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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?