Venous Interventions

Session: Educational Exhibit Presentations - Station 11: Venous Interventions

Provoked vs. Unprovoked: A Review of Our Current Understanding of Venous Thromboembolisms

Monday, March 6, 2023

5:25 PM – 5:30 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Caleb F. Solivio, BS (he/him/his)

Medical Student
California University of Science and Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AA

Ahmad Alach, BS

Medical Student
Kaiser Permanente Bernard J. Tyson School of Medicine
MG

Muhammad S. Ghauri, MS

Medical Student
California University of Science and Medicine
TS

Talha Shabbir, MS

Medical Student
California University of Science and Medicine
GV

Geogy Vatakencherry, MD, FSVM,FSIR

Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician
Austin N. Shinagawa, M.D.

Integrated Vascular and Interventional Radiology Resident
Kaiser Permanente Los Angeles Medical Center
Kartik Kansagra, MD

Vascular and Interventional Physician
KP VISLA
AB

Alok Bhatt, MD

Assistant Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente Los Angeles

Disclosure(s):

Caleb F. Solivio, BS: No financial relationships to disclose

Muhammad S. Ghauri, MS: No financial relationships to disclose

Geogy Vatakencherry, MD FSIR: No financial relationships to disclose

Kartik Kansagra, MD: No financial relationships to disclose

Learning Objectives:

Provide a conceptual framework for proper categorization of venous thromboembolisms (VTEs).

Understand the difficulties of proper categorization of VTEs and their implications.

Critically assess the utility of VTE categorization framework as it pertains to the management of VTE.

Background: Venous thromboembolisms (VTEs) are a common cause of mortality and morbidity in the United States, estimated to affect anywhere from 350,000 to 900,000 individuals annually {1}. After experiencing one VTE, patients are also more likely to experience another or several VTEs {2}. Traditionally, VTEs have been thought of as either provoked or unprovoked. Provoked VTEs have some associated risk factor(s) implicated in the development of the thrombus, whereas unprovoked VTEs do not have any overt risk factors and thus have more obscure development and pathophysiology {3}. Anticoagulation remains the mainstay treatment for VTEs in addition to other treatment methods such as thrombolysis, inferior vena cava (IVC) filters, and thrombectomy/embolectomy {4}. Choice and length of therapeutic intervention is largely dependent on physicians’ assessment of VTEs but variability in the spectrum of VTE natural histories makes identification and categorization difficult {5}. In this educational exhibit, we examine the challenge in categorizing VTEs as either provoked or unprovoked and its implication on therapeutic outcomes.

Clinical Findings/Procedure Details:

Define provoked and unprovoked VTEs.

Discuss some of the most common causes for VTEs.

Provide a conceptual framework for categorization of VTEs relative to their risk of recurrence.

Detail the utility of this conceptual framework as it pertains to the interventional radiologist.

Conclusion and/or Teaching Points: Proper management of VTEs extends past categorization of a VTE as provoked or unprovoked. Length of anticoagulation therapy should reflect a multidisciplinary clinical evaluation of a patient’s risk of recurrent VTEs.