Hello, my name is Oliver Schlager. I'm interventional angiologist at the Medical University in Vienna in Austria. And what we are going to discuss today are the 2025 Guidelines of the European Society of Vascular Medicine on interventional treatment of venous thromboembolism.

Radcliffe Vascular: What are the key updates to the guidelines?

Well, this guideline document comprises, three chapters. The first chapter is on interventional thrombus removal in patients with D vein thrombosis. In this chapter we primarily focus on patient selection, which means that we lay the point on how to select patients which are eligible for interventional thrombus removal, which mainly are patients with iliofemoral or iliocaval thrombosis.
And we put emphasis on the point that vascular specialists should be involved in the decision making process, when making decision on interventional therapy of these patients. Interventional treatment should include the use of intravascular ultrasound as well as the use of dedicated venous stents and thrombectomy devices.

Mainly these procedures should be done by using mechanical thrombectomy. The second chapter in this guideline document is on pulmonary embolism. In this chapter we again, put the focus on patient selection, which means that we have to differentiate between patients with low risk, intermediate low, intermediate high or high risk pulmonary embolism and interventional thrombus removal should be considered in patients which are intermediate high risk and which deteriorate over time.
And this is something which is new in this guideline document that we try to elaborate on the a development of symptoms over time and in patients which present with high risk pulmonary embolism and which are not eligible for systemic thrombolysis.

These also are patients which might benefit from catheter based therapy. The third chapter focuses on, IVC filters, which means filter placement in patients with peripheral venous thrombosis or pulmonary embolism and selection of patients which might benefit from implantation of inferior vena cava filters.

Radcliffe Vascular: What are the challenges and opportunities in implementing the new guideline recommendations into practice?

The challenges and opportunities in implementing these guidelines into clinical practice are to find the right balance between the advancements that we see in medicine nowadays. We had huge advancements in terms of improvements in catheter technology, over the past months.
We see catheters which are very efficient nowadays. And on the other side we also have to be very careful in patient selection, which means we should not treat any patient who principally can be treated by an interventional procedure.
But the main focus should be put on selecting the right patients and finding the right balance between opportunities and between potential benefit and also risk of these procedures.

Radcliffe Vascular: How have advances in thrombectomy technology influenced current treatment approaches?

The main advances probably are the development of mechanical thrombectomy devices, which means that for deep vein thrombosis we nowadays can treat most patients who have a potential benefit of interventional treatment, with pure mechanical thrombectomy.

Which means we do not need catheter directed thrombolysis in these patients anymore. And this is something which decreases the risk of bleeding and which increases the efficacy of these procedures and the need for intensive care units or intermediate care units after the interventional procedures.
For pulmonary embolism it's a bit similar, but in pulmonary embolism we still have patients in which a combination of mechanical thrombectomy catheters with infusion of thrombolytic agents might benefit from these procedures.

And in this field we still have ongoing trials. And we soon will see the result of these trials which hopefully will give us more information which patients have the greatest benefit of these procedures and of these technologies.

Radcliffe Vascular: What are your recommendations for establishing specialized VTE intervention centers?

I think the most important point is really to develop a team of specialists, which is the best way, a multidisciplinary team, including vascular physicians, cardiologists, radiologists, cardiovascular surgeons, anesthesists and other groups, groups hematologists.


And this group of specialists should be involved in the decision making process. And this applies for both groups of patients, patients with deep end thrombosis and patients with pulmonary embolism. Since many of these decisions are not so easy to make and in this situation it is very important to get the input of different disciplines.


Radcliffe Vascular: What are the key take-home messages for clinicians?

I think the key take home messages are maybe three or four points. First, out of my perspective, we have seen a lot of advancements and we should follow the way to assess the eligibility of patients presenting with either deep vein thrombosis or pulmonary embolism in specialized centers, which means centers which have the expertise for interventional treatment.

And these centers should be involved in the decision making process. Teams should be built up, which means pulmonary embolism research teams, PERT teams, or for deep vein thrombosis thrombosis response teams.

And these are multidisciplinary teams which should involve vascular specialists. This is the second point. The third point is it also requires equipment, which means catheter, technology for deep veins, intravascular ultrasound, specialized venous stents for pulmonary embolism, the setting in which, for example ECMO support is available, intensive care units are available.

And finally, and this is out of my perspective also a very important point treatment of these patients does not stop after the procedure, which means we also have to follow our patients after these procedures. We have to provide close follow up, which requires anticoagulation management, which requires inpatients with pulmonary embolism, sonographic evaluation of cardiac function of right ventricular dysfunction.

In follow up and in patients with deep end thrombosis, duplex sonographic follow up and assessment of functional scores, such as the development of the post thrombotic syndrome, for example, in patients initially presenting with deep vein thrombosis.