further imaging that should be my opinion cross-sectional imaging and their ...possibilities you conducive to you can do mr...is available some complicated fast most can do that however and this is serious aspects of radiation and...the are negative the side effects so ct can definitely
show you some well very clear science you don't probably need ...ct to see that you have...large leg but that's visual and, another thing is you can see dilated veins segments without contrast however the intraluminal subtle changes will not be image by ct will sm are still need to see the ct a protocol that can show me the subtle
...and tribulations as I can see with mr furthermore the traumas agent has been published ...estimation mr is really helpful so based upon that mr if it's still ephemeral
...the clear conservative treatments but it's a video from ...would like to suggests
a treatment and then you can decide for a treatments strategy. Three aspects the first onevenous...more important than it looks a and beginning because most will go through the ipsilateral popliteal vein it's easy xx accessible you can do the you can do trauma lysis of the femoral vein. And, electrics quite easily however maybe you don't need that
maybeonly the electric is occluded and you can do ...vein approach this...less-common for the patient is sometimes easier because of your...ability of ...material so that might be in a...option however if you can see here on the pictures and I'm still using errors here the arrow is pointing at a post-thrombotic formal way so this note from boasted
small it's fibrosis and size of this...marik... moving it has no used to do from a lysis for that one however you can see the ...fresh...in the perform the thing that's the main outflow branch you need to open that warm-up issue need to if you want... patients so for that you need a contralateral common from approach or jugular approach but I would suggest to...to come from a vein.
So, also that you can take out from this ...many different ways you can use a simple catheter was from a lysis they're all kind of new devices now on the on the market and improve comes ...constantly so we can multiply at least I can ...any over the...of that would be better. We keep that in mind.
What is important is a protection devices...know-how always aspx do you put in I ...filters and never put an ivc filter and never ...because most of these dt patients have an underlying compression and it's so severe that will multi any migration of thrombus beyond that pts however again with m rv you can see sometimes
extension of thrombus boss that compression lesion like a floating ...and those cases are use protection devices I think that's something different than and I've see filter the ...all the ...the clots ...thromboembolic complications away but a protection device might well and then a small bit about traumas h
...you can definitely see differences in thrombus ...for example, lower left will show you that's an acute thrombus all the way to the to the right and that's hard to? Show you something this one that's recanalized, recanalized often ...for two weeks two or three months that is not something you can take out with from a lysis or trauma to me it's decidable is way more
...the right one here. This acute and chronic can also differentiate between fibrosis and thrombosis so not chronic thrombus but really fibrosis this what we talking about so in what way this imaging results will also have a results on...the lysis results in that matter I do not know because I have to say that you know,
the recanalized...will...open ...from lysis but also I've seen very fresh...that also does not open up on trauma lysis so there's a lot of research to be done there. What is more clear for me is to stand underlying course? We hear more about this it might be may turner it might be a congenital I've ...obstruction or tumor and incidence in literature is very
...between thirty percent eighty percent lie I strongly believe that ...we hired an eighty percent. And, when you look up these data is no proof but the suggestion is might debts the more you...the better the outcome but I really need to ...more data on that this is a example because clearly see
an acute thrombus in the common iliac vein and a clear...
At this location. So, what do we do? A trauma lysis we use a normal...catheter twenty four hours later the femoral vein is open the eczema iliac vein is also open but the common ...is not ...so what we have done like five years ago we just continue from
...lysis made first seventy two hours but now we know much better ...an underlying lesion that needs to be treated so we do balloon ...can see this a true lesion because of ...in the balloon and afterwards the angiography and to see a clear improvement again five years ago probably I would be ...enthusiastic about it and would leave it which can see here the
rammed of contrasts the staying there and? What do we do now we places ...and the flow is definitely improved this is the way we treat our acute vte patients?
Then also...we need to know if we perform trauma ...from but to me we need to know how much stillness has been taken out you can just
...rely on phlebography...ivus elevation for thrombus removal why is that so important to articles the more trauma ...leave in the higher-risk you have an pts the more trauma ...the higher risk of recurrent ...and therefore again pts so ...elevation is extremely important as well as for thrombus removal
sfour. Evaluation of your stent procedure and then the lost aspects and this f absolute...thoughts this anti-coagulation...on follow-up is extremely ...we use six months of anticoagulation and then we stop is the standard and it's a nice and, we have a good outflow no
instant thromboses the follow-up we do the first follow-up is often two weeks and that makes sense because looking back at the upper...of the ...we own include the...still three weeks two weeks so is important to know if the stands are still open after two weeks and if the ...to openness two weeks because then we could do additional the trumbull lysis so in conclusion not all
...are like we need cross-sectional imaging to determine the treatment strategy and to offer traded intervention to are patients maximum traumas removal is definitely. Suggested and the arthur's as well to evaluate ...and offer all we need to remove the causal to dvd...the line compression there by you truly prevents recurrence and pts and finally help
...thank you for your attention.
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