New Standard of Management of
Deep vein thrombosis and Pulmonary
Embolism

Vietnam Heart Association Meeting
October 8th 2012 12:00-12:30 Hall C
Thach Nguyen, M.D. FACC FSCAI
St Mary Medical Center
Hobart IN USA

Deep Vein Thrombosis

• DVT is a blood clot
in a deep vein

• Annual US incidence
250,000. 50 percent
are “silent.”

• The blood clot or
part of it can break
free and causes PE 1. Bulger et al, Tech Vasc Interv Radiol 2004;7:50-4.
Complications of extensive DVT
phlegmasia cerulea
dolens
May-Thurner Syndrome
Post-thrombotic Syndrome:
Chronic pain

1) Prevention of clot propagation
2) Prevention of PE and recurrent thrombosis
3) Restoration of venous patency and flow
4) Preservation of valvular function
5) Elimination of clinical symptoms associated with PTS
Endovascular Rx for DVT:
A Contemporary Approach
-
Pharmaco-mechanical treatment (PMT): function to both
dissolve (lytic assisted) and mechanically remove clot

-3 main available techniques:
1) Angiojet
2) Trellis
3) EKOS
EKOS
TRELLIS
ANGIOJET
Ultrasound Accelerated
Thrombolysis
The Challenges why Thrombus Is So
Difficult To Dissolve
• Plasminogen receptor sites are embedded into thrombus
during formation
• Speed of lysis depends on ability of lytic to access
plasminogen receptor sites
• Tightly wound fibrin strands prevent lytic from penetrating

No valve or wall damage
Very low risk of embolization
Ultrasound: Mechanism of action
Standard Infusion Catheter
Spread of Stained t-PA
Plasma Clot
Plasma Clot
Spread of Stained t-PA
EkoSonic Endovascular
Device
Review of recent studies on catheter-
directed treatment for DVT
CDT improves patency and reduces PTS
compared to anticoagulation
CaVenT Trial:
Randomized, controlled clinical trial determining benefit of CDT
 209 patients in 20 Nowegian hospitals; first time, acute IFDVT
 Treatment: anticoagulation vs. anticoagulation + CDT with tPA
 Patency evaluated at 6 months f/u
 Post-thrombotic syndrome (PTS) rates evaluated at 6 and 24
months f/u
Enden et al.; CaVenT Study Group. Lancet. 2012 Jan 7;379(9810):31-8.
 CDT group achieved:
 Higher patency at 6 months f/u
 Lower rate of PTS at 24 months f/u

Enden et al.; CaVenT Study Group. Lancet. 2012 Jan 7;379(9810):31-8.
CDT improves patency and reduces PTS
compared to anticoagulation
1) Patient should have documented iliac, femoral,