The development of new stents specifically designed for deep venous reconstruction, new techniques for lysis and imaging are playing a key role in the treatment of deep vein thrombosis; an area that, according to Stephen Black (Guy’s and St Thomas NHS Foundation Trust, London, UK), member of the CX Programme Organising Board, has been largely neglected for years. In this interview, Black, who will be chairing a session dedicated to the deep venous system at the Venous Controversies session of CX 2015, speaks about the advances in the field.
What is the major controversy in deep venous treatment?
The main controversy is still the role of the new venous stents and whether these will really change treatment and outcome for patients with chronic obstructive disease causing post thrombotic syndrome.
What methods are showing optimal results in deep venous reconstruction?
Currently the new techniques for lysis and the development of more robust stents have renewed interest in this area. There is certainly great potential with these new developments; however, we still need to be cautious using them given the real absence of descent data to support how, when and why we treat these patients.
Now more stents have been developed specially for the venous anatomy; what impact have these devices had in the treatment of venous disease?
The new stents for venous treatment have raised awareness and led to a renewed focus on what was a largely neglected area for a number of years. Patients with symptoms after deep vein thrombosis are desperate for treatment and have received the answer of nothing to be done for too long. As a group of clinicians we need to embrace this momentum to see if we can make a difference to this group of patients.
What is the role of imaging in deep venous interventions?
The role of imaging is to try and outline anatomy in the best possible manner. In particular, we need to identify what inflow the patient will have into the area that needs stenting and also whether there is a problem more proximally. It helps to identify if there is an obstructive lesion (i.e. May Thurners/Cockets lesion) and whether the patient may require a purely stent procedure or possibly open surgery or a combination of both.
What imaging methods are showing best results?
Intravascular ultrasound (IVUS) and magnetic resonance imaging (MRI) currently have the greatest potential for diagnosis in deep venous treatment. MRI helps to reduce the radiation dose in what are usually a young group of patients. MRI has also the potential to age clot, which is really exciting (delegates will have the opportunity to learn about this MRI capability at the Venous Controversies of the CX Main Programme). IVUS may also help reduce radiation exposure but also provides significantly more real time detail when treating these patients.
Currently we are limited by the imaging modalities all providing us with static images. We need to develop techniques that help identify what the flow is like in the system and measure pressure.
The CX Venous Controversies Day will take place at the Charing Cross Symposium on Friday 1 May – Main Auditorium, Olympia Grand, London, UK.
Delegates will have the opportunity to get hands-on training on the latest techniques for deep venous thrombosis treatment at the CX Venous Workshop on Wednesday 29 April and Thursday 30 April – Gallery Upper Level, Olympia Grand, London, UK
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