Early treatment of DVT means more treatment options
There are four venous thrombus treatment options. The first is medication – anticoagulation and compression stockings – while the others are proactive endovascular treatments:
- Mechanical thrombectomy (MT)
- Pharmacomechanical thrombectomy (PMT)
- Catheter-directed thrombolysis (CDT)
Early detection provides physicians with a wider range of treatment options for their patients, including thrombus removal through endovascular treatments. Thrombus removal can only occur within 28 days or less of symptom onset.1
Treatment strategies
Treatment strategies will be case-specific and informed by the stage of the clot.
“There are patients, particularly those with extensive DVT, who, despite anticoagulation, will still develop chronic DVT and ultimately Post Thrombotic Syndrome (PTS).
The endovascular approach allows us the ability to address patients we can identify as being at high risk for PTS. We can treat them before their clot hardens and causes permanent damage to the vein, saving them from the lifestyle limitations caused by PTS.”2
Source: Endovascular Today, July 2012
Current Trends in Endovascular Management
Long-term economic benefits of endovascular treatments
Over a lifetime, endovascular thrombus removal, despite high initial costs, leads to cost savings in the management of post-thrombotic syndrome in the long term.3
Over a patient's lifetime, treatment with oral anticoagulant (OAC) was more expensive (£37,206) than catheter-directed thrombolysis (£32,043) and pharmacomechanical thrombectomy (£36,288). Patients on OAC also had fewer quality-adjusted life years (QALYs) on average (12.9) compared to CDT (13.5) and PMT (13.3). As a result, both CDT and PMT were considered better options (dominant) in terms of cost-effectiveness. CDT was cheaper by £5,163 and provided 0.6 more QALYs than OAC, while PMT was £917 cheaper and provided 0.3 more QALYs than OAC.3
Treatment options
Anticoagulation and compression stockings
Medication and compression stockings remain the current standard of care – and for many patients, this is enough. However, this approach
- Doesn’t remove thrombus
- Falls short of improving quality of life
- Doesn’t stop people from developing PTS
Moreover:
About 1/3 of patients mismanage their anticoagulation regimes4.
Mechanical thrombectomy
- Minimally invasive thrombectomy method
- Allows for rapid thrombus removal
- Can be used for both arterial and venous clots
- Not recommended as standalone management for acute DVT in current guidelines5
Pharmacomechanical thrombectomy
- Combination of drug and mechanical thrombectomy to remove thrombus6
- Allows medication to soften the clot, followed by mechanical action to remove the clot6
Advantages7:
- Minimally invasive
- Removes thrombus
- Reduce procedure time/length of ICU stay
- Rapid symptomatic relief
- Reduced lytic dosage
- Minimizes bleeding complications
Limitations:
- Specialized skills required
- Higher cost of disposables
- Effectiveness may be reduced in long-standing thrombus
Catheter-directed thrombolysis8
- Endovascular placement of infusion catheter into affected area
- Thrombolytic drug migrates into clot
Advantages:
- Technologically simple
- Minimally invasive
- Resolves thrombus
- Low equipment expense
Limitations:
- Extensive exposure to thrombolytics
- Extended ICU stay
- Post-treatment care can be complicated
- Logistically challenging (ICU, Labs, Nursing)
- Requires specialized skills
- Multiple visits to the procedure lab
When to lyse and when not to lyse? How I Choose the Best Strategy for My DVT Patients
Prof. Stephen Black at Vascular Interventions Online 2022
Reasons to watch:
- Pharmacomechanical Thrombectomy remains the gold standard.
- AngioJet with PowerPulse™ offers good efficacy and safety profile.
- Patient selection is crucial.
- Focus on the details, by incorporating contemporary practices its possible to achieve very low rates of PTS and low complication rates.
Boston Scientific options for minimally invasive endovascular treatments
Effective treatment options are key to achieving beneficial and lasting clinical outcomes for patients. Boston Scientific is in the unique position of offering a highly differentiated solution for proactive endovascular treatments.
AngioJet™ Ultra Peripheral Thrombectomy system
Angiojet is the only mechanical thrombectomy system with Power Pulse™ technology – giving you the option of adding lytic to your procedure when you encounter an organized clot.
This combination offers rapid and highly effective thrombus removal, and can often mean faster restoration of flow, reduced lytic needed and may shorten treatment time5.
Learn more about AngioJet >
AngioJet™ ZelanteDVT™ Thrombectomy Catheter
The AngioJet™ ZelanteDVT thrombectomy catheter is designed to treat DVT in large-diameter upper and lower peripheral veins. It removes 4X* the thrombus compared to earlier generations.
View the ZelanteDVT product page >
*When compared to current 6F AngioJet catheters. Bench test data on file.Bench test results may not necessarily be indicative of clinical performance
EKOS™ Endovascular System - ultrasound accelerated thrombolysis
Surgical thrombectomy was once the only option for patients with post-thrombotic damage, a complication of DVT. Studies show that the EKOS Endovascular System, which uses Acoustic Pulse Thrombolysis, is safe and effective for use in these patients.13
WALLSTENT™ Endoprosthesis
There is extensive evidence that WALLSTENT™ Endoprosthesis is safe and effective for the treatment of iliofemoral venous outflow obstruction. WALLSTENT is engineered to provide fracture resistance and withstand the forces common in venous anatomy.
References:
- Vedantham S, et al. Society of Interventional Radiology. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2014 Sep;25(9):1317-25.
- Endovascular Today, July 2012: Current Trends in Endovascular Management.
- Cost Effectiveness of Early Endovenous Thrombus Removal for Acute Iliofemoral Deep Vein Thrombosis in the United Kingdom, Joseph B. Babigumira, Stephen A. Black, Solomon J. Lubinga b, Anna L. Pouncey, Eur J Vasc Endovasc Surg (2024) 67, 490e498.
- Parker CS, et al. J Gen Intern Med. 2007;22(9):1254-9.
- Nicolaides, A. N. et al. International Union of Angiology (IUA). Volume 32, No 2. CDER Trust, London, UK. April 2013.
- Thorpe PE. October 2007; Endovascular Today.
- Ng TT, et al. Ann Vasc Surg. 2014;28(4):1039-44.
- Thorpe PE. October 2007; Endovascular Today.
- Garcia MJ et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: Final report of the prospective multicenter PEARL (Peripheral Use of AngioJet™ Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry. J Vasc Interv Radiol 2015;26(6):777-785.
- Tang T et al. Pharmacomechanical Thrombectomy versus catheter-directed thrombolysis for iliofemoral deep vein thrombosis: A meta-analysis of clinical trials. Clin Appl Thromb Hemost. 2019;25:1-8.
- Pouncey AL et al. AngioJet™ Pharmacomechanical Thrombectomy and Catheter Directed Thrombolysis vs. Catheter Directed Thrombolysis Alone for the Treatment of Iliofemoral Deep Vein Thrombosis: A Single Centre Retrospective Cohort Study. Eur J Vasc Endovasc Surg 2020;60(4):578-585.
- Lichtenberg MKW et al. Endovascular mechanical thrombectomy versus thrombolysis in patients with iliofemoral deep vein thrombosis – a systematic review and meta-analysis. Vasa 2021;50(1):59-67.
- Garcia MJ et al. Ultrasound-accelerated thrombolysis and venoplasty for the treatment of post-thrombotic syndrome: Results of the ACCESS PTS Study. J Am Heart Assoc 2020;9(3):e013398.
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