**7. Additional venous interventions**

Following mechanical or pharmacological thrombolysis for acute venous thrombolysis, additional endovascular interventions are usually necessary. Whether, there are focal stenoses uncovered following intervention as in Paget Schroetter syndrome, May -Thurner syndrome or fistula anastomoses in dialysis graft, there is typically some element of recoil in the vein, fixed stenosis or some chronic residual thrombus. Further interventions are required involving balloon venoplasty, stent placement or filter placement.

Current Endovascular Treatments for Venous Thrombosis 89

coagulation during and after dialysis catheter removal results in thrombosis of the graft. If unable to open the graft within a reasonable time, then other means of vascular access are required. Typically, another central venous dialysis catheter is needed until a new graft is

Interventional doctors are well adapted to lysis of dialysis graft using both pure pharmacological and mechanical thrombectomy. These grafts can be cleared of their thrombus burden in the interventional lab without requiring further surgery. Pure thrombolysis catheters like Speed Lyser delivers drug directly to the clot through multi-side holes via one micro catheter system. The drug is allowed to sit within the graft and dwell for a period of time called "lyse and wait" technique. Over this period of time, the clot is lysed and the graft is cleared of thrombus. TPA is used for this purpose. It can be injected directly into a graft. TPA can be given as a 6mg bolus within the dialysis grafts for this treatment. Following lysis, other interventions may be necessary to alleviate the source of the

Caval thrombosis can be acute or chronic. Filters can be used for the treatment of acute caval thrombosis, prophylaxis of pulmonary embolism and also be the source of caval thrombosis. Both treatment and cause of caval thrombosis makes interruption filters a double-edged

Furthermore, most of the patients undergoing venous thrombolysis receive retrieval Inferior Vena Cava filter before the intervention. This is usually placed at the same setting. This idea is to reduce the risk of an iatrogenic fatal pulmonary embolism during the procedure. This filter can then be removed if indicated up to six months following implantation. Prior to removing the filter, a duplex venous ultrasound of the lower extremities is obtained to

Parikh S, Motarjeme A, McNamara T, Raabe R, Hagspiel K, Benenati J, Sterling K, Comerota

Marchigiano G, Riendeau D, Morse CJ. "Thrombolysis of Acute Deep Vein Thrombosis".

Chamsuddin A, Nazzal L, Kang B, Best I, Peters G, Panah S, Martin L, Lewis C, Zeinati C,

Comerota AJ, Aldridge SE. Thrombolytic therapy for acute deep vein thrombosis. Semin

Plate G, Eklof B, Norgren L, et al. Venous thrombectomy for iliofemoral vein thrombosis —

A."Ultrasound-accelerated Thrombolysis for the Treatment of Deep Vein Thrombosis: Initial Clinical Experience". Journal of Vascular and Interventional

Ho H, Venbrux A. "Catheter-directed Thrombolysis with the Endowave System in the Treatment of Acute Massive Pulmonary Embolism: A retrospective Multicenter Case Series". Journal of Vascular and Interventional Radiology, 2008; 19(3):372-376.

10-year results of a prospective randomised study. Eur J Vasc Endovasc Surg

sword. Either way, endovenous means are used exclusively for caval thrombosis.

created or the present one is cleaned out.

underlying graft malfunction.

document clot resolution.

**13. References** 

**12. Inferior venacava filter placement** 

Radiology, 2008; 19(4) 521-528.

Vasc Surg 1992;5:76–84.

1997;14:367–374.

Critical Care Nursing Quarterly, 2006; 29:312-323.
