Chronic Venous Disease Diagnosis & Management Strategies

The discussion begins with the initial workup of patients presenting with chronic venous symptoms, emphasizing the importance of distinguishing post-thrombotic from non-thrombotic disease, as well as deep versus superficial pathology. Dr. Abramowitz highlights how a thorough medical history, including prior radiation or surgery, family history of thrombosis, prior DVTs, lymphedema, and recurrent central venous access, directly informs clinical decision-making. The physicians review the role of classification systems such as VCSS and CEAP, along with high-quality diagnostic imaging, including CT venography and duplex ultrasound performed on a tilt table.

The conversation also underscores the importance of DVT prevention and a system-wide approach to ensuring long-term follow-up for patients with venous thromboembolism. Dr. Abramowitz details his technical approach to chronic venous interventions, including evaluating adequate inflow with distal access, achieving luminal gain through balloon venoplasty, and selectively using stenting and debulking technologies. He explains the value of multiaxial systems to improve pushability during recanalization and the critical role of IVUS in ensuring stents are placed within healthy venous tissue.

The episode concludes with a discussion on the need for stronger data to guide DVT interventions, the importance of multidisciplinary collaboration to support lifelong anticoagulation when indicated, and future directions in chronic venous disease management.