Thread by @SIRspecialists

Kicking off multidisciplinary Research Consensus Panel (RCP) to finally investigate the ❓: what is the optimal medical therapy (OMT) following venous recan? Follow #VenousRCP throughout the day to learn more and contribute! #SIRFoundation @SIRRFS @SIR_ECS @JVIRmedia

🔴 Pathophysiology of venous thromboembolism #VTE
🟠Venous recanalization & stenting
🟡The mystery of medical therapy following recanalization
🟢Patency & outcome measures
🔵Economics & cost-effectiveness of treatment
🟣Future directions
#VenousRCP

🔴 ✅#VTE affects ~100 of every 100,000 people yearly in the US
✅Incidence of VTE ⬆️⬆️ exponentially with age, especially after 40
✅#Endovascular recan is a common tx; post-tx algorithms vary widely
✅More #epidemiology info @CircAHA bit.ly/37IptZh
@Pertconsortium

55 yoM w/ hx of recurrent #VTE & #IVC filter s/p iliocaval reconstruction & stent occlusion. Presents w/ severe post-thrombotic syndrome (PTS) and Villalta of 21.

What went wrong? #VenousRCP

Virchow’s triad remains foundation of #VTE.

Important cellular #research on #DVT & PTS focusing on biomarkers P-selectin, ICAM-1, NETs & others may help w/tx strategies

Review bit.ly/34yLyaU & bit.ly/37TmIUW

Antithrombotic agents may assist with stent patency. What combination is right for your #patient, if any?
#patientcare jvir.org/article/S1051-…

Warfarin has been used since 1954, but the Direct-Acting Oral Anticoagulants (#DOAC) are fairly new. What is your #DOAC of choice? #VenousRCP

🟠There is ongoing controversy in #VTE and #PTS management. Despite widespread use of #DOACs for treatment and prevention of VTE, there are still questions, and NO consensus regarding role of antiplatelet following venous stenting. bit.ly/3dWCv6G ejves.com/article/S1078-…

#Endovascular therapy has been helping patients with #VTE for years with evolving technologies.
Take a look at this review of medical and #endovascular therapies at bit.ly/2HqXzGG by @akhileshsistaMD

🟡What is your preferred stent for venous recanalizanalization / reconstruction? #VenousRCP

Many techniques for #endovascular venous recan for chronic occlusions: back end of wire, RF wire, needles, & more. Experience & #innovation are key for #patient safety. #VenousRCP #IRAD. A few examples w/ outcomes: bit.ly/3otZpY2 bit.ly/3jxCzux

More than just human plumbing! Complex flow mechanics can be altered by stents. Narrowing of the EIV after placement of an adjacent CIV stent is described by @ramseyVIR in this @JVIRmedia article. @SIRRFS #VenousRCP bit.ly/34vUMo7

Does distal stent location make a difference?
How low do you go? #VenousRCP

🟢Stent patency rate is not related to placement across the inguinal ligament, but underlying etiology and whether lesion is occlusive or non-occlusive. Stent placement into a dominant femoral inflow vein is promising in carefully selected patients. bit.ly/31IOgIS

Why is #Thrombus age so important to #outcomes? Management of acute thrombosis vs PTS is different; OMT is still unclear.

🔵💲 Each #VTE case results in preventable medical costs of ~ $20,000.
💲 #VTE is estimated to cost at least $7–12 billion/year in US.
💲 #Endovascular tx and standard tx for acute #DVT projected to be >$165k/patient
Find more info at bit.ly/3kuNZAO

#Quality of Life improvement after iliofemoral #DVT patients in #ATTRACT
VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group at 1, 6, 18, and 24 months
More at bit.ly/3kv2og6

That's a wrap on day 1 of #VenousRCP & our tweetorial. Plenty of #VTE, OMT, & #endovascular #medicaleducation #meded.

Follow along tomorrow to hear about how we move forward from here!

Welcome Back! Lots of great discussions yesterday! #SIRFoundation. @SIRspecialists @SVM_tweets @ASH_hematology @VascularSVS @VeinForum @JVIRmedia @SIRRFS #VenousRCP

There are still some remaining questions surrounding venous recan. #VenousRCP
-What is the optimal anti-thrombotic regimen?
-What is the best clinical follow up for patients undergoing treatment?
-What is the post-stenting medical and imaging follow up?

Case study: Another opportunity to help patients suffering from #VTE. 40 yoM with occluded stents recanalized & tx w/anti-coagulation & anti-platelet therapy.

In the future, multidisciplinary #research including benchtop, translational and clinical trials are anticipated (or ongoing).

On-going Trial: Chronic Venous Thrombosis: Relief With Adjunctive Catheter-Directed Therapy (The C-TRACT Trial) Learn more about how to join this study.
bit.ly/3moRx8c

Thanks for tuning in to our #VenousRCP #tweetorial! Much learned and a lot left to investigate!
#SIRFoundation #medtweetorial