CRT 2012 Venous Disease

Acute and Chronic DVT: Are They Treatable?

Anthony C. Venbrux, MD Professor of Radiology and Surgery Director, Cardiovascular and Interventional Radiology The George Washington University Medical Center Washington, DC

Anthony Venbrux, MD Cook, Inc. Cordis Endovascular Honoraria received for medical lectures: Cook, Inc. Cordis Endovascular Bard Peripheral Vascular Terumo Interventional Systems Medrad-Possis Interventional Rex Medical Consultant - Bard Peripheral Vascular Consultant - ArtVentive Medical

Acute or Chronic DVT: Are They Treatable? Objectives At the conclusion of this presentation, the participant should be able to: 1) Review the clinical aspects of venous thromboembolic disease, both acute and chronic. Demographics Natural history 2) Emphasize the importance of early referral and intervention in the setting of acute DVT and PE.

Incidence of Symptomatic Deep Venous Thrombosis 60 to 180 cases per 100,000 population per year 300,000 new cases per year Carter CJ, Prog Cardiovasc Dis 1994;36:423-438

Venous Thromboembolic Disease Anticoagulation fails to promote venous recanalization. Post-thrombotic syndrome may result.

Imaging

Risk Factors And Predisposing Conditions for DVT Prior history of DVT Immobilization Postoperative state Age > 40 years Malignancy Porter JM et al. J Vasc Surg 1988;8:172-181 Carter CJ, Prog Cardiovasc Dis 1994;36:423-438

Risk Factors And Predisposing Conditions for DVT Associated diseases Cardiac Neurologic Limb trauma and surgical procedures Coagulation abnormalities Porter JM et al. J Vasc Surg 1988;8:172-181 Carter CJ, Prog Cardiovasc Dis 1994;36:423-438

Risk Factors And Predisposing Conditions for DVT Hormonal therapy Pregnancy and postpartum state Obesity Porter JM et al. J Vasc Surg 1988;8:172-181 Carter CJ, Prog Cardiovasc Dis 1994;36:423-438

Treatment of Venous Thromboembolic Disease

Acute Deep Venous Thrombosis

due to pulmonary embolism 140,000-200,000 deaths in USA due to pulmonary embolism

Pulmonary Embolism 30% untreated 8% treated

Chronic Venous Insufficiency It is estimated that 3% of the Medicare population has or has had a venous stasis ulcer The average cost to Medicare for treatment of venous stasis ulcers $16,000,000/month

Economic Burden of Venous Stasis Ulcer Therapy 78 patients treated for venous stasis ulcer 71 (91%) of patients healed Mean duration of follow-up: 119 days Mean number of patient visit: 7 14 patients required 18 hospitalizations Olin et al. Vascular Medicine 1999;4:1-7.

Economic Burden of Venous Stasis Ulcer Therapy Average total Medicare cost per patient $9,685.00 Home health care (48% of costs) Hospitalizations (25% of costs) Home dressing changes (21% of costs) Olin et al. Vascular Medicine 1999;4:1-7

Chronic Deep Venous Thrombosis

48 Y/O Male Bilateral chronic leg swelling, pain, skin changes – venous hypertension (Left greater than right). History of DVT 5 years earlier. Had a “stent” placed in the venous system at the time of his initial DVT. Later found to be hypercoagulable, on chronic warfarin therapy.

Approach?

Diagnosis?

Therapy?

Take Home Points