Chuẩn mực mới trong điều trị thuyên tắc tĩnh mạch sâu và thuyên tắc động mạch phổi

New Standard of Management of Deep vein thrombosis and Pulmonary Embolism Vietnam Heart Association Meeting October 8th 2012 12:00-12:30 Hall C Thach Nguyen, M.D. FACC FSCAI St Mary Medical Center Hobart IN USA Deep Vein Thrombosis • DVT is a blood clot in a deep vein • Annual US incidence 250,000. 50 percent are “silent.” • The blood clot or part of it can break free and causes PE 1. Bulger et al, Tech Vasc Interv Radiol 2004;7:50-4. Complications of extensive DVT phlegmasia cerulea dolens May-Thurner Syndrome Post-thrombotic Syndrome: Chronic pain , swelling , skin ulceration • PE: most preventable cause of in-hospital death 1 • 70%-80% of fatal PEs occur in nonsurgical patients 2 The first manifestation of DVT/PE may be fatal PE 3 Pulmonary Embolism Unfractionated Heparin (UFH) and Systemic thrombolytic therapy Endovascular DVT Rx Passive infusion of fibrinolytic drugs into the clot (consist mostly of multisidehole infusion catheters) -Aka: catheter-directed thrombolysis (CDT) • Limitations: prolonged treatment times and the potential risk for bleeding associated with the use of current thrombolytic drugs 1) Prevention of clot propagation 2) Prevention of PE and recurrent thrombosis 3) Restoration of venous patency and flow 4) Preservation of valvular function 5) Elimination of clinical symptoms associated with PTS Endovascular Rx for DVT: A Contemporary Approach - Pharmaco-mechanical treatment (PMT): function to both dissolve (lytic assisted) and mechanically remove clot -3 main available techniques: 1) Angiojet 2) Trellis 3) EKOS EKOS