Lower Limb Management
Standard treatment of lower extremity DVTs consist of: anticoagulatnts, limb compression, elevation, and early amblulation. However, to prevent post-thrombotic syndrome (PTS), other interventions are used to achieve early thrombus removal, which can resolve venous obstruction and restore valve function in the thrombosed segment.
Surgical interventions for lower extremity DVTs consist of: Direct open surgical thrombectomy, suction thrombectomy, or catheter-directed thrombolysis (CDT). Contraindications for CDT consist of: allergies to thrombolytic agent, bleeding diatheses, coagulopathy, thrombocytopenia, renal or hepatic failure, or the presence of hemorrhagic prone tissue (stroke, myocardial infarction, major surgery, uncontrolled hypertension, metastatic malignancy or pregnancy).
Direct open surgical thrombectomy (with anticoagulants): promotes valvular and endothelial salvage, improved iliofemoral vein patency and preservation of femoropopliteal valve function. However, this method is not routine practice due to: surgical complications, the need for anaesthesia, and significant co-morbidity.
Suction thrombectomy: minimally invasive direct approach to early thrombus removal that can achieve successful recanalization. This method is considered more safe than the direct open surgical method and minimizes the risk of anti-coagulation-related hemorrhagic complications.
Catheter-Directed Thrombolysis (thrombolytic therapy = administration of thrombolytic agents that biologically impact the occluding thrombus; preferred method for treating proximal DVTs): CDT improves thrombus removal while reducing the drug dosage, treatment duration and bleeding complications, and has become the preference for early thrombus removal. CDT improves the preservation of venous endothelium and valvular function and should reduce the risk of recurrent DVTS and PTS.
*Following successful interventions, patients should be maintained on oral anticoagulation medications for an extended period of time.
References:
Nyamekye, I. and Merker, L. Management of proximal deep vein thrombosis. Phlebology. 2012; 27 Supplement 2: 61-72.
Standard treatment of lower extremity DVTs consist of: anticoagulatnts, limb compression, elevation, and early amblulation. However, to prevent post-thrombotic syndrome (PTS), other interventions are used to achieve early thrombus removal, which can resolve venous obstruction and restore valve function in the thrombosed segment.
Surgical interventions for lower extremity DVTs consist of: Direct open surgical thrombectomy, suction thrombectomy, or catheter-directed thrombolysis (CDT). Contraindications for CDT consist of: allergies to thrombolytic agent, bleeding diatheses, coagulopathy, thrombocytopenia, renal or hepatic failure, or the presence of hemorrhagic prone tissue (stroke, myocardial infarction, major surgery, uncontrolled hypertension, metastatic malignancy or pregnancy).
Direct open surgical thrombectomy (with anticoagulants): promotes valvular and endothelial salvage, improved iliofemoral vein patency and preservation of femoropopliteal valve function. However, this method is not routine practice due to: surgical complications, the need for anaesthesia, and significant co-morbidity.
Suction thrombectomy: minimally invasive direct approach to early thrombus removal that can achieve successful recanalization. This method is considered more safe than the direct open surgical method and minimizes the risk of anti-coagulation-related hemorrhagic complications.
Catheter-Directed Thrombolysis (thrombolytic therapy = administration of thrombolytic agents that biologically impact the occluding thrombus; preferred method for treating proximal DVTs): CDT improves thrombus removal while reducing the drug dosage, treatment duration and bleeding complications, and has become the preference for early thrombus removal. CDT improves the preservation of venous endothelium and valvular function and should reduce the risk of recurrent DVTS and PTS.
*Following successful interventions, patients should be maintained on oral anticoagulation medications for an extended period of time.
References:
Nyamekye, I. and Merker, L. Management of proximal deep vein thrombosis. Phlebology. 2012; 27 Supplement 2: 61-72.