When I was a resident, the stadard strategy for the management of acute deep venous thromboses usually involved consultation to the vascular surgery service by the admitting medical team. The vascular surgeon would evaluate the patient, describe that there was no role for open thrombectomy and suggest chronic anticoagulation. Periodically, interentional radiology would be involved and would agree that the risk of lysis in all but the most optimal medical candidates was frought with potential complications.
We would anticoagulate these people, acutely elevate their leg and send them out with compression stockings to mitigate the long term symptoms of edema and pain. As we know, at least fifty percent probably develop some symptoms of chronic venous insufficiency because of irreversible valvular damage and incomplete recanalization or the injured venous segment.
Not only are the symptoms of leg swelling, chronic pain, unsightly discoloration, impaired mobility and ulceration severely debilitating to the affected individual, the costs associated long term care of these patients over their lifetime is very high. As a director of a larger wound care center, I have several patients who, despite the most diligent, innovative and aggressive therapy; suffer from painful, disabling venous insufficiency ulceration.
Fortunately, technology to perform mechanical and pharmacologic lysis of venous thromboses has improved. The careful selection of patients appropriate for this therapy has resulted in excellent results when quality of life and subjective/objective symptom free endpoints are assessed.
Our guest blogger in the upcoming week will be Dr Santiago Chahwan of the Anchors Medical Centers Vascular Surgery Department in Naples Florida. Dr Chahwan completed his training at The Jobst Vascular Institute with Dr Anthony Comerota, a pioneer in the field of interventions for venous disease. Dr Chahwan has taken the same enthusiasm for this underappreciated problem and built of high volume venous interventions program in Naples.
His guest blog will focus on selection of the appropriate candidates for treatment, his techniques and tool box including his impressions of the Trellis device, and pearls for building a successful program in your institution. We look forward to these posts
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