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VENOUS THROMBOEMBOLISM - MANAGEMENT
Deep vein thrombosis is a frequent manifestation of venous thromboembolism in which there is a blood clot blocking a deep vein.
Clinical findings are important to the diagnosis of deep vein thrombosis but are poor predictors of the presence or severity of thrombosis.
Pulmonary embolism is the blockage of the blood vessels in the lungs usually due to blood clots from the veins, especially veins in the legs and pelvis.
Dyspnea, pleuritic chest pain, syncope and tachypnea occur in most cases of pulmonary embolism.
Massive pulmonary embolism has the prime symptom of dyspnea and systemic arterial hypotension that requires pressor support is the predominant sign.

Surgical Intervention

Vena Caval Interruption

Inferior Vena Caval Filters
  • Should be considered in DVT/PE patients with contraindication or complication of anticoagulant therapy
  • May also be considered in:
    • Patients that suffer from recurrent VTE despite adequate anticoagulant therapy
    • Patients with chronic recurrent embolism with pulmonary hypertension
  • May be indicated after surgical embolectomy or pulmonary thromboendarterectomy
  • Should not be used routinely in patients with DVT who are also being treated with anticoagulants
Thrombectomy

Percutaneous Venous Thrombectomy
  • Patients with acute DVT should not be treated with percutaneous thrombectomy alone
Surgical Venous Thrombectomy
  • To reduce acute symptoms and post-thrombotic morbidity in patients with acute iliofemoral DVT 
  • These patients have extensive venous thrombosis and have contraindications for anticoagulation and thrombolytic therapy

Invasive Procedures

Catheter Extraction

  • Catheter extraction involves the suction extraction of PE under fluoroscopy with ECG monitoring
  • This approach should be reserved for highly compromised patients who cannot receive thrombolytic therapy or whose status is so critical that it does not allow time to infuse thrombolytic therapy

Pulmonary Embolectomy

  • Performed in emergency situations when more conservative measures have failed
  • Should be reserved for the following patients:
    • Massive PE (preferably angiographically documented)
    • Hemodynamic instability despite Heparin and resuscitation
    • Failure of thrombolytic therapy or contraindication to its use
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