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EKOS Treatment

What Is It?
Using the EKOS EkoSonic Ultrasound Endovascular System to treat PAO is most effective when the clot is relatively new, usually when you have had symptoms for less than 30 days. EKOS ultrasound technology using sophisticated acoustic conditioning, is making it possible to dissolve clots quickly and safely. In most cases, treatment time can be completed the same day or overnight. Click on video below to see animation on how the EkoSonic Endovascular System works:

Symptoms of DVT
Although long periods of sitting (such as on an airplane) can cause DVT, it is rare. Most DVT occurs in sick or hospitalized patients who have had surgery, broken limbs, cancer or history of a heart attack, stroke or congestive heart therapy.
Symptoms include:

  • Redness or skin discoloration
  • Calf or leg pain or tenderness, especially when walking or standing
  • Swelling of the affected body part
  • Sensation of warmth
  • Leg fatigue

Why Treat DVT?
There are several reasons to seek immediate treatment for DVT. There is a risk that a portion of the clot could break off and travel to your lungs, blocking the blood flow and damaging your heart and lungs. This condition, called Pulmonary Embolism, can be fatal within a few hours.

There are also long-term consequences of DVT. If the clot is not dissolved within a few weeks, it can permanently damage the valves in your veins creating a condition called Post-Thrombotic Syndrome (PTS). An estimated 50 to 70 percent of patients with DVT eventually develop PTS, which can cause disability and impact quality of life.

The damaged valves do not properly direct the flow to the heart, allowing the blood to pool in the legs. Patients with PTS experience:

  • Chronic pain
  • Swelling
  • Skin ulcerations
  • Varicose Veins

The pooled blood also makes the patient more prone to develop another DVT and increases the risk for pulmonary embolism. For DVT below the knee, medical treatment with anticoagulant medication is often sufficient. However, if DVT is located above the knee, ask your physician whether more aggressive treatment is indicated.

Fibrin Without Ultrasonic Energy Fibrin With Ultrasonic Energy Fibrin With Ultrasonic Energy And Thrombolytic
Figure 1
Without Ultrasonic Energy
When a clot forms, plasminogen receptor sites are embedded deep into the fibrin. For the clot to be dissolved, lytic agents must be able to access those receptor sites. But the tightly wound fibrin strands prevent the drug from penetrating, limiting access to receptor sites on the interior of the clot.
Figure 2
With Ultrasonic Energy
The EKOS endovascular device is placed directly into the thrombus, where micro-transducers transmit high frequency, low power sound waves. The ultrasonic energy causes the fibrin strands to thin, exposing plasminogen receptor sites. That makes the thrombus more permeable and allows the lytic to penetrate deeper.
Figure 3
With Ultrasonic Energy And Thrombolytic
The EKOS drug delivery catheters deliver the lytic drug, while the non-cavitational ultrasound energy gently perfuses the drug deep into the clot, limiting the amount that escapes downstream. In vitro studies confirm that thrombus exposed to ultrasound absorbed 48% more t-PA in one hour, and 84% more in two hours, than thrombus not exposed.

Benefits to EKOS Treatment

  • Penetrates clots1, in difficult-to-reach places, such as behind valves
  • Exposes clot to greater drug uptake2
  • Captures drug within clot2
  • Uses 50-70% less lytic drug1
  • No thrombus fracture or breakage3, reducing the risk of distal embolism
  • No hemolysis4. Does not fracture red blood cells, so there is no adenosine and no additional compromise to renal function
  • No damage to valves4 or the vascular wall
  • Higher level of vessel patency, removes the thrombus more completely, possibly reducing the risk of Post-Thrombotic Syndrome (PTS)
  • Minimizes time in the vascular lab, reducing radiation exposure to patients and staff.

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1Parikh, S., Motarjeme, A., et. al. “Ultrasound-Accelerated Thrombolysis for the Treatment of Deep Vein Thrombosis: Initial Clinical Experience”. Journal of Vascular and Interventional Radiology, Volume 19, Issue 4, April 2008, pp 521-528.

2Francis, Charles W. et al. “Ultrasound Accelerates Transport of Recombinant Tissue Plasminogen Activator into Clots.” Ultrasound in Medicine and Biology 21.3 (1995): 419-424.

3Braaten, J., Goss, R., and Francis, CW. “Ultrasound Reversibly Disaggregates Fibrin Fibers.” Thromb Haemost 78 (1997) 1063-8.

4Soltani, A., et al “Absence of biological damage from prolonged exposure to intravascular ultrasound.” Ultrasonics 46 (2007) 60-67.

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