management of post-endovenous ablation venous thrombosis stephen f. daugherty, md, facs clarksville,...

MANAGEMENT OF POST-ENDOVENOUS ABLATION VENOUS THROMBOSIS

Stephen F. Daugherty, MD, FACSClarksville, Tennessee, USA

NO RELEVANTCONFLICTS 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, 2005-2009

EHIT/DVT PERFA 1.74% 0EVLA 1.52% 2 (0.05%)

Bennaroch-Gampel, et al. J Vasc Surg Venous 2013; 1: 26-32.

COMPLICATIONS OF ENDOVENOUS ABLATION IN RANDOMIZED CONTROLLED TRIALS (17)

EHIT DVTSVT PE

RFA 0 0 18 (5.4%) 1330 LIMBS

EVLA 7 (0.7%) 2 (0.2%) 53/947 01009 LIMBS (5.6%)

Dermody, et al. J Vasc Surg:Venous pub online 08 July 2013

RADIOFREQUENCY ABLATION6707 LIMBS TREATED

EHIT DVTPE

201 (3%) 9 2Sufian, et al. J Vasc SurgVenous 2013; 1:159-

164

PuggianiMarshSadek/KabnikHaqqaniRavi

NUMBER130

28203083

733000

EHIT DVT3 (2.3%) 0

7(0.25% 14(0.5%)174(2.4%) 0 0

2(2.7%)0 0 1

ENDOVENOUS HEAT-INDUCED THROMBUS

CLASS 1CLASS 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 THROMBOSISSAPHENOUS TRIBUTARIES

NONSTEROIDAL ANTI-INFLAMMATORIESASPIRINELASTIC COMPRESSIONWARM COMPRESSES IF DESIREDLOW MOLECULAR WEIGHT HEPARIN?

- DEPENDING ON SEVERITY- ANTI-INFLAMMATORY EFFECT

DEEP VEIN THROMBOSIS

EXTENSION OF SVT VIA PERFORATOR

AT A REMOTE SITEUSUALLY CALF VEINS

TREATMENT OF DVT

FULL ANTICOAGULATION- LMWH AND WARFARIN, OR- NOVEL ANTICOAGULANT

COMPRESSIONAMBULATIONPERIODIC ELEVATIONTHROMBOPHILIA WORK-UP

PULMONARY EMBOLUS

ANTICOAGULATIONIV HEPARIN INITIALLY; THEN

LMWH AND WARFARIN ORNOVEL ANTICOAGULANT

BILATERAL LOWER EXTREMITY DUPLEX USABDOMINAL VENOUS DUPLEX USTHROMBOPHILIA WORK-UP

ISCHEMIC NEUROLOGIC EVENTS

ONE PUBLISHED REPORT-Caggiali, Franceschini, J Vasc Surg 2010

TENNESSEE45 Y/O REGISTERED NURSETRANSIENT UPPER EXT WEAKNESS AND

LOSS OF CONSCIOUSNESS20 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 BRAINNEUROLOGIC CONSULTATION

EVALUATE FOR ANTICOAGULATION ORTHROMBOLYSIS

BILATERAL LOWER EXTREMITY DUPLEX USCARDIAC ECHO WITH BUBBLE TEST FOR PFOCAROTID DUPLEX USABDOMINAL VENOUS DUPLEX US?