医学交流课件：NEW IR for DVT.pptVIP

43y Female：idiopathic lt-DVT 2 days after onset Day 0 Gunther tulip filter Prone position Lt-Pop vein puncture 6F sheath 4F MP cath. with multi-sidehole CDT in the Pts room Day 2 partial thrombolysis Iliac vein compression← Lt Day 4 Thrombus only in iliac vein Manual thrombectomy No thrombus Wallstent IR 3 times Rest on bed 5 days. @10 years, no symptom, oral VKA 60y Female: Lt-DVT　 Day 0 NO IVC filter Pulse-spray Thrombectomy CDT shrinking lt-CIV iliac vein compression OR chronic DVT ? Dx: Acute on Chronic DVT NEED filter? Day 3 Day 1 CDT No thrombus Iliac vein stent? NO stent Good Outflow Flow of DVT patients in Wakayama Dx IVC filter Pop puncture P-CDT thrombectomy CDT Stenting Retrieve IVC filter Venography CDT CCU,ICU Symptomatic PE EKOS（) US assisted Francis CW, Ultrasound in Medicine and Biology 21, 1995 DVT TREATMENT OPTIONS (NOT Available in JAPAN) Ultrasonic energy causes fibrin to thin Drug deep into the clot AngioJet Ultra Thrombectomy System(BSCI) Pulse-spray Thrombolysis Negative Vortex Aspiration Kasirajan, JVIR 12,2001 Trellis(Covidien) Isolated Pharmaco-mechanical Thrombolysis Thrombectomy OSullivan GJ, JVIR 18(6) 2007 Large bore aspiration Essentially perfusion circuit Possibility to remove LARGE volume quickly ?BUT 24F (Asians may forget it !) Sinus-Venous stent (OptiMed) Radial force For Iliac vein compression Zilver Vena　（COOK) Device lag Insurance coverage in Japan Device available Not available Off label use IVC filter Almost all Drug Urokinase t-PA ≤240,000 IU/day, for 7 days Heparin LMWH (low molecular weight heparin) Stent All venous stent Catheter Pulse-spray EKOS Manual aspiration AngioJet Trellis AngioVac Many restrictions in Japan ?Have to devise these combined procedures. (complex, time-consuming) Conclusion IR for DVT provides rapid symptom relief and prevention of PTS-related disability. The quality of evidence in support of these treatments continues to improve. In particular, pharmacomechanical thrombolysis treatments