Endovascular Interventions for Lower Extremity Deep Venous Disease

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Registered Radiologist Assistant: 2.50
Patient Care: 0.50
Pharmacology: 0.50
Procedures: 2.00
Neurological, Vascular, and Lymphatic Sections: 2.00

Vascular-Interventional Radiography: 2.50
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 2.00
Vascular Interventional Procedures: 2.00

Outline

1. Introduction
2. Part 1: Acute Lower Extremity Deep Vein Thrombosis
   1. Epidemiology
   2. Beyond Pulmonary Embolism: Postthrombotic Syndrome
   3. Risk Factors for Developing PTS after DVT
   4. Noninterventional Methods to Prevent PTS
   5. Beyond Anticoagulation: The ìOpen Veinî Hypothesis and Lessons Learned from Systemic Thrombolysis for DVT
   6. Image-Guided Endovascular Thrombus Removal: Description and Evolution of Techniques
   7. Patient Selection for Catheter-directed Therapy: Anatomic and Clinical Considerations
   8. The Role of Imaging in Stratifying Patients and Planning for Potential Intervention
   9. Outcomes of Interventional DVT Therapy
3. Part 2: Interventional Management of Chronic Lower Extremity Deep Venous Disease
   1. Background
   2. Patient Assessment
   3. Noninterventional Management
   4. Imaging Assessment
   5. Patient Selection and Preparation
   6. Interventional Treatment of Iliocaval Stenoses and Occlusions
   7. Complications
   8. Postprocedural Management
   9. Outcomes
4. Conclusion

Objectives

Upon completion of this course, students will:

1. state the prevalence of lower extremity deep venous disease
2. discuss the most feared consequence of deep venous thrombosis
3. list three parenteral anticoagulation drugs
4. list the symptoms of post-thrombotic syndrome
5. recall outcomes from the Venous Thrombosis Outcomes (VETO) study
6. explain pathogenesis of post-thrombotic syndrome
7. recall complications from reflux and or obstruction of the venous system
8. list patient types that have relatively minor risk of post-thrombotic syndrome
9. explain what types of DVT increase risk of post-thrombotic syndrome
10. identify medical trials associated with treating post-thrombotic syndrome
11. state how VTE is associated with post-thrombotic syndrome
12. recall the first endovascular thrombolytic method for DVT
13. list alternate access points for when the popliteal vein is occluded
14. list the lytic drugs currently used in clinical practice for CDT procedures
15. state the typical infusion time period for catheter-directed thrombolysis
16. identify the imaging modality utilized before, during, and after lytic therapy
17. list treatments for post-thrombectomy obstructive lesions
18. list the potential disadvantages of percutaneous mechanical thrombectomy
19. name the components of pharmacomechanical catheter-directed thrombolysis
20. list the general categories for PCDT technique
21. discuss the groups of clinical severity for DVT
22. describe patients suitable for aggressive therapy to prevent PTS
23. review imaging modalities to determine highest sensitivity and specificity for detection of infrainguinal deep venous thrombosis
24. state the imaging modalities used for evaluating difficult patients with DVT
25. review limitations of multiple interventional DVT studies
26. recall what catheter-directed thrombolysis trial was sponsored by the National Heart, Lung, and Blood Institute
27. know the annual cost associated with venous ulcers in the United States
28. state how chronic venous disease develops
29. review statistics related to chronic lower extremity disease and PTS
30. explain the importance of documentation criteria for chronic lower extremity deep venous disease
31. list non-interventional options for DVT treatment
32. name the indications for imaging the deep venous system in chronic venous disease
33. indicate the use of computed tomography for imaging IVC filters
34. state the routes of entry into the venous system
35. document patient positioning for accessing the popliteal vein
36. list the types of iliocaval obstructions
37. describe findings from the PREPIC trial
38. identify the best imaging modality for detection of luminal narrowing
39. state the most common complication associated with interventional treatment of venous disease
40. state the duration of anticoagulation therapy for non-thrombotic disease