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Trellis DVT Presentation3

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Text of Trellis DVT Presentation3

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  • AgeTravelImmobilizationHistory of DVTMalignancySurgery Trauma

    Hypercoagulable StatesPregnancyOral ContraceptivesCentral venous cathetersSLE

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  • Pulmonary Embolism (PE).Post Thrombotic Syndrome (PTS).

  • Deep Vein Thrombosis (DVT) = a blood clot that forms within a vein and remains in the place where it originatedPulmonary Embolism (PE) = a blood clot that propagates and travels to the heart or lungs

    1. Stasis, or stagnant blood flow through veins This increases the contact time between blood and vein wall irregularities. It also prevents naturally occurring anticoagulants from mixing in the blood. Prolonged bed rest or immobility promotes stasis.2. Coagulation Coagulation is encouraged by the presence of tissue debris, collagen or fats in the veins. Orthopaedic surgery often releases these materials into the blood system. During hip replacement surgery, reaming and preparing the bone to receive the prosthesis can also release chemical substances (antigens) that stimulate clot formation into the blood stream.3. Damage to the vein walls This can occur during surgery as the physician retracts soft tissues as part of the procedure. This can also break intercellular bridges and release substances that promote blood clotting.Other factors that may contribute to the formation of thrombi in the veins include:Age Previous history of DVT or PE Metastatic malignancy Vein disease (such as varicose veins) Smoking Estrogen usage or current pregnancy Obesity Genetic factors *

  • Anatomic Criteria- Proximal ThombusCavalIliac veinFemoral vein

    Clinically SymptomaticActive/functional patients. Patients with massive swelling venous gangrene. Tolerate anticoagulation.Optimal outcome with acute DVT (2 weeks).

  • Improve quality of life.Preserve valve function and decrease post thrombotic syndrome (PTS)

  • Anticoagulation (Gold Standard).Inferior vena cava filter (Greenfield Filter)Interventional treatment.

  • does prevent clot propagation1.does reduce risk of pulmonary embolism.But, it typicallydoes NOT resolve clot.16does NOT rapidly resolve symptoms.16does NOT prevent PTS (Post Thrombotic Syndrome

    ANTICOAGULATION ALONE IS NOT ENOUGH

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  • Catheter directed lytics.EKOS catheter.Angiojet.Trellis Pharmaco-mechanical thrombectomy.

  • Proximal and distal balloons, with ballooninflation syringes, a thrombolysis infusion port, the thrombusaspiration syringe, and a drive unit for mechanical dispersionof the thrombolytic agent

    Potential Advantages of Local Thrombolysis and Mechanical Thrombectomy

    Local delivery of thrombolytic agent Smaller doses of thrombolytic agent Shorter duration of thrombolysis Avoid risks of systemic effects of thrombolytic agents- Can be used in patients with relative contraindicationsto thrombolysis- Decreases bleeding complications Less costlyThe Trellis thrombectomy system (Covidien)

  • Done in a Cardiovascular cathlab.Prone position (Popliteal vein approach).Percutaneous via 8 French Sheath.General vs. local with sedation (patient preference).

  • Isolated Pharmacomechanical Thrombolysis using the Trellis Peripheral Infusion System As presented at VEITH 11/2008 ~ 1,304 Venous Patients Commercial Registry

  • 54 year old male with recent resection of brain tumor presents to ER with massive right leg swelling that had been present for 24 hours. Denied chest pain or SOB. Venous US-extensive acute occlusive venous thrombus from ankle up to common femoral vein.

  • Initiated on anti-coagulant

    (Heparin(LMW),Thienopyridine,tPATissue Plasminogen activators ) in ER. Venogram Trellis Mechanical Thrombectomy Planned.

  • Can be done as an outpatient.Bedrest for 2-4 hours.Thigh high ACE wrap for 3 days, then compression stocking. Still need anticoagulation!!

  • The restoration of rapid inline venous flow was 100%, 50%-82% lysis was achieved in 82% of cases, mean tPA dose was 13.4 mg, mean treatment time was 91 minutes, and primary patency rate was 100% at 1-month follow-up

  • In patients with DVT involving, the ilio-femoral and the upper-extremity vessels,

    The use of the Trellis device was associated with a high technical success rate as well as a satisfactory 12-month patency rate.

    Reduced lytic dose shorter treatment time and hospital stay,No bleeding complications ( major bleeding, access-site pseudoaneurysms, distal embolism, or arteriovenous fistula formation.)

  • REFERENCES`)Total preservation of patency and valve function after percutaneous pharmacomechanical thrombolysis using theTrellis-8 system for an acute, extensive deep venous thrombosis.Wormald JR, Lane TR, Herbert PE, Ellis M, Burfitt NJ, Franklin IJ.2)Ann R Coll Surg Engl. 2012 Mar;94(2):e103-5. doi: 10.1308/003588412X13171221589496 3)http://www.ncbi.nlm.nih.gov/pubmed/17538133 Pharmacomechanical thrombectomy of acute deep vein thrombosis with theTrellis-8 isolated thrombolysis catheter.O'Sullivan GJ1,Lohan DG,Gough N,Cronin CG,Kee ST.

  • *Deep Vein Thrombosis (DVT) = a blood clot that forms within a vein and remains in the place where it originatedPulmonary Embolism (PE) = a blood clot that propagates and travels to the heart or lungs

    1. Stasis, or stagnant blood flow through veins This increases the contact time between blood and vein wall irregularities. It also prevents naturally occurring anticoagulants from mixing in the blood. Prolonged bed rest or immobility promotes stasis.2. Coagulation Coagulation is encouraged by the presence of tissue debris, collagen or fats in the veins. Orthopaedic surgery often releases these materials into the blood system. During hip replacement surgery, reaming and preparing the bone to receive the prosthesis can also release chemical substances (antigens) that stimulate clot formation into the blood stream.3. Damage to the vein walls This can occur during surgery as the physician retracts soft tissues as part of the procedure. This can also break intercellular bridges and release substances that promote blood clotting.Other factors that may contribute to the formation of thrombi in the veins include:Age Previous history of DVT or PE Metastatic malignancy Vein disease (such as varicose veins) Smoking Estrogen usage or current pregnancy Obesity Genetic factors *

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