1.8 Treatment Strategies For Thrombus Removal for Acute DVT. Treatments that actively remove thrombus in patients with acute DVT have the potential to reduce acute symptoms and the risk for PTS. Thrombus removal directly reverses venous obstruction and can restore function in valves that were immobilized by thrombus. Indirectly, early removal of thrombus obstruction can prevent late development of venous valvular incompetence secondary to venous dilation in distal venous segments that were never involved with thrombosis. Randomized trials, patient registries and studies of other designs support that successful thrombus removal, using a variety of techniques can improve patient outcomes. It is also possible that thrombus removal and relief of venous obstruction may reduce the risk of recurrent VTE. Patients with iliofemoral DVT are the subset of patients with the largest thrombus burden and highest risk for post-thrombotic morbidity, with up to 75% having chronic painful edema and 40% having venous claudication when treated with anticoagulant therapy alone.

MSAT is a minimally invasive endovascular treatment that offers fast, safe and complete dissolution of clots, allowing blood flow and valvular function to be restored. In clinical studies using MSAT as a standalone therapy, complete lysis was achieved in 70% of cases and partial lysis in 21%. In comparison, only 31% of cases in the National Venous Registry achieved complete lysis, even when post-adjunctive therapy was included. MSAT offers a safe treatment alternative that significantly reduces the risk of Post-Thrombotic Syndrome compared to anti-coagulation therapy.

1.9.1 In selected patients with extensive acute proximal DVT (eg, iliofemoral DVT, symptoms for < 14 days, good functional status, life expectancy > 1 year) who have a low risk of bleeding, we suggest that CDT may be used to reduce acute symptoms and post-thrombotic morbidity if appropriate expertise and resources are available.

MSAT is a sophisticated enhancement of catheter-directed thrombolysis (CDT) that enables clots to be safely dissolved, more completely and in a fraction of the time required by traditional CDT. Less time to complete dissolution means a lower lytic drug dosage and that means an even lower risk of complications.

1.9.3 We suggest pharmacomechanical thrombolysis (e.g. with inclusion of thrombus fragmentation and/or aspiration) in preference to CDT alone to shorten treatment time if appropriate expertise and resources are available.

“MSAT is a safer alternative to pharmacomechanical thrombolysis which shortens treatment time without the risks associated with thrombus fragmentation, and without damaging valves or the vascular wall. The EkoSonic system has the advantages of conventional CDT but 4 times faster without evidence of thrombus breakage or hemolysis. This translates into less time, less drug, less side effects, said Robert Hubert,” President and C.E.O. of Ekos Corporation.