**5. References**


and vitamin-K antagonists(u). The diagnosis of anomalies in the inferior vena cava influences the strategy for prevention the pulmonary embolism and long them maintenance treatment. The use of mechanical device as caval filter is clearly limited by the anomalous anatomy of the inferior vena cava and, generally, is-not indicated. On the other hand the use of oral anticoagulant (commonly warfarin) should be adjusted to maintain a target international normalized ratio of 2.5 (range 2-3) and extended indefinitely in absence of main contra-

At present the introduction of new drugs as the factor Xa antagonists (rivarixaban, apixaban, edoxaban, ect) and the direct thrombin inhibitors as dabigatran etexilate could improve the therapeutic options. The promising results of the recent clinical studies in terms of efficacy and safety, suggest that these new drugs may allow a reduction of the length of hospital stay after an acute DVT, and a better adherence to guidelines in the long term treatment. The principal advantages of these drugs are the absence of the need of a routine coagulation monitoring and a therapeutic activity not influenced by dietary regimen and by drugs as NSADIs and statins(u). Potential limitations are the lack of specific antidotes (however the hal-life of these drugs is relative short) and the absence of a simple assay for

In conclusion these interesting pharmacological characteristics could improve the benefit-

The complexity of the ontogeny of the IVC, with numerous anastomosis formed between the three primitive paired veins, can lead to a wide array of variations in the basic plan of venous return from the abdomen and lower extremity. Some of these anomalies have significant clinical implications. Although vascular structures can usually be readily identified on contrast-enhanced CT scans, identification of unusual venous arrangements may be difficult in those cases in which intravenous contrast material is contraindicated. In such patients, MR imaging may be used to distinguish aberrant vessels from masses by demonstrating flow voids or flow-related enhancement. The echo-scanning may suggest the presence of venous anomalies but usually it insufficient for a detailed diagnosis. A

risk balance of long-term anti-coagulant therapy and the overall clinical outcome.

knowledge of IVC and renal vein anomalies is essential to avoid diagnostic pitfalls.

venous thrombosis. *Thromb Haemost*. 1997;78:1-6.

en pacientes jóvenes. *Med Clin (Barc).* 2004;123:217-9.

[1] Rosendaal F. Thrombosis in the young: epidemiology and risk factors. A focus on

[2] García-Fuster MJ, Fernández C, Forner MJ, & Vayá A. Estudio prospectivo de los

[3] Ruggeri M, Tosseto A, Castaman G & Rodeghiero F. Congenital absence of the inferior

[4] M. Bianchi, D. Giannini, A. Balbarini, M.G. & Castiglioni. Congenital hypoplasia of

factores de riesgo y las características clíni- cas de la enfermedad tromboembólica

vena cava: a rare risk factor for idiopathic deep vein thrombosis. *Lancet*.

inferior vena cava and inherited thrombophilia: rare associated risk factor for

indications(d).

**4. Conclusions** 

**5. References** 

2001;357:441.

quantification of activity or plasma level.

idiopathic deep vein thrombosis. A case report. *J Cardiovasc Med* (Hagerstown). 2008 Jan;9(1):101-4.


**4** 

**Endovascular Therapies in Acute DVT** 

Deep venous thrombosis of the lower limb is a common disease with an incidence of 80 per 10000 (Patel et al 2011) and has potential fatal consequences in the form of pulmonary

It is usually seen in patients undergoing major surgery particularly orthopaedic surgery, trauma, prolonged immobilisation or hypercoagulable states (such as in the context of malignancy). There are associations with drugs such as the oral contraceptive pill and

Deep venous thrombosis of the lower extremity can occur anywhere from the ankle to the IVC, however it is those that occur between the IVC and femoral veins that most often lead to venous hypertension, resulting in the more severe symptoms. They are also more likely to

The clinical spectrum can range from being completely asymptomatic to post thrombotic

Traditionally, DVTs have been treated with the use of oral anticoagulation medication (such as warfarin) for a period of 6 months. However, this is associated with a high risk for recurrent thrombosis, and approximately one third will develop post thrombotic syndrome despite treatment (Prandoni et al 1996). The recurrence of DVT is thought to be related to damage to the venous valves during an episode of thrombosis and the low rate of recanalisation particularly in caval/iliac/femoral venous thrombosis, which leads to obstruction and venous hypertension. It has been suggested that anticoagulation therapy alone may be inadequate to prevent the damage to the venous valves in the setting of caval/iliac/femoral DVT. Moreover, it has been shown that early thrombus removal is associated with a lower incidence of symptoms related to post thrombotic syndrome (Sharafuddin 2003). These factors have prompted use of invasive techniques such as catheter directed thrombolysis and mechanical thrombectomy, particularly in the acute setting, for

There are currently two large randomised controlled trials (TORPEDO and ATTRACT) underway investigating the efficacy of these invasive techniques and early results suggest

hormone replacement therapy (tamoxifen) that predispose to hypercoagulability.

**1. Introduction** 

**2. Pathology and clinical presentation** 

syndrome: ulceration, pain, and intractable oedema.

recur (Vendatham 2006).

thrombus removal.

embolism.

Jeff Tam and Jim Koukounaras

*The Alfred Hospital* 

*Australia* 

[21] Mavrakanas T, Bounameaux H. The potential role of new oral anticoagulants in the prevention and treatment of thromboembolism. *Pharmacology & Therapeutics* 130 (2011) 46–58
