A Referral Pathway: Treating Patients With Severe Venous Disease Using Mechanical Thrombectomy

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Dr. Nicolas Mouawad shares background and key insights from his brief report, "A Referral Pathway for Treating Patients With Severe Venous Disease Using Mechanical Thrombectomy." Read the full paper here.

Transcript:

Nicolas Mouawad, MD, MPH, MBA:

Hi everybody, my name is Dr. Nicolas Mouawad. I'm the Chief of Vascular and Endovascular Surgery, the Vice Chair of Surgery, and the Chair of Cardiovascular Research at McLaren Health System in Bay City, Michigan.

I'm very happy to be here today to talk to you all about patients with deep venous obstructions and DVT, as well as chronic venous leg ulceration secondary to these post-thrombotic obstructions. We performed a specific study at our institution, single center retrospective of all patients presenting with CEAP 6 disease, active ulceration, that underwent mechanical thrombectomy to manage its deep post-thrombotic obstructions.

The cohort was 11 patients and 14 limbs, 4 of which were female and 7 male. We described clinical success and technical success, with technical success being able to cross the thrombotic obstruction and clinical success demonstrating a reduction in CEAP 6 disease or a decrease in the CEAP and venous clinical severity score. We had 100 % clinical success, and we had 100 % technical success. On close evaluation of our patients, in fact, all patients have ultimately ended up healing their wounds secondary to mechanical thrombectomy and management of those deep venous obstructions and ultimately restoring cephalad flow and luminal gain within their deep venous systems.

We really do believe there is an opportunity to help these patients heal wounds, particularly secondary to deep venous obstructions, with the use of the mechanical thrombectomy device, a ClotTriever catheter, that was used in our particular study.

Yeah, we felt it very important to help disseminate our results, particularly due to management of these patients with chronic venous wounds and venous leg ulcers. We felt that the Wounds journal was the appropriate medium to disseminate this information, and we really wanted to help focus on collaboration between interventionalists and local post-acute care providers that manage patients with wounds. I felt that it was these wound care centers, and our close collaboration with them that referred the patients to us for further evaluation, it was that opportunity, and in fact, that participation or that engagement between providers that allowed us to ultimately and successfully heal these patients’ wounds and avoid long-term sequelae of venous leg ulcerations and ultimately avoid them from having an amputation.

I think anecdotally no, but the results were pleasantly surprising because I thought there was an opportunity here to really help these patients. Generally speaking, management of patients with post thrombotic obstructions or deep venous disease secondary to obstruction is usually leg elevation, compression therapy, and chronic local wound care. But now there is an opportunity to consider an interventional perspective, help remove these deep venous obstructions, manage these webbing or synechiae ultimately to restore cephalad flow and luminal gain, ultimately restore flow. And ultimately, again, to decrease venous leg ulcerations or help promote wound healing.

There's multiple things I think would be fantastic for research, but outside of actual clinical research, I think it is an opportunity to look at different pathways to make sure that all of us, the whole care pathway of these patients with venous leg ulcers or deep venous obstructions is highlighted. Management with advanced practice providers, wound care centers, interventionalists, those that are deep venous operators, I think having this open participatory and engaging conversation is important because that's how we identify these patients.

There are things that we can do nowadays that can help these patients heal these wounds. Of course, we’ve got to keep close follow-up. I tell everybody that it's not just a procedure that's successful, but there is, of course, the whole patient care continuum: close follow-up, leg elevation, focused information from our wound colleagues, diabetic control, management of infection or sepsis. So there's a variety of things that have to happen and not just a procedure, it's the whole care continuum that is important.

What I'd like to add is that never give up. There are new things. I think the fantastic part about medicine is that there are always new concepts, new procedures, new devices or innovations that are occurring. So stay abreast of all this with the Wounds journal, with your local data, because you might learn something along the way. I mean, I think we all want to provide patients the best care possible. We want it, of course, to be safe, efficacious, but ultimately durable. And the days of these chronic wounds where there is nothing that can be done, I think you should revisit that and see if something might be available currently.