Vascular specialists are heralding a variety of advances in the treatment of pulmonary embolism (i.e., a blood clot in a major artery in the lungs), a number of which will be presented today at the 39th VEITH symposium. Many doctors are prescribing Xarelto for a blood thinner. But there are many side effects with Xarelto. So get a second opinion and do your research with any new drugs you are thinking of taking.
The treatments that will be featured at dedicated sessions of the gathering on Wednesday, November 14, and Friday, November 16, include ultrasound-guided endovascular techniques, new atherectomy devices that pulverize clots and suction-tipped catheters that swallow them, filters inserted into the interior vena cava to block clots from the lower extremities from traveling to the lungs, and new anticoagulant medications.
Acute pulmonary embolism (PE) is characterized as either massive, when the patient presenting is hemodynamically unstable or in shock and literally at risk of dying, or sub-massive, when the patient is hemodynamically stable and not a fatality risk. Massive PE requires immediate aggressive intervention, using catheterguided thrombolytic agents to dissolve the clot, or conventional surgical thrombectomy or atherectomy to break it apart and remove it. Each of these therapies carries some risk, however, and because sub-massive PE is not lifethreatening, experts disagree on whether to treat sub-massive aggressively at all, relying instead on anticoagulants alone to help eliminate the clot over a more extended period of time.
One of the newer treatment methods that will garner significant attention at the VEITHsymposium is ultrasoundaccelerated thrombolysis, (EKOS) which offers a means of delivery of thrombolytic agents directly to the embolism. The EKOSonic Endovascular System has been shown to result in rapid dissolution of the thrombus in both massive and submassive PE. Ultrasound-accelerated thrombolysis is approved in Europe for treating both massive and submassive PE. In the United States the product has been cleared by the FDA for the infusion of solutions in the pulmonary arteries. Several studies are underway with this device including ULTIMA (European randomized trial) and SEATTLE II (prospective, single arm study in the U.S.)
The Vortex Medical AngioVac Cardiopulmonary Bypass Circuit is a large-bore device designed to remove undesirable intravascular material, such as clots, tumors, or any type of foreign material in the vascular system. The system was designed to remove the entire clot burden intact. The technology works by inserting a narrow tube (catheter) through the veins and into the lungs. Once in place, the catheter quickly vacuums the clot. The AngioVac is indicated for use in procedures requiring extracorporeal circulatory support for periods of up to six hours.
Another endovascular thrombectomy device being discussed for use in treatment of massive pulmonary embolism is the AngioJet rheolytic thrombectomy catheter that uses high velocity saline jets for thrombus aspiration, maceration, and evacuation.
Finally discussions on the proper conditions for consideration of any endovascular procedure as treatment of choice will be discussed.
Ultrasound-Assisted Thrombolysis For Massive And Submassive PE presented by Dr. Nils Kucher, Professor of Cardiology, University of Bern (Switzerland).
New Findings In The Use Of Ultrasound Accelerated Thrombolysis In The Treatment Of Submassive PEs presented by Dr. Tod Engelhardt, Associate Professor of Surgery, Tulane Medical School (New Orleans, LA)
Endovascular Treatment Of Massive PE: How And When Should It Be Done presented by Dr. David Gillespie, Professor of Surgery, University of Rochester School of Medicine and Dentistry (Rochester, NY).
Update On VORTEX Suction Thrombectomy Catheter To Treat PEs And IVC Thrombi: Clinical Experience, Safety And Precautions, presented by Dr. Christopher Kowlek, Assistant Professor of Surgery, Harvard Medical School (Boston, MA).
Does Treatment With The Trellis Mechanical Thrombectomy Device Decrease The Postthrombotic Syndrome After 2 Years: Results Of The ISOL-8 Multicenter Trial, presented by Dr. Paul J. Gagne, Clinical Associate Professor of Surgery, New York University School of Medicine, (NY, NY).
Value Of Ultrasound Accelerated Thrombolysis In DVT: When Is It Indicated, presented by Dr. Cees Wittens, Professor of Venous Surgery, Maastricht University Medical Center (Maastricht, The Netherlands).
Update On New Anticoagulants For Venous Thromboembolism Prophylaxis And Treatment, presented by Dr. Thomas W. Wakefield, The James C. Stanley Professor of Vascular Surgery, University of Michigan, (Ann Arbor, MI).