Venous Thromboembolism: A Practical Guide in Interventional Radiology

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. Venous Thromboembolism: A Practical Guide in Interventional Radiology 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.

Key features:

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.

Table of Contents:

Chapter 1

1 Introduction

References

Chapter 2

2 Pharmacologic Management of Venous Thromboembolism

Role of Pharmacologic Treatment of VTE

Traditional Anticoagulants

Heparins and Heparin

Warfarin

Newer Anticoagulants

Special Populations

References

Chapter 3

3 Imaging of Deep Vein Thrombosis and Pulmonary Emboli

Ultrasound

Accuracy of Doppler Ultrasound for Diagnosis of DVT

Indication

Technique

Imaging Features

Pitfalls

Computed Tomography Pulmonary Angiography

Indication

Technique

Imaging Features

Pitfalls

Special Considerations

Nuclear Medicine

Accuracy of Nuclear Medicine Studies for VTE Diagnosis

Indication

Technique

Imaging Features

Pitfalls

Special Considerations

Conventional Pulmonary Angiography

Indication

Technique

Imaging Features

Pitfalls

Special Consideration

References

Chapter 4

4 Catheter-Directed Thrombolysis Treatment of Deep Venous Thrombosis

Anatomy

Diagnosis

Anticoagulation

Systemic Thrombolytic Therapy for VTE

Catheter-Directed Thrombolysis for DVT

Mechanical Thrombectomy

Who Benefits from Pharmacomechanical Therapy

Upper Extremity

References

Chapter 5

5 Inferior Vena Cava Filter Placement

Introduction

History and Background of IVC Filters

IVC Filter Placement Indications

Contraindications

Choosing a Filter

Permanent and Removable Filters

Deployment Methods

Placement Location

Variants

Deployment Complications

Timing of IVC Filter Placement

Postplacement Management

Conclusion

References

Chapter 6

6 Retrievable Inferior Vena Cava Filters: Challenges in Device Utilization, Advanced Retrieval

Introduction

Permanent versus Retrievable

Obstacles to Filter Retrieval

Filter Types and Removal Techniques

Standard Technique

Advanced Retrieval

Conclusion

References

Chapter 7

7 Inferior Vena Caval and Right Atrial Thrombus

Introduction

Etiologies

Congenital IVC Anomalies

Congenital Coagulopathies

Acquired Coagulopathies

Medical Devices

IVC Filtration

Intracardiac Devices

Diagnosis

Diagnostic Imaging—IVC

Diagnostic Imaging RA

Medical Management

Interventional Management

Acute IVC Thrombosis

Chronic IVC Thrombosis

Right Atrial Interventions

Conclusion

References

Chapter 8

8 Interventional Approaches to Recanalization of Chronic Central Venous Occlusions

Introduction

Indications/Contraindications for Recanalization in CTO

Patient Selection and Preprocedure Workup

Technique

Equipment

Patient Positioning/Access/Technique

Balloon Angioplasty/Stenting

Postprocedural Management

Complications/Special Considerations

CTO due to IVC Filter Occlusion

Stent Migration/Malpositioning

Stents Trapped in Filters

Clinical Data and Outcomes

Conclusion

References

Chapter 9

9 Pulmonary Embolism

Clinical Assessment: Massive versus Submassive

Medical/Systemic Treatment of PE: Anticoagulation and Thrombolysis

Pharmacologic Catheter-Directed Lysis

Traditional vs. Ultrasound Assisted (EKOS)

Contraindications/Cautions

Patient Monitoring

Mechanical Thrombectomy

Aspiration Thrombectomy

Rotational Devices

Hydrodynamic Devices

Surgical Thrombectomy

References

Chapter 10

10 Venous Thromboembolism: Management of Bleeding Complications

Bleeding Complications Associated with Venous Thromboembolism Treatment

Patient Selection and Monitoring for Bleeding Complications

Management of Bleeding Complications

Summary

References

Quality Improvement and Safety of Treatment of Thromboembolic Disease and Guidelines and Compli

References

Filter-Related Adverse Events and Thresholds

References

Index