MANAGEMENT OF POST-ENDOVENOUS ABLATION VENOUS THROMBOSIS Stephen F. Daugherty, MD, FACS Clarksville, Tennessee, USA.

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Presentation transcript:

MANAGEMENT OF POST-ENDOVENOUS ABLATION VENOUS THROMBOSIS Stephen F. Daugherty, MD, FACS Clarksville, Tennessee, USA

NO RELEVANT CONFLICTS OF INTEREST

ENDOVENOUS HEAT-INDUCED THROMBUS DEEP VEIN THROMBOSIS INCIDENCE IN LITERATURE SURVEY RADIOFREQUENCY ABLATION (RFA)0-16% ENDOVENOUS LASER ABLATION (EVLA) 0-8%

NATIONAL SURGICAL QUALITY IMPROVEMENT PROJECT 3874 PATIENTS, EHIT/DVTPE RFA1.74%0 EVLA1.52%2 (0.05%) Bennaroch-Gampel, et al. J Vasc Surg Venous 2013; 1:

COMPLICATIONS OF ENDOVENOUS ABLATION IN RANDOMIZED CONTROLLED TRIALS (17) EHITDVTSVT PE RFA (5.4%) LIMBS EVLA 7 (0.7%) 2 (0.2%) 53/ LIMBS (5.6%) Dermody, et al. J Vasc Surg:Venous pub online 08 July 2013

RADIOFREQUENCY ABLATION 6707 LIMBS TREATED EHITDVTPE 201 (3%) 9 2 Sufian, et al. J Vasc SurgVenous 2013; 1:

Puggiani Marsh Sadek/Kabnik Haqqani Ravi NUMBER EHIT DVT 3 (2.3%) 0 7(0.25% 14(0.5%)1 74(2.4%) 0 0 2(2.7%) 0 0 1

ENDOVENOUS HEAT-INDUCED THROMBUS CLASS 1 CLASS 2 CLASS 3 CLASS 4 - OBSERVATION OR ANTIPLATELET RX - LOW MOLECULAR WEIGHT HEPARIN OR ANTIPLATELET AGENTS WEEKLY ULTRASOUND FOLLOW-UP - LOW MOLECULAR WEIGHT HEPARIN +- ORAL ANTICOAGULATION - LOW MOLECULAR WEIGHT HEPARIN AND ORAL ANTICOAGULATION

SECONDARY THROMBOSIS SAPHENOUS TRIBUTARIES NONSTEROIDAL ANTI-INFLAMMATORIES ASPIRIN ELASTIC COMPRESSION WARM COMPRESSES IF DESIRED LOW MOLECULAR WEIGHT HEPARIN? - DEPENDING ON SEVERITY - ANTI-INFLAMMATORY EFFECT

DEEP VEIN THROMBOSIS EXTENSION OF SVT VIA PERFORATOR AT A REMOTE SITE USUALLY CALF VEINS

TREATMENT OF DVT FULL ANTICOAGULATION - LMWH AND WARFARIN, OR - NOVEL ANTICOAGULANT COMPRESSION AMBULATION PERIODIC ELEVATION THROMBOPHILIA WORK-UP

PULMONARY EMBOLUS ANTICOAGULATION IV HEPARIN INITIALLY; THEN LMWH AND WARFARIN OR NOVEL ANTICOAGULANT BILATERAL LOWER EXTREMITY DUPLEX US ABDOMINAL VENOUS DUPLEX US THROMBOPHILIA WORK-UP

ISCHEMIC NEUROLOGIC EVENTS ONE PUBLISHED REPORT - Caggiali, Franceschini,J Vasc Surg 2010 TENNESSEE 45 Y/O REGISTERED NURSE TRANSIENT UPPER EXT WEAKNESS AND LOSS OF CONSCIOUSNESS 20 DAYS AFTER RFA BILATERAL ANTERIOR ACCESSORY SAPHENOUS VEINS

- LARGE PATENT FORAMEN OVALE - 55 DAYS AFTER ABLATION AND 35 DAYS AFTER STROKE, LOWER EXTREMITY DUPLEX US SHOWS A VERY SMALL AMOUNT OF THROMBUS IN A FOCAL DILATATION (12 mm) OF A GSV

STROKE MANAGEMENT MAGNETIC RESONANCE IMAGING OF BRAIN NEUROLOGIC CONSULTATION EVALUATE FOR ANTICOAGULATION OR THROMBOLYSIS BILATERAL LOWER EXTREMITY DUPLEX US CARDIAC ECHO WITH BUBBLE TEST FOR PFO CAROTID DUPLEX US ABDOMINAL VENOUS DUPLEX US?