TCT TORPEDO

1,165 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,165
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

TCT TORPEDO

  1. 1. Mohsen Sharifi,MD,FACC, Mahshid Mehdipour, Curt Bay, PhD, Gary Smith,MD, Jalaladdin Sharifi,MD for the "TORPEDO" investigators<br /> <br />Arizona Cardiovascular Consultants & A.T. Still University, Mesa, AZ<br />No Disclosures<br />
  2. 2. TORPEDO TRIAL<br />Thrombus Obliteration by Rapid Percutaneous Endovenous Intervention in Deep Venous Occlusion “TORPEDO” trial : Mid –Term results<br />
  3. 3. Percutaneous Endovenous Intervention Reduces Recurrent Venous Thromboembolic Disease and Post-Thrombotic Syndrome in Acute Proximal Deep Venous Thrombosis:- Report of the “TORPEDO” trial at Mid-Term Follow-up. <br />
  4. 4. Venous Thromboembolism (VTE)<br />Consists of two clinical pictures:<br /> 1- Deep vein thrombosis (DVT)<br /> 2- Pulmonary embolism (PE)<br />Intimately related to etiology, treatment and outcome<br />50% of proven DVT also have PE<br />70% of proven PE also have DVT<br />
  5. 5. VTE<br />Incidence: 1-2/1000 /year<br />Up to 90% of PE originate in LE DVT,s<br />< 2% of PE originate in UE DVT<br />Most thrombi (80-90%) originate in the Soleal veins of the calf<br />Majority of calf thrombi (80-70%) resolve spontaneously<br />20-30% of DVT,s propagate to Popliteal, femoral or iliac veins<br />10-20% of all DVT,s begin in proximal veins without prior calf involvement<br />
  6. 6. Important Fact on Prox. DVT<br />21% of adequately anticoagulated patients develop PE<br />Up to 50% Patients on anticoagulation develop PTS at 3-5 years<br />Estimated cost of VTE 1.5 Billion<br />(Plate G, Ohlin P, Eklof B. Pulmonary embolism in the acute ileofemoral venous thrombosis. Br J Surg 1985;72:912–915.)<br />
  7. 7. No Randomized trial in Reduction of DVT Sequelae with Percutaneous Endovenous Intervention (PEVI)<br />
  8. 8. Patients with acute symptomatic proximal DVT<br />First Randomized Prospective Trial<br />
  9. 9. Patients with acute symptomatic proximal DVT<br />
  10. 10.
  11. 11. 183 Randomized<br />Control<br />No=92<br />PEVI<br />No=91<br />8 pts<br />PEVI <br />88<br />Control<br />81<br />F/U at 30±5months<br />
  12. 12. Primary endpoints<br />Development of:<br />Post- thrombotic Syndrome<br />Recurrent Venous Thromboembolic Disease<br />
  13. 13. Secondary Endpoints<br />Skin Induration<br />Leg Edema<br />Hospital Stay<br />Subjective Perception of Improvement<br />Bleeding<br />
  14. 14.
  15. 15. Anticoagulation-Alone Group= Control<br />Heparin 80U/kg bolus; 18U/kg/hr<br />APTT 1.5-2 X Normal<br />Enoxaperin 1mg/kg SQ BID<br />Simultaneous Coumadin<br />5 day parenteral regimen + 24 hr overlap with warfarin<br />Compression Stockings 20-30 mmHg<br />
  16. 16. PEVI<br />Same as Control<br />Within 24 hours to Angio Suite<br />All received retrievable IVC filters<br />ASA 81-325 given<br />PEVI according to venography findings<br />Anticoagulation not withheld<br />
  17. 17. US Guided<br />Micropuncture Needle<br />Popliteal Approach<br />5 Day Parenteral Therapy Not Required<br />Ambulate in 1 Hour<br />
  18. 18. PEVI MODALITIES<br />
  19. 19.
  20. 20.
  21. 21. Spectrum of Venoocclusive Disease<br />Distorted<br /> venous Architecture<br />Acute Thrombus + Preserved Venous Anatomy<br />
  22. 22.
  23. 23.
  24. 24.
  25. 25. PTS= presence of at least 2 new symptoms: leg burning. pain, aches, discomfort, restlessness, tingling plus the following signs<br />*= more than 1000 milliseconds of reflux on venous spectral Doppler in a segment of the deep venous system without previous reflux or more than 500 ms increase in the extent of reflux if previously present.<br />+ PTS= post-thrombotic syndrom= Finding must be present for diagnosis; - = finding must be absent for diagnosis; ± = presence or absence of finding would not affect diagnosis<br />
  26. 26.
  27. 27.
  28. 28.
  29. 29.
  30. 30. BREAKDOWN PRIMARY ENDPOINTS<br />
  31. 31. TOTAL OUTCOME<br />
  32. 32. Role of ASA on PTS<br />RR= 0.37, 95% CI: 0.19- 0.74, p=0.006.<br />
  33. 33. Secondary Endpoints<br />
  34. 34.
  35. 35.
  36. 36. ConclusionsPEVI + anticoagulation is superior to anticoagulation alone in:<br />Reduction of recurrent VTE.<br />Reduction of PTS<br />Reduction of hospital stay<br />Reduction of leg edema<br />Reduction of skin induration<br />Reduction in duration of parenteral anticoagulants<br />Subjective perception of improvement<br />

×