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5 year quality of life data after EKOS®
treatment in acute DVT
Jochen Grommes MD
European Vascular Center Aachen-Maastricht
GxUS-EKO-2016-0006
LINC 2016
5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016 page 2
Disclosure of speaker’s interests
conflict of interest
See below
Potentially relevant company relationships
in connection with event 1
BTG
• Sponsorship or research funding2
• Fee or other (financial) payment3
• Shareholder4
• Other relationship, i.e. …5
Cook2
ab medica2,3
• Reason for early clot removal:
• Relief of acute symptoms • Swelling
• Pain
• Edema
• Risk reduction for posthrombotic syndrome (PTS) • residual venous obstruction
• residual thrombus
• valve incomptence
page 3 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
• New endovascular techniques are becoming more popular
• US 2013: 300.000 catheter-directed thrombolysis for DVT
• New pharmacomechanical devices were developed
• Most experience derives from small case series addressing patency
• CaVent-trial is the only PRT who presented long-term results
page 4 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
Seite 5 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
• EkoSonic® Endovascular System: ultrasound-accelerated catheter-directed
thrombolysis (UACDT)
• Mechanical: high frequency, low energy ultrasound
• Drug: recombinant tissue plasminogen activator • Bolus 5mg, 1mg per hour
• Heparin PTT 40-60 seconds
Seite 6 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
• Angiography
Start of UACDT
Seite 7 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
• Angiography
24 hours 48 hours
Seite 8 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
• Angiography
72 hours
Seite 9 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
• Follow-up:
• Clinical examination
• Ultrasound
• Assessment of PTS: Villalta-Score (score 0-33)
• Quality of life:
• Generic measures using ShortForm Health Survey-36 (SF36)
Physical Component Summary (PCS)
Mental Component Summary (MCS)
• Disease-specific measures using Venous Insufficiency Epidemiological and Economic Study (Veines)-Qol/Sym
Veines-Qol 26-items Questionaire
Veines Sym subscale of the Veines-Qol measuring venous symptoms
Seite 10 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
Our experience
•Since 2009: 40 patients with iliofemoral DVT (female: 21), 51 legs
•Recurrent DVT: 17/40
•Iliofemoral DVT with involvement of the inferior caval vein: 18/40
•Treatment time 79 ± 31 h (min 24 hours; max 120 hours)
•rtPA dosage 80.2 ± 35.9 mg
Seite 11 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
Primary Patency (n=51):
• >90% reduction of thrombus : 27
• 50-90% reduction of thrombus: 13
• < 50 % reduction of thrombus: 6
• no success: 5
• success: 79% (40/51)
50
-90 %
<50
%
No
su
ccess
> 9
0 %
red
ucti
on
of
thro
mb
us
0
20
40
60
Seite 12 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
n=387 (male=197)
> 9
0 %
red
ucti
on
of
thro
mb
us
no PTS
mild
moder
ate
seve
re0
20
40
60
80
100
Data percentage
no PTS
mild
moderate
severe
Seite 13 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
Follow-up Villalta-Score:
• low incidence of severe PTS after CDT
no PTS mild PTS moderate
PTS
severe
PTS
perc
enta
ge
successful EKOS/UACDT (n=21)
EKOS/UACDT without success (n=7)
no PTS
mild
moder
ate
seve
re0
20
40
60
80
100
Data percentage
no PTS
mild
moderate
severe
no PTS mild PTS moderate
PTS
severe
PTS perc
enta
ge
Kahn SR Determinants of health-related
Qol during the 2 years following DVT
J Thromb Haemost 2008 (n=387)
Seite 14 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
Quality of life I: SF36 PCS and MCS
1 2 3 4 5
0
20
40
60
Data 2
PCS
MCS
UACDT
PCS
MCS
Korlaar
2004 Ashrani
2010
Roberts
2014 Kahn
2008
UACDT
Kah
n SR e
t.al.
0
20
40
60
Data 3
VeinesQol
VeinesSym
Seite 15 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
Quality of life II VeinesSym/Qol
Kahn 2008 UACDT
VeinesQol
VeinesSym
Seite 16 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
• Follow-up shows improved patency after EKOS/UACDT in comparison to
conservative treatment
• Low incidence of complications
• Improved Qol after EKOS/UACDT in comparison to the literature
• We need (more) results of prospective randomized trials
Seite 17 5 year quality of life data after EKOS® treatment
in acute DVT, Lunch meeting at LINC 2016
background methods results conclusion
•Thank you for attention!
5 year quality of life data after EKOS®
treatment in acute DVT
Jochen Grommes MD
European Vascular Center Aachen-Maastricht
GxUS-EKO-2016-0006
![Current Drug Therapy€¦ · of acute DVT and PE is 9.0% and 30.1% in the first 3 months respectively [2]. Without adequate treatment, upto 50% of the patients with DVT may develop](https://img.pdfslide.us/doc/110x75/6041608628a049533e7d569f/current-drug-therapy-of-acute-dvt-and-pe-is-90-and-301-in-the-first-3-months.jpg)
