Lower Extremity Venous Thrombolysis with Adjunctive Mechanical Thrombectomy

https://doi.org/10.1016/S1051-0443(07)61864-8Get rights and content

PURPOSE

To evaluate the use of adjunctive mechanical thrombectomy (MT) with pharmacologic catheter-directed lower extremity venous thrombolysis.

MATERIALS AND METHODS

Catheter-directed thrombolysis with adjunctive MT was used to treat 28 symptomatic limbs in 20 patients (22 procedures) with lower extremity deep vein thrombosis (DVT) between August 1997 and July 2001. Procedural success, major bleeding, thrombolytic infusion time, and total thrombolytic agent dose were recorded.

RESULTS

Procedural success was achieved in 23 of 28 limbs (82%). Fifteen patients (18 limbs) received iliac vein stents. Major bleeding was observed after three of 22 procedures (14%) and resulted in transfusion in two patients and endometrial ablation in the third patient. Mean per-limb infusion time was 16.8 hours ± 12.8. Mean per-limb total doses were lower than those reported in published studies of DVT thrombolysis: 2.67 million U ± 1.60 urokinase, 18.4 mg ± 10.7 tissue plasminogen activator, and 13.8 U ± 6.9 reteplase. Venographic analysis demonstrated minimal thrombus removal (26.0% ± 24.1) when using MT alone, compared with substantial thrombus removal (62.0% ± 24.9) when using MT after pharmacologic thrombolytic agents had been administered (P = .006).

CONCLUSION

The use of adjunctive MT to augment pharmacologic catheter-directed DVT thrombolysis provides comparable procedural success and may reduce the required thrombolytic dose and infusion duration.

Section snippets

Patients

Our institutional review board approved this retrospective investigation. A computer search of our interventional radiology database was used to identify all patients who underwent catheter-directed venous thrombolysis with adjunctive MT for lower extremity and/or inferior vena caval DVT. From August 1997 through July 2001, 20 patients were identified as having undergone 22 separate procedures in the treatment of 28 symptomatic limbs. The patients' medical records, radiology reports, and

Procedural Success and Complications

Procedural success was achieved in 23 of 28 limbs (82%) that received pharmacologic thrombolysis with adjunctive MT. One additional patient had a successful clinical result after an adjunctive surgical procedure—after successful iliac vein thrombolysis and stent placement, a limited surgical thrombectomy was used to remove residual occlusive thrombus in the common femoral vein. Fifteen patients (18 limbs) received iliac vein stents.

Thrombolytic treatment failed in four limbs. Early in our

DISCUSSION

Catheter-directed thrombolysis has proved effective in treating iliofemoral DVT, but several disadvantages of therapy have limited its widespread acceptance. First, bleeding complications have been reported to occur in 0%–25% of patients in single-center series and occurred in 11% patients in a multicenter venous registry study (1, 2, 4). Second, the prolonged infusion times (2–3 d) typically required to treat iliofemoral DVT can be difficult to tolerate for some patients, and complications may

CONCLUSIONS

In summary, our experience and literature review have led us to several conclusions: (i) the MT method we used to treat DVT is unlikely to provide adequate thrombus removal alone as judged by evaluation of venograms obtained immediately after MT; (ii) the adjunctive use of MT devices with pharmacologic thrombolysis of DVT is safe and provides procedural success comparable but not demonstrably superior to that achieved with thrombolytic agents alone; (iii) caval interruption is not routinely

References (24)

  • JW Jaffe et al.

    Venous valvular assessment after retrograde catheterization

    J Vasc Interv Radiol

    (1996)
  • MJA Sharafuddin et al.

    Injury potential to venous valves from the Amplatz Thrombectomy Device

    J Vasc Interv Radiol

    (1999)
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    None of the authors has identified a conflict of interest.

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