**Part 2**

**Management and Complications** 

76 Venous Thrombosis – Principles and Practice

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**5** 

*USA* 

**Current Endovascular** 

*Vascular and Interventional Radiology* 

*St. Josephs Hospital and Medical Center, Tampa* 

Glenn W. Stambo

**Treatments for Venous Thrombosis** 

Venous disease continues to increase in number of patients throughout the 2000's. With continued use of venous access devices, dialysis and cancer on the increase and overall patient sedentary life style, we will continue to see more and more venous disease in our population. Overall, venous disease is far more prevalent in the population than arterial disease. However, it is less diagnosed than arterial disease due in part too less acute symptomatology. Patients tend to present later in their disease process due to a multitude of factors including lack of debilitating symptoms, non-life threatening presentation and

Symptoms like gradual leg swelling in DVT patients, arm swelling in Dialysis fistulas and facial edema in superior vena cava (SVC) syndrome are slowly progressive until symptoms become debilitating. Even pulmonary emboli can be sub clinical with only non-specific findings like dyspnea and chest discomfort. Coumadin and the other low molecular weight heparin products are used as outpatient therapies in oral or injection preparations. These are adequate therapies for further prevention of clot formation and help resolve clots outside the hospital setting. However, weekly blood draws and side effects of these drugs particularly in the elderly can be significant and are potential reasons for multiple

The standard treatment for deep venous thrombosis and pulmonary is anti-coagulation embolism. Intravenous heparin is used in the acute hospital setting. Coumadin and the other

For those patients with significant clot burden within peripheral or pulmonary embolism, endovenous therapies can be used if not candidates for anticoagulation. These patients present emergently with significant morbidity. In fact, acute extensive DVT of the lower extremity can cause severe peripheral vascular arterial emergency called Phlegmasia Cereulens Dolans. This disorder needs rapid clot lysis to dissolve the massive clot burden. Thus, only catheter directed thrombolysis could provide this direct form of endovenous therapy. Whether it is acute, semi acute or chronic venous occlusive process, endovenous therapies have become the first line of therapy. If left untreated or inadequately treated with

readmissions to the hospitals related to complications from bleeding.

low molecular weight heparin products are used as outpatient therapies.

conventional means, patients may develop post thrombotic syndrome.

**1. Introduction** 

manageable discomfort until later stages.

**2. Treatment options** 
