Commentary: "Single Center Experience with the AngioVac Aspiration System."

Abstract

© 2018 Chang YS. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. Venous thromboembolism (VTE), which includes Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) is the third most frequent cardiovascular disease1,2. VTE is a condition which affects all patients regardless of age, gender and ethnicity. It is estimated to have an annual incidence which ranges from 104-183 per 100,000 person-years, similar to that of stroke. The variation of incidence rates may depend on multiple factors including age distribution and ethnicity, and the risk factors exposed by the patient population3-15. The important risk factors for VTE include increasing age, high body mass index, male gender, malignancy, immobilization, oral contraceptive pills, pregnancy, and coagulopathies. Due to its high recurrence rate and the patient population at risks who often presents with multiple comorbid conditions, VTE results in a healthcare financial burden of $10 billion annually in the United States2. It is undoubtedly a major public health concern with the burden of disease affecting both developed and developing nations. Untreated VTE often presents with chronic and potentially lifethreatening complications such as post-thrombotic syndrome (PTS) and chronic thromboembolism pulmonary hypertension (CTEPH). CTEPH is reported as a complication in 3.8% of patients who experienced acute pulmonary embolism and is associated with significant morbidity and mortality16. PTS occurs in 20%-50% of the patients, presenting with clinical manifestations of chronic leg pain, edema and ischemic ulcers; negatively impacting the quality of life for the patients17. American Heart Association recommends warfarin remains as the first line treatment for acute proximal DVT to prevent recurrence and PE; American College of Chest Physicians guideline suggests non-vitamin K antagonist being the first line18,19. Additionally, Larsen et al reported patient-self-management of oral anticoagulation promotes treatment adherence leading to decreased recurrence of DVT among those patients20. However, 20-50% of patients continue to develop PTS with adequate oral anticoagulant21. Early en-bloc removal of the thrombus is preferred by using catheterdirected therapy. Recent studies suggest the potential benefits of early thrombus removal in restoring venous patency and valvular competency22. The conventional surgical management of VTE is of historical value now; with the advent of pharmacomechanical thrombolysis and catheter-directed thrombolysis which may be more efficient with fewer bleeding complications.