Management of Acute Deep Vein Thrombosis - Anticoagulation and Beyond

Abstract

Introduction: Deep vein thrombosis though being a common disorder in vascular practice , up to 50% of  these patients are symptomatic  presenting varying range of symptoms, edema being  most common symptom ,tenderness  in 75% , leg pain present in 50% of the patients. Symptoms of             pulmonary edema present in significant number of patients

 Objectives: to emphasize on the different                         interventional  modalities available for the treatment of   symptomatic dvt and the need for appropriate selection of  different modalities to achieve best outcomes in terms of  limb salvage and preventing life loss.

 Materials and methods: All Inpatients with proven DVT admitted in our institute, with symptoms of moderate to severe pain, unresolving or worsening pain, phlegmasia, distal vascular compromise, symptoms of pulmonary embolism, contraindication to anticoagulation, were included in our study.  The multi modal intervention  included

         1.  Catheter directed thrombolysis

2.  Open venous thrombectomy

3.  Systemic thrombolysis

4.  Ivc filter placement

 Results: Total of  21 patients were considered for non      pharmacologic treatment for various indications and        subjected   to     appropriate     intervention.  10 patients were managed with IVC  filter placement, 8 patients had      Catheter directed thrombolysis. 1 patient  had open      venous thrombectomy and  Systemic thrombolysis was administered  in 2 patients. 100% limb salvage was achieved in intervention group.

   Conclusion: Though anticoagulation has been the prime modality directed towards management of deep vein thrombosis, some special situations warrant additional surgical or mechanical techniques for various indications. these treatment improved limb salvage rates in patients with impending gangrene.

 Keywords: thrombectomy, gangreme, CDT.