A high-yield guide for interventional radiologists on venous thromboembolic disease

Epidemiological analyses estimate venous thromboembolism (VTE) impacts as many as 600,000 individuals annually in the United States, and it is the leading preventable cause of in-hospital mortality. Diagnosing VTE based on clinical symptoms is generally unreliable due to nonspecific signs, while patient management is influenced by thrombosis severity, location, and underlying risk factors. Practical Guides in Interventional Radiology: Venous Thromboembolism (VTE) by renowned radiologists Jeffrey Weinstein, Jeet Minocha, and Joshua D. Dowell focuses on helping clinicians improve VTE diagnosis, decision-making, and procedural outcomes.

The first chapter covers interventional radiology basics that lay the groundwork for effective management of patients with VTE, including pathogenesis, patient diagnosis, and medical therapies. Chapters 2 and 3 discuss pharmacologic treatment and imaging of deep vein thrombosis (DVT) and pulmonary emboli (PE), respectively. Chapters 4 to 9 provide practical guidance on patient selection and workup, basic and complex interventional techniques, and management of potential complications for a variety of pathologies and interventions. The final chapter presents a Q&A and VTE-related safety issues.

An authoritative review of VTE by a curated collection of experts in the field
A reader-friendly primer on the evaluation and management of DVT, PE, and intracardiac thrombus based on evidence-based practices
Practical guidance on deployment and retrieval of inferior vena cava (IVC) filters
This resource is essential reading for interventional radiology residents and fellows, as well as early-career clinicians who are intricately involved in the management of patients with deep venous disease.

This book includes complimentary access to a digital copy on https://medone.thieme.com.


Foreword
1 Introduction
1.1 References
2 Pharmacologic Management of Venous Thromboembolism
2.1 Role of Pharmacologic Treatment of VTE
2.2 Traditional Anticoagulants
2.2.1 Heparins and Heparin Derivatives
2.2.2 Warfarin
2.3 Newer Anticoagulants
2.4 Special Populations
2.5 References
3 Imaging of Deep Vein Thrombosis and Pulmonary Emboli
3.1 Ultrasound
3.1.1 Accuracy of Doppler Ultrasound for Diagnosis of DVT
3.1.2 Indication
3.1.3 Technique
3.1.4 Imaging Features
3.1.5 Pitfalls
3.2 Computed Tomography Pulmonary Angiography
3.2.1 Indication
3.2.2 Technique
3.2.3 Imaging Features
3.2.4 Pitfalls
3.2.5 Special Considerations
3.3 Nuclear Medicine
3.3.1 Accuracy of Nuclear Medicine Studies for VTE Diagnosis
3.3.2 Indication
3.3.3 Technique
3.3.4 Imaging Features
3.3.5 Pitfalls
3.3.6 Special Considerations
3.4 Conventional Pulmonary Angiography
3.4.1 Indication
3.4.2 Technique
3.4.3 Imaging Features
3.4.4 Pitfalls
3.4.5 Special Consideration
3.5 References
4 Catheter-Directed Thrombolysis Treatment of Deep Venous Thrombosis
4.1 Anatomy
4.2 Diagnosis
4.3 Anticoagulation
4.4 Systemic Thrombolytic Therapy for VTE
4.5 Catheter-Directed Thrombolysis for DVT
4.6 Mechanical Thrombectomy
4.7 Who Benefits from Pharmacomechanical Therapy
4.8 Upper Extremity
4.9 References
5 Inferior Vena Cava Filter Placement
5.1 Introduction
5.2 History and Background of IVC Filters
5.3 IVC Filter Placement Indications
5.4 Contraindications
5.5 Choosing a Filter
5.5.1 Permanent and Removable Filters
5.6 Deployment Methods
5.6.1 Placement Location
5.6.2 Variants
5.7 Deployment Complications
5.8 Timing of IVC Filter Placement
5.9 Postplacement Management
5.10 Conclusion
5.11 References
6 Retrievable Inferior Vena Cava Filters: Challenges in Device Utilization, Advanced Retrieval Techniques to Optimize Outcomes
6.1 Introduction
6.2 Permanent versus RetrievableIVCFs
6.3 Obstacles to Filter Retrieval
6.4 Filter Types and Removal Techniques
6.4.1 Standard Technique
6.4.2 Advanced Retrieval Techniques
6.5 Conclusion
6.6 References
7 Inferior Vena Caval and Right Atrial Thrombus
7.1 Introduction
7.2 Etiologies
7.2.1 Congenital IVC Anomalies
7.2.2 Congenital Coagulopathies
7.2.3 Acquired Coagulopathies
7.2.4 Medical Devices
7.2.5 IVC Filtration
7.2.6 Intracardiac Devices
7.3 Diagnosis
7.3.1 Diagnostic Imaging IVC
7.3.2 Diagnostic Imaging RA
7.4 Medical Management
7.5 Interventional Management
7.5.1 Acute IVC Thrombosis
7.5.2 Chronic IVC Thrombosis
7.5.3 Right Atrial Interventions
7.6 Conclusion
7.7 References
8 Interventional Approaches to Recanalization of Chronic Central Venous Occlusions
8.1 Introduction
8.2 Indications/Contraindications for Recanalization in CTO
8.3 Patient Selection and Preprocedure Workup
8.4 Technique
8.4.1 Equipment
8.4.2 Patient Positioning/Access/Technique
8.4.3 Balloon Angioplasty/Stenting
8.5 Postprocedural Management
8.6 Complications/Special Considerations
8.6.1 CTO due to IVC Filter Occlusion
8.6.2 Stent Migration/Malpositioning
8.6.3 Stents Trapped in Filters
8.7 Clinical Data and Outcomes
8.8 Conclusion
8.9 References
9 Pulmonary Embolism
9.1 Clinical Assessment: Massive versus Submassive
9.2 Medical/Systemic Treatment of PE: Anticoagulation and Thrombolysis
9.3 Pharmacologic Catheter-Directed Lysis
9.3.1 Traditional vs. Ultrasound Assisted (EKOS)
9.3.2 Contraindications/Cautions
9.3.3 Patient Monitoring
9.3.4 Mechanical Thrombectomy
9.3.5 Aspiration Thrombectomy
9.3.6 Rotational Devices
9.3.7 Hydrodynamic Devices
9.3.8 Surgical Thrombectomy
9.4 References
10 Venous Thromboembolism: Management of Bleeding Complications
10.1 Bleeding Complications Associated with Venous Thromboembolism Treatment
10.1.1 Patient Selection and Monitoring for Bleeding Complications
10.1.2 Management of Bleeding Complications
10.1.3 Summary
10.1.4 References
10.2 Quality Improvement and Safety of Treatment of Thromboembolic Disease and Guidelines and Complication Thresholds for Treatment of DVT and PE
10.2.1 References
10.3 Filter-Related Adverse Events and Thresholds
10.3.1 References
Contributors
Index