The national principal investigator of the ATTRACT study shares his insights on DVT treatment, regulatory hindrances in the venous space, and the progression of interventional radiology fellowships.
Venous return is attained through a complex interaction of valves, muscle pumps, and pressure gradients and is greatly influenced by position. In the upright position, gravity is counteracted by the valve-pump system; however, in the supine position, hydrostatic pressure disappears, and pressure gradients effect flow. Duplex ultrasound (DUS) technology uses sound to provide relatively limited information about this complex physiologic system. The physician must therefore rely mostly on clinical skills when treating patients with venous disease.
Varicose veins are largely treated by changing the circulatory pattern created by the underlying valvular failure. This frequently involves disconnecting superficial and deep connections that have incompetent valves to stop the flow from high-pressure deep veins back into low-pressure superficial veins and then ablating the damaged superficial veins (varicosities) either surgically, chemically, or thermally. Because there are numerous connections from superficial to deep veins (perforators) that could potentially fail,1 recurrence should be less of a surprise than the lack thereof. Good treatment necessitates the identification of these abnormal connections, which requires imaging that both identifies the perforator and demonstrates the abnormal flow. The use of duplex ultrasound has greatly improved the accuracy of identifying the problematic perforator, the most common being the saphenofemoral junction.
Determining therapeutic protocol for acute and chronic DVT.
Clarification of questions arising about the use of a new code for venous embolization, 37241.
Michael R. Jaff, DO, discusses the differences between the arterial and venous stent landscapes and what the future might hold.
A study that examined the incidence of cerebral microembolization and silent cerebral infarction after thoracic endovascular aneurysm repair (TEVAR) concluded that two-thirds of patients undergoing MRI had evidence of silent cerebral infarction—a previously unrecognised burden.
Suresh Vedantham, professor of Radiology, Interventional Radiology Section, Washington University School of Medicine in St Louis, USA, spoke to Interventional News on the latest from the paper “Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal” hot on the heels of its online publication in the Journal of Vascular and Interventional Radiology (JVIR).
Sapan Desai (Department of Vascular Surgery, Southern Illinois University, USA) and colleagues report in the Journal of Vascular Surgery that the ongoing decrease in open aneurysm repair that has occurred as a result of the increase in endovascular aortic aneurysm repair (EVAR) may mean that next-generation vascular surgeons do not gain sufficient experience in open repair during training and, therefore, may be ill prepared to perform the procedure.
Cardiatis announced plans of targeting Crawford Extent V lesions with its second generation aortic multilayer flow diversion device, the Cardiatis C5.
November 5, 2014—VIVA Physicians, Inc. announced that Peter A. Schneider, MD, presented findings from a subanalysis of a series of patients treated by urgent endovascular aneurysm repair (EVAR) using EndoAnchors (Aptus Endosystems, Inc.) in the larger ANCHOR global registry. Dr. Schneider presented the ANCHOR subset data during the late-breaking trials session at the VIVA 2014: Vascular InterVentional Advances meeting in Las Vegas, Nevada. There is critical need in urgent EVAR for a bailout adjunct to treat proximal seal complications or address concerns in complex proximal neck anatomy, noted the announcement.
November 5, 2014—VIVA Physicians, Inc. announced that Ali Azizzadeh, MD, presented findings from the United States investigational device exemption DISSECTION trial of Medtronic, Inc.’s Valiant Captivia thoracic stent graft during the late-breaking trials session at the VIVA 2014: Vascular InterVentional Advances meeting in Las Vegas, Nevada. The study evaluated the Valiant Captivia for endovascular aortic repair in acute type B aortic dissection.
November 4, 2014—Veryan Medical Ltd announced that 2-year data from the MIMICS study were presented during the late-breaking clinical trials session at the VIVA 2014: Vascular InterVentional Advances meeting in Las Vegas, Nevada. Principal Investigator Professor Thomas Zeller, MD, of Universitäts-Herzzentrum in Freiburg-Bad Krozingen, Germany, presented the MIMICS data.
November 5, 2014—Shockwave Medical announced clinical results from DISRUPT PAD, a single-arm, multicenter study evaluating the safety and utility of the company’s Lithoplasty balloon catheters for the treatment of peripheral artery disease, at the VIVA 2014: Vascular Interventional Advances meeting in Las Vegas, Nevada. DISRUPT Principal Investigator Marianne Brodmann, MD, of the Medical University of Graz in Austria, presented the results.
November 4, 2014—VIVA Physicians, Inc. announced that Lawrence Garcia, MD, presented findings from the SUPERB trial during a late-breaking trials session at the VIVA 2014: Vascular InterVentional Advances meeting in Las Vegas, Nevada. SUPERB was a prospective, multicenter, nonrandomized, single-arm, investigational device exemption study that evaluated the safety and effectiveness of Abbott Vascular’s Supera peripheral stent system for the treatment of superficial femoral (SFA) and proximal popliteal arteries (PPA) in patients with lifestyle-limiting claudication or rest pain.
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