Catheter-Directed Thrombolysis of Iliofemoral DVT

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

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
Image Production: 0.50
Image Acquisition and Equipment: 0.50
Procedures: 1.50
Vascular Interventional Procedures: 1.50

Outline

1. Introduction
2. Clinical Evaluation
3. Imaging
4. Treatment Modalities
   1. Systemic Anticoagulation
   2. Systemic Thrombolysis
   3. Catheter-directed Thrombolysis
   4. Pharmacomechanical CDT and Percutaneous Mechanical Thrombectomy
   5. Indications for Use of Standard CDT and Pharmacomechanical CDT
   6. Stent Placement
5. Conclusion

Objectives

Upon completion of this course, students will:

1. list the goals of DVT treatment in the acute care setting
2. cite the standard of care for DVT
3. describe which clot types present a therapeutic challenge
4. list endovascular thrombus removal and dissolution strategies
5. list disease-specific factors to consider upon clinical evaluation for DVT
6. name the categories for dividing the chronicity of DVT cases
7. differentiate between proximal and distal regions for DVT
8. list chronic symptoms of proximal DVT
9. summarize imaging exams used to diagnose DVT
10. state the limitations of ultrasound for the diagnosis of DVT
11. list reasons to use CT or MR venography for diagnosis of DVT
12. state when IVC filter placement is necessary prior to endovascular thrombolysis or thrombectomy
13. list the advantages of CT venography over duplex ultrasound
14. state why systemic anticoagulation is the standard of care for DVT
15. recall systemic anticoagulation treatment time for acute DVT patients
16. list anticoagulant medications used for systemic anticoagulation therapy
17. state the major limitation of anticoagulation as an isolated therapy
18. differentiate between systemic thrombolysis and anticoagulation
19. state why systemic thrombolysis is no longer in clinical use
20. list the endovascular thrombus removal categories
21. state the most commonly used endovascular thrombus removal techniques
22. recall thrombolytic agent delivery techniques
23. list commonly used thrombolytic agents
24. recall what imaging study should be performed post CDT
25. differentiate between multiple trials for CDT
26. state percentage of hemorrhage complication with CDT
27. list common bleeding complications associated with CDT
28. describe ultrasound-assisted CDT
29. differentiate between thrombectomy techniques
30. describe the isolated thrombolysis pharmacomechanical catheter-directed technique
31. list the major complications associated with CDT
32. recall percentage of CDT cases in which major hemorrhage is a complication
33. compare and contrast the difference between pharmacomechanical CDT and conventional CDT
34. differentiate between professional organizations and their guidelines for CDT
35. list consequences to not placing stents for residual proximal venous stenosis