Steven Abramowitz, MD

Drs. Misaki Kiguchi and Kyle Reynolds (@KReyMD) review several of the most impactful deep venous trials to date to help better understand current guidelines and what the future looks like. evtoday.com/articles/2024-…

@NickMouawadMD @VascularSVS @JenniferSvahnMD @DejahJudelson Great talk, @JenniferSvahnMD @DejahJudelson @NickMouawadMD and thanks for organizing, #svstweetchat @VascularSVS!

@VascularSVS @JenniferSvahnMD @sdabramowitz @DejahJudelson Sooo glad to be alongside this great panel!! And thank you all for joining us tonight!! Looking forward to the next #svstweetchat !! @VascularSVS

Thank you to our awesome panelists and all who joined tonight's #SVSTweetChat! We hope you had as much fun as we did. Join us in March for the next chat! #vascsurg @NickMouawadMD @JenniferSvahnMD @sdabramowitz @DejahJudelson

@VascularSVS @NickMouawadMD @JenniferSvahnMD @DejahJudelson Talk about a need for more data! For Acute IF-DVT patients with stents, antiplatlet and 4-6 weeks lovenox followed by DOAC/Warfarin. #SVSTweetChat

Lat question of the night! Q4: What is your post-intervention medical management? @NickMouawadMD @JenniferSvahnMD @sdabramowitz @DejahJudelson #SVSTweetChat #vascsurg

@BillBeckerman @VascularSVS @NickMouawadMD @JenniferSvahnMD @DejahJudelson Well said @BillBeckerman Problems with over intervention or poor technical results in deep venous disease isn't "private practice" v. "academic practice." It is lack of training/understanding in indications, disease state and pathophysiology. #SVSTweetChat

@VascularSVS @NickMouawadMD @JenniferSvahnMD @sdabramowitz @DejahJudelson If the only symptom is “varicose veins” - no. If there’s varicose veins as well as life limiting edema, wounds, etc … different story. But I have a high threshold for placing a piece of metal that will be in a persons pelvis for their next 50-100 years.

Q3: Is there a role for iliac vein stenting in patients with varicose veins? @NickMouawadMD @JenniferSvahnMD @sdabramowitz @DejahJudelson #SVSTweetChat #vascsurg

@JenniferSvahnMD @VascularSVS @NickMouawadMD @DejahJudelson There are some great ongoing studies re: this Q. It depends on presentation of disease (cosmetic v symptoms v trophic changes). I image early if there is a high suspicion of IF disease (DVT hx, prior IF stent). #SVSTweetChat

@VascularSVS @NickMouawadMD @sdabramowitz @DejahJudelson Proximal stenting is not indicated as a primary treatment of superficial truncal/axial reflux and varicose veins - iliac vein stenting indications are usually more related to sx of deep vein reflux, outflow obstruction, swelling, dermatitis, etc

@DejahJudelson @VascularSVS @NickMouawadMD @JenniferSvahnMD Healthy to Healthy is important, but part of the story! Don't forget the to add outflow and inflow. "Healthy Inflow to Healthy Outflow." #SVSTweetChat

@VascularSVS @NickMouawadMD @JenniferSvahnMD @sdabramowitz I also use IVUS 100% of the time, try to find normal to normal! #svstweetchat

Q2: You have decided to stent - where do you start? @NickMouawadMD @JenniferSvahnMD @sdabramowitz @DejahJudelson #SVSTweetChat #vascsurg

@VascularSVS @NickMouawadMD @JenniferSvahnMD @DejahJudelson I start and end with IVUS. #SVSTweetChat

@VascularSVS @NickMouawadMD @JenniferSvahnMD @DejahJudelson I think pre-intervention imaging with IVUS is very helpful here! This can help differentiate NIVLs or PTS v. spasm and reduce unnecessary stunting. When in doubt, anticoagule and re-image at a later date! #svstweetchat

@DejahJudelson @VascularSVS @NickMouawadMD @JenniferSvahnMD I generally do not use prophylactic filters. #SVSTweetChat

@VascularSVS @NickMouawadMD @JenniferSvahnMD @sdabramowitz Does anyone use prophylactic filters for these patients? I don’t but curious as to what my colleagues do #svstweetchat

Q1: Acute iliofemoral DVT - when do you intervene and how? @NickMouawadMD @JenniferSvahnMD @sdabramowitz @DejahJudelson #SVSTweetChat #vascsurg

@ProleneQueen @VascularSVS @NickMouawadMD @JenniferSvahnMD @DejahJudelson I understand that approach but we don't have the best tools to predict who will develop mod-severe PTS and who will not. The impact for those that do can be devastating. #SVSTweetChat

@VascularSVS @NickMouawadMD @JenniferSvahnMD @sdabramowitz @DejahJudelson I will say I’m very conservative and tend to do anticoag + compression most of the time unless phlegmasia or severe symptoms + good life expectancy. Curious to hear what the experts do! #SVSTweetChat

@JenniferSvahnMD @VascularSVS @NickMouawadMD @DejahJudelson @jennifersvahnMD I would argue there are very few absolute contraindications with many of the tools we have now. Window for intervention can span acute to subacute to chronic. #SVSTweetChat

@VascularSVS @NickMouawadMD @sdabramowitz @DejahJudelson Immediate intervention indicated at time of dx - anticoag. UNLESS absolute contraindication >> in which case need filter placed to protect from PE. Additonal considerations include thrombolysis, thrombectomy +/- stent if indicated

@VascularSVS @NickMouawadMD @JenniferSvahnMD @DejahJudelson Treating acute IF-DVT can be about both reducing PTS incidence and rapidly restoring QOL. Underlying pathology dictates my approach - PTS and acute clot, thrombosed stents v. first time clot can all respond to mechanical or lytic-based approach. #SVSTweetChat

@BillBeckerman @MedStarHealth @MedStarWHC @MedStarHeart @Georgetown_IR @VeinForum @VascularEVS @MountSinaiIR @SinaiVascular Thanks, Bill. Retroperitoneal deployment can be a way to go for agenesis patients with wounds!

Impressive early results of complete iliocaval reconstruction by Steve Abramowitz of @MedStarHealth, another great multidisciplinary collaborative effort. 100% technical success, 100% patency at 6mo! #VAM2019 #VAM19