Ultrasound-Guided Microthrombectomy: An Effective Symptomatic - - PowerPoint PPT Presentation

Ultrasound-Guided Microthrombectomy: An Effective Symptomatic Treatment For Uncomplicated Superficial Venous Thrombophlebitis

Agnieszka Witkowska MD1, DaeHee Kim MD1,2, Ali Ardestani MD MSC1, Christopher Bolus MD1, Shams Iqbal MD1, Christopher Molgaard MD1 , Heideh Ahari MD1, Sebastian Flacke MD PHD1, Brian Davison MD1,3

1- Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA, USA 2- Memorial Sloan Kettering Cancer Center, New York, NY, USA 3- The Vanishing Vein, Framingham, MA, USA

Disclosures

• Authors have no conflict of interest in relation to this

presentation.

Background

• Superficial thrombophlebitis is an inflammation of a vein due to blood

clot in a vein located just below the skin's surface.

• The incidence is unclear; thought to be higher than that of deep vein

thrombosis, which is estimated at one per 1000.1

• Standard treatment includes:
• Heat
• Elevation
• NSAIDs
• Compression stockings
• Often improves on its own, but can be very painful and prolonged.

Background

Microthrombectomy:

• Classically used to prevent post-sclerotherapy skin hyperpigmentation.
• Anecdotally utilized for symptomatic relief from venous wall distention

by the clot.

Objective

• To assess the efficacy of this minimally invasive technique in patients

with uncomplicated focal superficial venous thrombosis (SVT).

Methods: Procedure

Longitudinal ultrasound image demonstrates non-compressible, thrombosed, dilated superficial saphenous tributary vein. Under the real-time sonographic guidance, a 21 gauge needle is advanced into the center of the thrombosed superficial vein.

Methods: Procedure

Typical appearance is usually dark deoxygenated blood/currant jelly consistency fluid. After the initial aspiration additional material can

• ften be expelled through

the puncture site. The content is aspirated into a syringe.

Methods: Procedure

The area of treatment is indicated by the finger. Post-drainage transverse ultrasound image demonstrates the collapsed vein.

Methods: Study Population

98 patients with focal leg pain and fullness + documented venous insufficiency by Doppler ultrasound at an outpatient vein clinic

• 48 patients w/o prior SVT or vein treatment
• 50 patients w/ recent sclerotherapy (45) or EVLT (5)
• Mean age 48 (age range 31-78)
• 65% female / 35% male

65 patients with alternative diagnosis

33 patients SVT (+) Excluded Included

Methods: Study Population

33 patients SVT (+)

3 (25%) Isolated segmental saphenous tributary SVT

12 (36%) Thrombosed varicosity w/o prior vein treatment 21 (64%) Focal SVT (<3cm) within tributaries after prior vein treatment

2 (17%) Multifocal SVT within tributaries 7 (58%) SVT extending into GSV (> 10cm away from the saphenofemoral junction)

Results

33 patients SVT (+) 32 Treated with ultrasound-guided needle microthrombectomy

1 Treated with systemic LMWH due to progressive extension of SVT

1 (3%) No relief of symptoms

31 (97%) Immediate pain relief

12 (38%) No recurrent symptoms 17 (53%) Mild residual symptoms 3 (9%) Recurrent symptoms

Assessment

• f pain using

5–grade pain scale on post- procedure appointment.

Excluded

Summary

• Significant portion (33.7%) of the patients with focal leg pain had SVT

within varicosity or posttreatment veins.

• No intra- or post-procedural complications observed.
• Very high immediate treatment response rate was observed (96.9%).
• 38 % without recurrent symptoms.
• 62% with mild residual or recurrent symptoms; however, given low risk,

it can be repeated in those patients.

Conclusion Percutaneous needle microthrombectomy is an effective symptomatic treatment in uncomplicated SVT, which can be performed and repeated in an

• utpatient setting without significant risk.

References

• 1. Nagarsheth, K. H., & Rosh, A. J. (2017, August 17). Superficial

Thrombophlebitis (V. L. Lopez, Ed.). Retrieved September 10, 2017, from http://emedicine.medscape.com/article/463256-

• verview?src=refgatesrc1&pl=1
• 2. Zelikovski, A. Haddad, M., Sahar, G. and Reiss, R. (1986). The role of

ambulatory surgery of thrombosed varicose veins. Phlebology, I, 135- 137

• 3. Hobbs, J.T. (1977) Superficial thrombophlebitis. In The Treatment of

Venous Disorders (ed. J.T. Hobbs), MTP, Lancaster, pp. 414-427

Thank you Questions?