Pacemaker induced #DVT Placed 2 years ago for HCM. Surprisingly sudden onset left arm swelling. 8️⃣F Brachial vein access ✅Glide advantage/IVUS cross ⚡️CAT 7 Lightning 🎈DCB 12 x 60 Impact Cause of DVT: poor collaterals and lead fibrosis. Anyone used DCB in this space?

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I have done several with DCBs! We have gotten reasonable results, better than PTA alone. I would be interested in pooling data as not much out there on this topic. Our group is very interested in lead -related venous occlusion. A few papers on the topic (@enricoferroMD @ZimetbaumP ): 1) 2)

@t_intheleadcoat @AntoniousAttall @drochohan @IRKhalsa @RajWellnessMD @EricSecemskyMD @jcgeorgemd @HadyLichaaMD @SMPatelMD @JayMathewsMD Nice case with lovely results. No one knows if DCB in veins helps or not. Generally DVT has a large component of venous stasis w hypercoag state not necessarily endothelial injury as the initiating event, so mechanistically DCB is +-?

@t_intheleadcoat @AntoniousAttall @drochohan @IRKhalsa @RajWellnessMD @EricSecemskyMD @jcgeorgemd @HadyLichaaMD @SMPatelMD @JayMathewsMD I don’t think DCBs have much of a role in treating venous disease since most cases aren’t caused by plaques or endothelial issues. Most are external compression or fibrotic. But if you have access to them, they’re probably a better option than PTA 🤷🏽. Excellent result 👏🏽

@t_intheleadcoat @AntoniousAttall @drochohan @IRKhalsa @RajWellnessMD @EricSecemskyMD @jcgeorgemd @HadyLichaaMD @SMPatelMD @JayMathewsMD Just as an anecdotal example, I’ve used large DCBs for chronic venous obstruction within the thoracic outlet and have seen more durability compared to regular angioplasty; in one patient (who served as their own control) we got extra 2 months of patency

@t_intheleadcoat @AntoniousAttall @drochohan @IRKhalsa @RajWellnessMD @EricSecemskyMD @jcgeorgemd @HadyLichaaMD @SMPatelMD @JayMathewsMD Fantastic result... Nice learning ...Thanks

@t_intheleadcoat @AntoniousAttall @drochohan @IRKhalsa @RajWellnessMD @EricSecemskyMD @jcgeorgemd @HadyLichaaMD @JayMathewsMD Nice job the ones I have with this seem to come back even with oac —do we ever recommend extraction, leadless pacer? Or just life long oac or higher INR goals?

@t_intheleadcoat @AntoniousAttall @drochohan @IRKhalsa @RajWellnessMD @EricSecemskyMD @jcgeorgemd @HadyLichaaMD @SMPatelMD @JayMathewsMD Great case. Post procedure anticoagulants……..!?!?

@t_intheleadcoat @AntoniousAttall @drochohan @IRKhalsa @RajWellnessMD @EricSecemskyMD @jcgeorgemd @HadyLichaaMD @SMPatelMD @JayMathewsMD Perfect spot for DCB trial, if fails within three months then stent

Great case and you did everything like I would EXCEPT I would use a larger catheter for thrombectomy - 16 flowtriever bareback or -penumbra cat12 Totally agree for DCB. Trials show that patients w AVF/AVG access and similar narrowing benefit significantly (thx @roblookstein )