1. CRT Venous Disease

2. Acute and Chronic DVT: Are They Treatable?

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

4. 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

5. 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.

6. 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:

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

8. Imaging

11. 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:
Carter CJ, Prog Cardiovasc Dis 1994;36:

12. 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:
Carter CJ, Prog Cardiovasc Dis 1994;36:

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

14. Treatment of Venous Thromboembolic Disease

15. Acute Deep Venous Thrombosis

19. due to pulmonary embolism
140, ,000 deaths in USA
due to pulmonary embolism

21. Pulmonary Embolism
30% untreated
8% treated

22. 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

24. 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.

25. 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

26. Chronic Deep Venous Thrombosis

27. 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.

28. Approach?

34. Diagnosis?

35. Therapy?

48. Take Home Points