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Pharmacomechanical Thrombolysis for Treatment of Acute DVT in a Patient with Inferior Vena Cava Atresia Salman Arain, MD, FACC Assistant Professor of Medicine - Cardiology University of Texas Health Sciences Center – Houston Texas, USA LINC 2016 - Global Expert Exchange

Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

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Page 1: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

Pharmacomechanical Thrombolysis for Treatment of Acute DVT in a Patient

with Inferior Vena Cava Atresia

Salman Arain, MD, FACC Assistant Professor of Medicine - Cardiology

University of Texas Health Sciences Center – Houston Texas, USA

LINC 2016 - Global Expert Exchange

Page 2: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

Disclosure Speaker name: Salman A. Arain, MD

.................................................................................

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest

LINC 2016 - Global Expert Exchange

Page 3: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

Case History

• 30 year old white female with no known past medical history with a 2 day history of bilateral lower extremity pain and swelling.

LINC 2016 - Global Expert Exchange

Page 4: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

A. D. C. B.

Baseline Angiogram

LINC 2016 - Global Expert Exchange

Page 5: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

A T8-9

L1-L2

Thrombosed Distal IVC

CT on Day 1

B

C

LINC 2016 - Global Expert Exchange

Page 6: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

A B

Day 2 – Initial Angio

LINC 2016 - Global Expert Exchange

Page 7: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

A. D. C. B.

Day 2 – Thrombectomy followed by IVUS

LINC 2016 - Global Expert Exchange

Page 8: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

A. B.

1. 12.0 mm

2. 9.8 mm

Thrombus

Day 2 - IVUS

LINC 2016 - Global Expert Exchange

Page 9: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

Aspirated thrombus from the right iliac veins.

A. C. B. C.

Balloon

Balloon

Trellis Wire

Day 2 – Thrombectomy

LINC 2016 - Global Expert Exchange

Page 10: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

A. D. C. B.

Day 2 - Trellis in the LLE

LINC 2016 - Global Expert Exchange

Page 11: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

A. B. C.

10 x 30 mm SMART Stent

Day 3 – Angio

LINC 2016 - Global Expert Exchange

Page 12: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

Final Angio

LINC 2016 - Global Expert Exchange

Page 13: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

Clinical Follow-up • An extensive workup for hypercoagulability and

malignancy was unremarkable.

• Patient was started on warfarin and bridged to a therapeutic INR with enoxaparin.

• The patient was discharged on day 10 at which time she could ambulate without any difficulty.

• She was asymptomatic at the time of her last follow-up (17 months).

LINC 2016 - Global Expert Exchange

Page 14: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

Thank You

LINC 2016 - Global Expert Exchange

Page 15: Pharmacomechanical Thrombolysis for Treatment of Acute DVT ... · Speaker name: Salman A. Arain, MD ..... I have the following potential conflicts of interest to report: Consulting

Pharmacomechanical Thrombolysis for Treatment of Acute DVT in a Patient

with Inferior Vena Cava Atresia

Salman Arain, MD, FACC Assistant Professor of Medicine - Cardiology

University of Texas Health Sciences Center – Houston Texas, USA

LINC 2016 - Global Expert Exchange