Endovascular management in venous disease

BACKGROUND: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are under-recognized entities and can be often difficult to diagnose. Occasionally, clinical symptoms, such as pain and swelling, are non-specific or absent. If left untreated, the thrombus can get dislodged and migrate to cause life-threatening pulmonary embolism. MATERIALS AND METHODS: Twenty patients presenting with limb edema and local increase in temperature were screened with color Doppler. Of the 20 cases, three were treated for upper limb venous disease and 17 were treated for lower limb disease. Cases detected to be positive for DVT were taken up for diagnostic venography using DSA. On confirmation, these patients were offered endovascular management viz. percutaneous recanalization by thromboaspiration or thrombolysis or a combination of both. Patients with residual stenosis or vessel occlusion were treated with balloon angioplasty/stent placement. The patients were assessed with a color Doppler study at 6, 12, 24, and 36 months. RESULTS: Of the 20 cases, four patients underwent thromboaspiration, eight underwent thrombolysis, eight were treated with angioplasty, and seven patients required stent placement. Technical success was achieved in 95% (19 of 20) of the cases treated with thrombolysis and/or venous stent placement. One patient had complete occlusion of the vein preventing passage of catheter and thromboaspiration. Three patients were treated for upper limb disease and on follow-up studies, all three remained patent while of the 16 patients treated for lower limb disease, 13 remained patent giving a success rate of 81.25%. No complications occurred in any of the patients. Two patients developed a stent thrombus at 48 and 72 h respectively, both of which were recanalized by balloon angioplasty. CONCLUSIONS: In venous thrombosis, color Doppler helps in the detection and morphological analysis of disease, while venography confirms and assists in managing venous thrombosis using interventions. Endovascular interventional management includes percutaneous recanalization by thromboaspiration or thrombolysis or a combination of both. Patients with residual stenosis or vessel occlusion vessel can be further treated with balloon angioplasty/stent placement.