Interventional Management of dvT : Top 10 Technical Tips

V enous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease in the United States after myocardial infarction and stroke.1 The incidence of acute DVT is approximately 70 to 100 out of 100,000 people each year, with more than 100,000 to 300,000 cases annually in the United States.2,3 Acute PE has an annual incidence of approximately 1 per 1,000 people in the general population, with a mortality rate of approximately 30% in untreated patients.4 Although VTE can be asymptomatic, its sequelae can include severe morbidity from postthrombotic syndrome (PTS), death from acute pulmonary embolus, or, less commonly, limb loss (venous gangrene, phlegmasia cerulea dolens). VTE is also associated with a significant economic burden. The cost of treating a single VTE event is between $10,000 and $16,000 per person, with a total United States annual expense of more than $2 billion.5 A study by Guanella et al found that more than half of the total financial burden associated with VTE was attributable to missed work days, transportation costs for medical visits, home attendants, and other ancillary expenses.6 PTS is characterized by myriad symptoms such as leg swelling, heaviness, aching, lifestyle-limiting venous claudication, skin hyperpigmentation, venous varicosities, and venous stasis ulcers in rare cases (Figure 1).7,8 Although not completely understood, the underlying mechanism is thought to be twofold: (1) venous hypertension caused by incomplete clearance of the obstructing thrombus and (2) valve incompetence/ reflux from direct valve damage by an inflammatory response to thrombosis.9 PTS has been reported in as many as half of all patients on standard anticoaguInterventional Management of dvT: Top 10 Technical Tips