URR Treatment of Venous Disease and Procedures Flashcards
treatment for Superficial Venous thrombosis
-conservative treatment methods usually suffice
-apply a warm compress to the vein
-elevate legs when seated
-ambulation
-ibuprofen or other non steroidal anti-inflammatory drug
-if the thrombus extends into the deep system, more aggressive treatment is usually required
treatment for acute DVT
-subcutaneous shot of lovenox immediately
-heparin administered for 5-10 days to stop the progression of clot, but does not have clot lysing properties to decrease the clot that has already formed
-after heparin dosage completed and recanalization has occurred, warfarin is administered to prevent future clot formation
-First DVT occurrence - coumadin or warfarin
-calf vein DVT was formerly treated conservatively w/ leg elevation and warm compresses; new recommendations call for 4 weeks of low dose heparin treatment
how to treat significant DVT?
-may be treated w/ a lytic agent such as strephtokinase
-clot busting benefits of the medication must outwiegh the risk for other bleeding complications caused by lytic agents
-usually reserved for situations where loss of the leg is a concern (phlegmasia)
what is catheter directed thormbolysis (CDT)?
-refers to delivery of lytic agent directly to the site of the thrombus using an intravenous catheter
-this method offers improved clot resolution and decreased risk of hemorrhage compared to standard systemic therapy
what is percutaneous mechanical thrombectomy (PMT)
-catheter used to deliver thrombolytic drugs directly to the area of thrombus
-the “jets” of flow of the lytic drug help to break up the thrombus as the catheter is advanced within the vein
-the catheter also has a suction function that retrieves the particles of thrombus
-some physicians may place a greenfield filter in the IVC before the procedure
-this method of DVT removal offers immediate improvement of symptoms, decreased treatment times, and reduced incidence of post thrombotic syndrome when compared to standard systemic thrombolysis
what is venous thrombectomy
-open surgical procedure where thrombus is manually extracted
-used in patients with phlegmasia alba dolens and phlegmasia cerulean dolens
-also used for patients that cannot undergo lytic therapy
-performed to correct ilio-femoral vein stenosis
how to treat persistent chronic thrombosis?
warfarin or coumadin as oral medication for up to 6 months post diagnosis; both interfere with clot formation, DO NOT lyse current clot just prevent more from forming
what is greenfield filter?
-most commonly inserted through the FV or IJV but subclavian vein can also be used
-usually made of stainless steel, titanium, or nitinol
-umbrella like device that is anchored into the IVC below the level of the renal veins
-designed to prevent embolism from the legs from reaching the lungs (does not prevent thrombus formation)
-used in patients that have hx of multiple DVT formation or PE and those that cannot maintain the necessary coagulation therapy
what is a venous stent
-most commonly used to treat chronic iliocaval venous obstruction an may thurner syndrome
-intravenous catheter used to eval the pressure in the IVC and in the iliac vein
->2 mmHg difference indicates significant venous stenosis is present
-intravenous balloon catheter used to deploy the stent and the balloon in inflated to open the vessel and expand the stent into place
-can also be placed during a percutaneous mechanical thrombectomy
-intravascular US can be used to assess the stenosis in the vein prior to the procedure (>50% requires treatment)
-2D and doppler eval should be performed to assess patency of the graft
-much lower incidence of thrombosis and stenosis of the graft than arterial bypass grafts
what is a venous bypass?
-used to treat ilio-femoral venous obstruction
-performed on patients that cannot be stented, have a hx of stent failure or lengthy areas of occlusion
-fem-fem graft
-ilio caval graft
-saphenous vein can be used but it must be unaffected by disease and of adequate size
-best results seen with a PTFE graft
-2D and doppler eval should be performed
-much lower incidence of thrombosis and stenosis of the graft than arterial bypass grafts
what is a fem-fem graft?
-left side obstruction: connected distal to the obstruction and flow moves left to right in the graft
-right side obstruction: connected distal to obstruction flow moves right to left in the graft
what is a ilio caval graft?
connected distal to the obstruction in the leg and flow is diverted around the diseased segment into the IVC
what is conservative therapy for insufficiency treatment
compression stockings, avoid high heel shoes, elevate legs and exercise in mild cases
contraindications for compression therapy
-peripheral arterial disease; ankle brachial index <0,5
-ischemic rest pain
-congestive heart failure
the more perpendicular the US beam is to the needle/catheter, the better the what
reflection and visualization
