1620_Ting.pdf

1、Deep Vein Disease:Iliac Vein Compression and DVT ManagementWindsor Ting MD FACC FACSProfessor of Surgery&RadiologyMount Sinai Medical CenterNew YorkConflicts of InterestBoston Scientific:grant recipient,consultantMedtronic:consultantAOTI:speakerDVT900,000 individuals affected by DVT/PE25%of PE,the f

2、irst symptom is sudden death60,000-100,000 Americans die of VTE annually Treatment of DVTNew medical therapeutic options:Direct oral anticoagulants(DOACs)Many catheter thrombectomy devices:Boston Scientific AngioJet ZelenteDVT,Penumbra Lightning Flash 2.0,Inari ClotTriever SystemMay Thurner Syndrome

3、25 y/o male Presenting with acute left leg pain&swellingVenography:extensive DVT left CIV EIV CFV.Collaterals suggested a chronic componentAngiojet thrombectomyTPA(1 mg/hour)infusion x 24 hours.Left CIV EIV CFV patentSignificant clots and stenosis 16 mm x 90 mm WallstentThe stent was dilated with a

4、16 mm angioplasty balloon.Flow through the iliac veins was excellent atcase conclusion.80 y/o woman presenting with cold left leg&saddle PE.3/11/2024 Open left CFA embolectomy3/19/2024 Catheter closure of PFO3/21/2024 Venogram,catheter thrombectomy Venogram:left CIV DVT thrombusIVUS showed thrombus

5、extended into IVC,both CIV w moderate stenosis(50%-60%)Several technical approachesSuction catheter thrombectomyCompletion IVUS showed residual DVT thrombus in CIV&distal IVCBilateral iliac kissing stents62 y/o femaleAcute DVT left CIV EIV CFV FVAngioJet thrombectomy,balloon angioplasty,EKO tPA infu

6、sion x 12 hoursCompletion venogram showed patent vesselsIVUS showed moderate L CIV stenosisPatient declined stent placement2024 CT showed moderate L CIV compression2025 Venogram showed normal iliacIVUS showed moderate L CIV stenosisHow to M