Transcript Document

Emergency
THROMBUS
Management
Identifying and Managing Patients
with Peripheral Arterial Occlusion (PAO)
and Venous Thrombosis (DVT)
in the ER and ICU
Emergency THROMBUS Management
Peripheral Thrombus
What causes it?
• Peripheral thrombus is characterized by
reduced blood flow in vessels outside the
central and cerebral circulation.
• Causes include:
– Atherosclerosis
–
–
–
–
–
–
Trauma
Bacterial or viral infection
Inflammation
Irregular anatomy
Chronic venous insufficiency
Hypercoaguable blood disorders
Source: University of Chicago Hospitals website,
www.uchospitals.edu/online-library/content=P00236
Emergency THROMBUS Management
Prevalence of Peripheral Thrombus
• Affects over 12 million people in the U.S.
• Can affect anyone, but is most common in
people over 50
• Peripheral thrombus in the body’s
extremities can lead to peripheral arterial
occlusion (PAO) or deep vein thrombosis
(DVT), with significant adverse
consequences
Source: University of Chicago Hospitals website,
www.uchospitals.edu/online-library/content=P00236
Emergency THROMBUS Management
What Is a Thrombus?
Thrombus, an intravascular aggregation of platelets, fibrin and
entrapped blood cells, can cause a vessel occlusion.
Emergency THROMBUS Management
Vessel Occlusion
Partial Occlusion
Complete Occlusion
Emergency THROMBUS Management
Thrombus Formation in PAO & DVT
• Peripheral Arterial Occlusion (PAO):
thrombus forms in arteries of upper or lower
extremities
• Deep Vein Thrombosis (DVT): thrombus
forms in deep veins of upper or lower
extremities
• PAO and DVT are often:
–
–
–
–
Asymptomatic
Unrecognized
Under-diagnosed
Under-treated
Emergency THROMBUS Management
Vascular Emergencies Are Under-diagnosed
• Symptoms can
mimic other
conditions
• Health care professionals
may be inexperienced in
recognizing symptoms
Source: McDermott MM, et al. Asymptomatic PAD is independently
associated with impaired lower extremity functioning: The women’s
health and aging study. Circulation 2000;101:1007-1012.
Emergency THROMBUS Management
A Medical Emergency
• If not treated promptly,
serious complications may result:
- Severe pain and discomfort
- Ulcers (PAD)
- Serious muscle and tissue damage, leading to amputation
(PAO)
- Pulmonary embolism (DVT)
- Post-thrombotic syndrome (DVT)
- Phlegmasia cerulea dolens
- Heart attack
- Stroke
- Death
• Early detection and treatment may prevent
long-term effects, disability and death
Emergency THROMBUS Management
Ensuring Good Patient Outcomes
• Be aware of risk factors
• Identify symptoms
• Use appropriate
diagnostic tools
• Know treatment
options
• Consult a vascular
specialist
Emergency THROMBUS Management
Five-Year- All Cause Mortality for ALI & Selected Diseases
63%
0.7
Mortality
0.6
0.5
39%
0.4
28%
0.3
0.2
30%
21%
14%
0.1
0
Breast
Cancer
CAD*
Stroke†
PAD
Colorectal
Cancer
ALI
Cause of Death
* CAD defined as previous MI or unstable angina.
† Stroke defined as ischemic stroke.
Six-year mortality in 65-75 age group.
Source: Weitz, Ljungman, Hartmann, Hunt and ACS.
Emergency THROMBUS Management
30-Day Mortality
30-Day All-Cause Mortality ALI, Stroke & MI
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
15%
12%
6%
MI*
* Treated with PCI
Stroke †
ALI
Disease
† Ischemic Stroke
Source: Dormandy, Earnshaw, Keeley, Dalby, Williams and Fang
Emergency THROMBUS Management
Event-Free Survival
Four-Year Event-Free Survival – IC, CLI, & ALI
60%
50%
50%
40%
25%
21%
30%
20%
10%
0%
IC
CLI
ALI
Disease Severity
Source: Swedvasc.
Emergency THROMBUS Management
Amputation Rates and Duration of ALI
Amputation Rate
25%
20%
20%
12%
15%
10%
6%
5%
0%
12 Hours or
Less
13-24 Hours
24+ Hours
Duration of Ischemia
Source: TASC
Emergency THROMBUS Management
30-Day Consequences of ALI, AMI, & Stroke
AMI
Stroke
ALI
Death
6%
12%
15%
Stroke
1%
19%
2%
3%
2nd MI
28%
Disability
12%
Amputation
Source: Earnshaw, Keeley and Fang
Emergency THROMBUS Management
ALI Survivors – Two-Year Outcome
Mortality
Amputation
(After 30
Days)
Major
Medical
Events
Recurrence of
Ischemia
Reintervention
35%-52%
12%-24%
31%
11%
9%-15%*
* Within 30 days
Source: Campbell and Pemberton
Emergency THROMBUS Management
Peripheral Arterial Disease (PAD)
Thrombus formation in arteries of upper and lower
extremities:
• PAD affects approximately 8-12 million people
in the U.S., mainly those who are 50 and older
• Affects 12-20% of Americans who are 65 and older
• PAO due to PAD causes 160,000 amputations
annually, with mortality rates of:
 30% at 5 years
 50% at 10 years
Sources:
American Heart Association website, www.americanheart.org, 1-6-06.
Society of Interventional Radiologists website, www.sirweb.org, 1-6-06
Ouriel KJ. Detection of peripheral arterial disease in primary care. JAMA 2001;286:1380-1381.
Emergency THROMBUS Management
PAD: Risk Factors
• Advancing age (50 years or older)
• Diabetes mellitus
• Elevated lipids
• Hypertension
• Heart disease
• Male gender
• Smoking
• Obesity
• Sedentary lifestyle
• Family history
Emergency THROMBUS Management
PAD: Symptoms
• Absence of a pulse in the legs and feet
• Aches, cramps, muscle fatigue, numbness or
pain
• Changes in skin temperature (typically
coldness)
• Edema or swelling of the extremities
• Persistent drug-refractory hypertension
• Nonhealing skin ulcers
• Thickened nails or dry and shiny skin
Emergency THROMBUS Management
PAD: Other Symptoms
• Onset of severe pain or aching pain at rest
• Claudication
• Pallor in affected extremity
• Cyanosis of the toes
• Gangrene
Emergency THROMBUS Management
Remember the 6 Ps of Diagnosis for PAO
Pulselessness
P(pale
allor
skin tone)
Paresthesia
(burning, prickling,
tingling sensation)
Source: Navarro F. Peripheral arterial disease. The Cleveland Clinic,
www.clevelandclinicmeded.com/disease management/cardiology/pad/pad.htm,
original published date, May 2002.
Pain
Poikilothermy
(cold)
Paralysis
Emergency THROMBUS Management
PAD: Adverse Outcomes
• Critical limb ischemia
leading to:
–
–
Amputation
Death
20% OF
PATIENTS
WILL DIE!
• At 6 months,
approximately 20% of
patients with critical limb
ischemia will die and 35%
will experience amputation
35% OF
PATIENTS
WILL NEED
AMPUTATION!
• Approximately 160,000 amputations
occur in the U.S. yearly due to PAO
• Heart attack / Stroke
Sources:
Rajan DK, et al. Quality improvement guidelines for percutaneous
management of acute limb ischemia. Journal of Vascular Interventional
Radiology 2005;16:585-595.
Emergency THROMBUS Management
PAD: Diagnostic Tools
• Physical exam:
– Compare affected limb to healthy limb
– Observe physical signs
– Palpate peripheral arteries
• Patient history:
– Onset and duration of acute symptoms,
characteristics of pain
– Identify risk factors:




Smoking
Diabetes
Obesity
Other
Emergency THROMBUS Management
PAD: Diagnostic Tools
• Do not rely on history and physical examination
alone
– The PARTNERS Study found that physicians who rely on the
symptom of claudication are likely to miss 85-90% of cases
– PAD is easily detected with ABI testing
• Measure Ankle-Brachial Index (ABI)
– Compares systolic blood pressure at ankle with
brachial systolic pressure
– Simplest method for estimating blood flow to
lower extremities
– 90% sensitivity; 98% specificity
• ABI readings:



1 - 1.1 = normal
< 0.9 = presence of PAD
< 0.26 = severe limb-threatening occlusion
Sources:
De Sanctis, JT. Percutaneous interventions for lower extremity peripheral vascular
disease. American Academy of Family Physicians 2001;64:1965-1972.
Navarro F. Peripheral arterial disease. The Cleveland Clinic,
www.clevelandclinicmeded.com/disease management/cardiology/pad/pad.htm,
original publication date, May 2002
Emergency THROMBUS Management
PAD: Diagnostic Tools
• Ultrasound & Doppler velocity waveforms
• Computerized tomography (CT)
• Segmental blood pressure measurements
• Pulse volume recording
• Magnetic resonance angiography (MRA)
• Contrast angiography
Emergency THROMBUS Management
PAO: Treatment Options
• Often a multidisciplinary, multimode approach
• Disciplines:
– Interventional radiology, vascular surgery,
interventional cardiology
• Treatment modes include:
– Pharmacologic (thrombolytics, anticoagulants)
– Surgical (bypass, surgical cut-down)
– Percutaneous intervention (angioplasty and stents,
mechanical thrombectomy)
– Combination therapy (mechanical thrombectomy,
thrombolytics, PTA )
Sources:
The Merck Manual of Diagnosis and Therapy, Sec. 16, Ch. 212,
Peripheral Vascular Disorders
De Sanctis, JT. Percutaneous interventions for lower extremity
peripheral vascular disease. American Academy of Family Physicians
2001;64:1965-1972.
Emergency THROMBUS Management
PAO: Treatment Options
Thrombolytic Therapy
• Catheter infusion of thrombolytic agents
• Infusion may last 8 - 48 hrs with multiple trips to
lab to assess thrombus resolution
Advantages:
– Easy to administer
– Effective
Disadvantages:
– Potential for
bleeding complications
– Distal embolization risks
– Higher doses and longer
infusions increase
risk of potential
complications
SOURCE:
Rajan DK, et al. Quality improvement guidelines for percutaneous
management of acute limb ischemia. Journal of Vascular
Interventional Radiology 2005;16:585-595.
Emergency THROMBUS Management
PAO: Treatment Options
Surgery
• Surgical bypass
(uses patient’s own vessel or
synthetic graft to bypass occlusion)
• Surgical cut-down to remove clot
Advantages:
– Good long-term
patency
– Option for multiple
stenoses
Disadvantages:
– Invasive approach
– High mortality rates
– General anesthesia needed
– Long healing time for an
already unhealthy limb
– Long hospital stay
Source: STILE Investigators. Results of a prospective randomized
trial evaluating surgery versus thrombolysis for ischemia of the
lower extremity. The STILE Trial. Annals of Surgery 1994:
220(3):251-266.
Emergency THROMBUS Management
PAO: Treatment Options
PTA (percutaneous transluminal angioplasty,
with or without stents)
• Inflation of small high-pressure balloon
to open the obstructed vessel
• Often used in combination with MTD &
thrombolytics
Advantages:
– Local anesthesia
– Short hospital stay
– Minimally invasive
Disadvantages:
– High recurrence rate
without stents
– Distal embolization
if thrombus is not
removed prior to PTA
Emergency THROMBUS Management
PAO: Therapies
Mechanical Thrombectomy Device (MTD)

Emerging treatment option
that allows mechanical
removal of thrombus
• Powerful saline jets create a low
pressure zone around the
catheter tip that causes a
vacuum effect. Thrombus is
drawn into the catheter, where it
is fragmented by the jets and
then removed from the body
AngioJet® Thrombectomy System
Emergency THROMBUS Management
PAO: Therapies
MTD Advantages:
– Minimally invasive
– Rapid resolution of symptoms
Disadvantages:
– Hemolysis
– Embolization risk
– Quickly removes occlusion from body
– Restores blood flow quickly to
endangered limb
– Minimizes embolization risk
– Can be used to deliver thrombolytics
to thrombus burden
– Always leaves surgery
as an option
Emergency THROMBUS Management
PAO: Treatment Options
Combination Therapy: MTD, Thrombolytics, PTA
MTD:
• Breaks up thrombus, removes debris
• Provides rapid revascularization
• May decrease duration and dose of thrombolytics
Thrombolytics:
• If thrombus remains after MTD, thrombolytics can complete
removal (especially relevant with older, chronic thrombus or
MTD-inaccessible vessels)
PTA/Stenting
• Restores vessels to reference diameter
Emergency THROMBUS Management
PAO: Treatment Options
New Combination Therapy:
Power Pulse™ Delivery
• Utilizing MTD to power-infuse lytic
solution directly into the clot
• Wait time followed by removal using
MTD in thrombectomy mode
• AngioJet Thrombectomy indicated
for the controlled and selected
infusion of physician-specified fluids,
including thrombolytic agents
• Combination of chemical and
mechanical thrombolysis
Emergency THROMBUS Management
Case Study
INSERT CASE STUDY
Emergency THROMBUS Management
Venous Thrombosis
Thrombus formation in deep veins of legs or thighs
Approximately 600,000 new cases are diagnosed in
the U.S. each year
Source: sirweb.org
Emergency THROMBUS Management
Venous Thrombosis
Thrombus formation in deep veins of legs or thighs
Approximately one-third develop pulmonary embolism (PE)
Source: sirweb.org
Emergency THROMBUS Management
Deep Venous Thrombosis
DVT in the U.S.:
• Symptomatic PE is the most important acute
complication of DVT
– 600,000 new DVT cases a year
– Responsible for 200,000 deaths (more than
combined deaths from AIDS and breast cancer)
– Leading cause of preventable in-hospital mortality
• Diagnosis is confirmed in only 20-30% of ER
patients with clinically suspected DVT
Sources:
Society of Vascular Surgeons website, www.vascularweb.org, 1-6-06
Schreiber, D. Deep venous thrombosis and thrombophlebitis.
www.emedicine.com/emerg/topic122.htm, last updated October 2005.
Emergency THROMBUS Management
Venous thrombosis: Causes
Precipitating causes are usually:
• Injury / trauma
• Surgery
• Cancer
• Prolonged inactivity
• Bed rest post-op or post-partum
• Extended plane or car travel (longer than 4 hrs)
• Contraceptives/estrogen therapy
• Severe infection
• Undiagnosed anticoagulation disorder
Source: Schreiber, D. Deep venous thrombosis and thrombophlebitis.
www.emedicine.com/emerg/topic122.htm, last updated October 2005.
Emergency THROMBUS Management
Venous thrombosis : Risk Factors
•
•
•
•
•
•
•
•
•
•
•
•
Over 40 years old
Cancer
Obesity
Previous or family history of DVT/PE
Recent surgery, particularly orthopedic,
within past 4 weeks
Paralysis or immobility for longer than 3 days
Contraceptives/estrogen therapy
Pregnancy
Smoking in females
Serious illness: CHF, MI, sepsis, ulcerative colitis
Anticoagulation disorders
Trauma: spinal cord injury, burns,
lower extremity fractures
Source: Schreiber, D. Deep venous thrombosis and thrombophlebitis.
www.emedicine.com/emerg/topic122.htm, last updated October 2005.
Emergency THROMBUS Management
Venous thrombosis : Symptoms
DVT in Upper & Lower
Extremities:
• Sudden swelling in affected limb
• Limb pain/tenderness
• Pain on dorsiflexion of the foot
• Dilated superficial collateral veins
• Cyanosis or pallor
• Warm skin over area of thrombosis
• Lack of distal pulses
Often difficult to differentiate from
non-thrombotic disorders
Source: Schreiber, D. Deep venous thrombosis and thrombophlebitis.
www.emedicine.com/emerg/topic122.htm, last updated October 2005.
Emergency THROMBUS Management
Venous thrombosis: Complications
• Pulmonary embolism
(approximately one-third develop PE)
• 200,000 deaths from PE every year
• Post-thrombotic syndrome leading to
Chronic Venous insufficiency, valvular
incompetence and venous ulcers
• Critical limb ischemia
Pulmonary Embolism
Emergency THROMBUS Management
Venous thrombosis: Diagnostic Tools
• Patient risk factors/medical history
• Physical exam
– Specific limb symptoms (edema, pallor)
• Duplex ultrasound
• MRI
• Venography
• D-dimer
Emergency THROMBUS Management
Venous thrombosis : Treatment Options
Anticoagulation is Standard of Care
(heparin, warfarin, LMWH)
Advantages:
•
•
•
•
Reduces occurrence of a PE
Can decrease symptoms
Easy to administer LMWH
Only approved treatment at this time
Disadvantages:
• Bleeding complications from long-term use of anticoagulants
• Does not decrease thrombus burden
• Has not been shown to reduce incidence of valve damage
Source: AbuRahma AF. Iliofemoral deep vein thrombosis: Conventional therapy versus
lysis and percutaneous transluminal angioplasty and stenting. Annals of Surgery 2001:
233(6):752-760.
Emergency THROMBUS Management
Venous thrombosis : Treatment Options
Thrombus Removal:
• Surgical removal
• Catheter-directed thrombolytic therapy (off-label)
• Mechanical Thrombectomy Device (MTD)
Thrombus Containment:
• IVC filters are placed to help prevent PE
Emergency THROMBUS Management
Venous thrombosis: New Treatment Option
A New Option
• Mechanical Thrombectomy for the removal of
venous thrombus
Mechanical Thrombectomy Advantages
•
•
•
•
On-label
Quick reperfusion
Removal of thrombus vs. dissolving
Can be used with other treatment strategies
Emergency THROMBUS Management
Venous thrombosis: New Treatment Option
Potential benefits:
• Minimally invasive
• May resolve symptoms rapidly
• Further study needed to determine if early thrombus
removal preserves normal valve function
• May quickly remove occlusion from body
• May decrease amount and duration of thrombolytics
Potential risks:
• Kidney impairment due to hemolysis
• Embolization including PE
Emergency THROMBUS Management
Venous thrombectomy: Clinical Data
Emergency THROMBUS Management
Venous thrombosis: AngioJet® Therapy
Adjunctive Percutaneous Mechanical
Thrombectomy for Lower-extremity Deep Vein
Thrombosis: Clinical and Economic Outcomes
Hyun S. Kim, MD, Ajanta Patra, MD, Ben E. Paxton, BA, Jawad Khan, MD,
and Michael B. Streiff, MD
Journal of Vascular and Interventional Radiology, vol.17, number 7, July 2006
CONCLUSIONS:
“Percutaneous CDT with rheolytic PMT is as effective as CDT alone
for acute iliofemoral DVT but requires significantly shorter
treatment and lower lytic agent dose, resulting in lower costs.
Randomized studies to confirm the benefits of
pharmacomechanical thrombolysis in the treatment of DVT are
warranted.”
Emergency THROMBUS Management
Venous thrombosis: AngioJet® Therapy
A study of pre-treatment using thrombolytic infusions
followed by Mechanical Thrombectomy for the removal of
Venous Thrombus
60
56.6
50
40
30
30.3
20
10
6.7
3.42
2.95
2.5
0
Tx duration hr
Source
Kim et al,
Journal of Vascular and Interventional Radiology
Vol.17,7,July 2006
Uk Dose (million U)
CDT Alone
Number of Venograms
CDT & PMT
Emergency THROMBUS Management
Venous thrombosis: AngioJet® Therapy
Dollars per treatment
$12,000
$10,000
$10,127
$8,000
$6,000
$5,128
$4,000
$2,000
$0
CDT Alone
CDT Alone
Source
Kim et al,
Journal of Vascular and Interventional Radiology
Vol.17,7,July 2006
CDT & PMT
CDT & PMT
Emergency THROMBUS Management
Venous thrombosis: AngioJet® Therapy
Complications
CDT Alone
(26 Limbs)
CDT & PMT
(19 Limbs)
Major Bleeding
2 (7.7)
1 (3.8)
1 (3.8)
1 (5.3)
0
1(5.3)
Minor Bleeding
Pulmonary
embolism
Source
Kim et al,
Journal of Vascular and Interventional Radiology
Vol.17,7,July 2006
Emergency THROMBUS Management
Venous thrombosis: AngioJet® Therapy
Catheter-direct thrombolysis versus
pharmacomechanical thrombectomy for treatment of
symptomatic lower extremity deep venous thrombosis
Peter H. Lin, MD, Wei Zhou, MD, Alan Dardik, MD, Firas Mussa, MD,
Panos Kougias, MD, Nasim Hedayati, MD, Joseph J. Naoum, MD,
Hosam El Sayed, MD, Eric K. Peden, MD, Tam T. Huynh, MD
The American Journal of Surgery vol.192, number 6, Dec. 2006
Conclusions:
“PMT with adjunctive thrombolytic therapy is an effective treatment
modality in patients with significant DVT. When compared to CDT, this
treatment provides similar treatment success with reduced ICU, total
hospital length of stay and hospital costs.”
Emergency THROMBUS Management
Venous thrombosis: AngioJet® Therapy
CDL VS. PMT Treating 98 Patients with Venous Thrombus
80%
75%
70%
68%
60%
70%
64%
50%
40%
30%
30%
25%
20%
10%
6%
4%
0%
Primary 1yr
patency
Complete thrombus
removal
Catheter Directed lytics
Source
Lin et al,
American Journal of Surgery
Vol.192 ,6, Dec. 2006
Partial thrombus
removal
Hemorrhagic
complications
Pharmacomechanical thrombectomy
Emergency THROMBUS Management
Venous thrombosis: AngioJet® Therapy
Treatment Outcomes CDL vs. PMT 98 Patients
90%
80%
81%
70%
75%
72%
70%
60%
50%
40%
30%
30%
25%
20%
10%
0%
Complete treatment success
Source
Lin et al,
American Journal of Surgery
Vol.192 ,6, Dec. 2006
Partial treatment success
Catheter Directed Lytics
Immediate clinical improvement
Pharmacomechanical Thrombectomy
Emergency THROMBUS Management
Venous thrombosis: AngioJet® Therapy
Hospital Stay & Associated Costs
Total Hospital Cost
9
PMT $47,742 + $19,247
8
CDL $85,301 + $24,832
7
P Value <.01
8.4
6
5
4.6
4
3
2
1
2.4
0.6
0
Mean ICU Stay (days)
Source
Lin et al,
American Journal of Surgery
Vol.192 ,6, Dec. 2006
Catheter Directed Lytics
Overall Hosp Length Of Stay
(days)
Pharmacomechanical Thrombectomy
Emergency THROMBUS Management
Venous thrombectomy: MTD results
Preliminary MTD Results in DVT Removal
Retrospective review:
•
•
•
•
7 participating centers
44 patients
Mean age 50.9
Upper and lower extremity
DVTs
Thrombolytics:
• Pre-MDT:
• Post-MDT:
• No thrombolytics:
• PTA:
• Stent:
• IVC filter:
24 (55%)
25 (57%)
10 (23%)
16 (41%)
16 (41%)
5 (11%)
Major complications hemaglobinuria/hematuria following MTD,
• Following MTD, reported in 6 patients (14%).
• All were successfully resolved in 48-72 hours.
Sources:
Kasirajan K, et al. Rheolytic thrombectomy for management of venous thrombosis: Results of a multi-center venous
registry. Journal of Vascular Interventional Radiology 2003;14:S16.
Emergency THROMBUS Management
Venous thrombectomy: MTD Results
In 44-patient retrospective study:
50% had
> 90% of
thrombus
removed
25% had
50-90% of
thrombus
removed
16% had
< 50% of
thrombus
removed
Sources:
Kasirajan K, et al. Rheolytic thrombectomy for management of venous thrombosis: Results
of a multi-center venous registry. Journal of Vascular Interventional Radiology 2003;14:S16.
Emergency THROMBUS Management
Case Study
INSERT CASE STUDY
Emergency THROMBUS Management
Summary
• PAD and Venous Thrombus are under-diagnosed
and under-treated
• Early treatment is critical to decrease
adverse effects of Arterial and Venous Thrombus
• In severe cases may result in medical emergencies if not
treated promptly
• Your vascular specialist can provide information about:
–
–
–
–
Risk factors
Symptoms
Complications
Treatment options
Emergency THROMBUS Management
Summary
New interventional therapies offered by your
vascular specialist:
• Minimally invasive
• Able to treat Arterial and Venous Thrombus
• Provide opportunity to decrease complications
• May Decrease patient hospital stay
• May Improve patient outcomes
• Used in venous applications
• Emerging techniques for restoring vessel patency include:
–
Mechanical thrombectomy
–
Balloon angioplasty
–
Stenting
Emergency THROMBUS Management
Summary
A promising new therapy:
The mechanical thrombectomy device (MTD)
• Minimally invasive
• Available in most major hospitals
• Proven effective in arterial thrombus removal
• On-label for venous thrombosis
Long-term follow-up for DVT/PTS has not been studied
Emergency THROMBUS Management
Remember
• Be aware of risk factors and symptoms
• Ask the right questions
• Use appropriate diagnostic tools
• Know the treatment options
• Consult with your vascular specialist
Emergency THROMBUS Management
Glossary
ABI: ankle-brachial index
CDL: catheter-directed lytics
ALI: Acute Limb Ischemia
IC: Intermittent Claudication
DVT: deep vein thrombosis
embolism: a clot that moves from one part of the body to another
MTD: mechanical thrombectomy device
PAD: peripheral artery disease
PAO: peripheral arterial occlusion
PTA: percutaneous transvenous angioplasty
thrombus: formation of a clot within a blood vessel
Emergency THROMBUS Management
Emergency Thrombus Management
The AngioJet® System includes several catheter models that are marketed for
thrombectomy of coronary arteries and bypass grafts, A.V. access conduits,
peripheral arteries, and peripheral veins. Select models are also marketed for
Power Pulse Delivery. See product Information for Use for specific and
complete prescribing information.
© 2007 AngioJet and Power Pulse are trademarks of Possis Medical, Inc.
1644-001 02 3/07
Emergency THROMBUS Management