Deep vein thrombosis invasive therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Catheter directed thrombolysis (CDT) and pharmacomechanical catheter directed thrombolysis (PCDT) are indicated for the treatment of iliofemoral deep vein thrombosis (IFDVT) that is associated with circulatory abnormalities that are limb threatening. | Catheter directed thrombolysis (CDT) and pharmacomechanical catheter directed thrombolysis (PCDT) are indicated for the treatment of iliofemoral deep vein thrombosis (IFDVT) that is associated with circulatory abnormalities that are limb threatening. Stent placement in the iliac veins can be considered following CDT and PCDT for the treatment of obstructive lesions. Stent placement can also be considered to attenuate symptoms of severe post thrombotic syndrome associated with iliac vein obstruction. | ||
==2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)<ref name="pmid21422387">{{cite journal|author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 |pmid=21422387 | doi=10.1161/CIR.0b013e318214914f| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>== | ==2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)<ref name="pmid21422387">{{cite journal|author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 |pmid=21422387 | doi=10.1161/CIR.0b013e318214914f| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Catheter directed thrombolysis (CDT) and pharmacomechanical catheter directed thrombolysis (PCDT) are indicated for the treatment of iliofemoral deep vein thrombosis (IFDVT) that is associated with circulatory abnormalities that are limb threatening. Stent placement in the iliac veins can be considered following CDT and PCDT for the treatment of obstructive lesions. Stent placement can also be considered to attenuate symptoms of severe post thrombotic syndrome associated with iliac vein obstruction.
2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)[1]
Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)[1]
| Class III (No Benefit) |
| "1. Systemic fibrinolysis should not be given routinely to patients with IFDVT (Level of Evidence: A)." |
| "2. CDT or PCDT should not be given to most patients with chronic DVT symptoms (>21 days) or patients who are at high risk for bleeding complications (Level of Evidence: B)." |
| Class I |
| "1. CDT or PCDT should be given to patients with IFDVT associated with limb-threatening circulatory compromise (ie, phlegmasia cerulea dolens) (Level of Evidence: C)." |
| "2. Patients with IFDVT at centers that lack endovascular thrombolysis should be considered for transfer to a center with this expertise if indications for endovascular thrombolysis are present (Level of Evidence: C)." |
| Class IIa |
| "1. CDT or PCDT is reasonable for patients with IFDVT associated with rapid thrombus extension despite anticoagulation (Level of Evidence: C) and/or symptomatic deterioration from the IFDVT despite anticoagulation (Level of Evidence: B)." |
| "2. CDT or PCDT is reasonable as first-line treatment of patients with acute IFDVT to prevent PTS in selected patients at low risk of bleeding complications (Level of Evidence: B)." |
Recommendations for Percutaneous Transluminal Venous Angioplasty and Stenting (DO NOT EDIT)[1]
| Class IIa |
| "1. Stent placement in the iliac vein to treat obstructive lesions after CDT, PCDT, or surgical venous thrombectomy is reasonable (Level of Evidence: C)." |
| "2. For isolated obstructive lesions in the common femoral vein, a trial of percutaneous transluminal angioplasty without stenting is reasonable (Level of Evidence: C)." |
| "3. The placement of iliac vein stents to reduce PTS symptoms and heal venous ulcers in patients with advanced PTS and iliac vein obstruction is reasonable (Level of Evidence: C)" |
| "4. After venous stent placement, the use of therapeutic anticoagulation with similar dosing, monitoring, and duration as for IFDVT patients without stents is reasonable (Level of Evidence: C)" |
| Class IIb |
| "1. After venous stent placement, the use of antiplatelet therapy with concomitant anticoagulation in patients perceived to be at high risk of rethrombosis may be considered (Level of Evidence: C) " |
References
- ↑ 1.0 1.1 1.2 Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (2011). "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association". Circulation. 123 (16): 1788–830. doi:10.1161/CIR.0b013e318214914f. PMID 21422387.