013 and December 2014. Vascular lab studies conducted for evaluation of venous insufficiency were excluded. The electronic medical records were reviewed to evaluate for contraindications for thrombolysis. Results: Over a 2-year period, there were 689 referrals to the outpatient vascular laboratory for the evaluation of patients with suspected DVT. Of the 689 referrals, 47 (6.8%) were found to have acute and 66 (9%) were found to have chronic DVT. Of the 47 patients with acute DVT, 41 involved the lower extremities. Fifteen of the 41 patients (36%) with extensive acute iliofemoral DVT had no absolute or major contraindications for CDT. Of these 15 patients, only 33% were referred to a vascular specialist