Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

Deep vein thrombosis

“…Venous ulcers are typically located medially above the ankle, with an irregular outline, and can be discoloured, oedematous, and exudative. The main risk factors include recurrent ipsilateral DVT and non-therapeutic international normalised ratio (>50% of the time) 28. Other risks include advanced age, increased body mass index, female sex, and size and location of thrombosis 2829…”

“…Selection of patients must be guided by a multidisciplinary approach, with inputs from a vascular surgeon and interventional radiologist, and must consider patient preferences 2845464748…”

Pathogenesis of Thromboembolism and Endovascular Management

“…The use of ultrasound equipped catheters such as EkoSonic catheter (EKOS, Bothell, WA), termed US-assisted CDT, is notable as opposed to infusion-only CDT (see Figure 1). US-assisted CDT aids in dispersing the thrombolytic drug within the clot, thereby maximizing drug distribution and minimizing mechanical damage of the venous wall [10, 11, 53]. The spectrum of conditions in which CDT is applicable is broad and can include chronic iliac and/or caval stenosis or occlusions with or without IVC filter, May-Thurner syndrome and its variant, and femoropopliteal disease in addition to DVT [10, 11, 54, 55].…”

“…Disadvantages of CDT include admission of the patient to an intensive care unit. Complications span a spectrum of minor bleeding at the access site to major bleeding (2.8%), PE (0.5%), and possibly significant pain and therefore it requires strict monitoring for bleeding complications and patient discomfort [10, 11]. However, if it is performed safely, some of the benefits of performing CDT can include a decreased incidence of recurrent thrombotic events with improved quality of life.…”

“…However, oncology patients presenting a higher risk of thromboembolism must be considered and assessed before CDT given the significantly higher mortality in this group when compared to that of the general population following DVT. Postprocedure aggressive anticoagulation is advocated although this has not been well studied [10, 11]. Supportive treatments including compression stockings are also suggested [10, 11].…”