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Review
. 2018 Feb 15;131(7):733-740.
doi: 10.1182/blood-2016-11-693663. Epub 2018 Jan 2.

How I use catheter-directed interventional therapy to treat patients with venous thromboembolism

Suresh Vedantham  1 , Akhilesh K Sista  2
Affiliations
Review

How I use catheter-directed interventional therapy to treat patients with venous thromboembolism

Suresh Vedantham et al. Blood. .

Abstract

Patients who present with severe manifestations of acute venous thromboembolism (VTE) are at higher risk for premature death and long-term disability. In recent years, catheter-based interventional procedures have shown strong potential to improve clinical outcomes in selected VTE patients. However, physicians continue to be routinely faced with challenging decisions that pertain to the utilization of these risky and costly treatment strategies, and there is a relative paucity of published clinical trials with sufficient rigor and directness to inform clinical practice. In this article, using 3 distinct clinical scenario presentations, we draw from the available published literature describing the natural history, pathophysiology, treatments, and outcomes of VTE to illustrate the key factors that should influence clinical decision making for patients with severe manifestations of deep vein thrombosis and pulmonary embolism. The results of a recently completed pivotal multicenter randomized trial are also discussed.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
Submassive pulmonary embolism in patient 2. (A) Coronal CT demonstrating thrombus (arrows) in the right main and left lower-lobe pulmonary arteries. (B) Bulky thrombus is identified in the right lower-lobe pulmonary artery (arrow). (C) Wires and catheters traversing the thrombus in the right main and lower-lobe pulmonary artery. (D) Completion pulmonary angiography demonstrating good pulmonary perfusion.
Figure 2.
Figure 2.
Massive pulmonary embolism in patient 3. (A) Axial CT image demonstrating thrombus in the right and left main pulmonary arteries. (B) Axial CT image through the heart demonstrating an enlarged RV (dashed line) to LV (solid line) ratio. (C) Thrombus on pulmonary angiography (arrows), extending from the left main pulmonary artery into the left lower-lobe pulmonary artery. (D) Indigo aspiration device (arrow) within the left lower-lobe pulmonary artery. (E) Placement of bilateral CDT infusion catheters (arrows).
See this image and copyright information in PMC

References

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