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Catheter-Directed Thrombolysis with Percutaneous Rheolytic Thrombectomy Versus Thrombolysis Alone in Upper and Lower Extremity Deep Vein Thrombosis

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Abstract

Purpose

To compare the efficacy of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for upper and lower extremity deep vein thrombosis (DVT).

Methods

A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian DVT treated with urokinase CDT was identified, and a chart review was conducted. Demographic characteristics, treatment duration, total lytic dose, clot lysis rates and complications were compared in patients treated with urokinase CDT alone or combined CDT and rheolytic PMT.

Results

Forty limbs in 36 patients were treated with urokinase CDT alone. Twenty-seven limbs in 21 patients were treated with urokinase CDT and rheolytic PMT. The mean treatment duration for urokinase CDT alone was 48.0 ± 27.1 hr compared with 26.3 ± 16.6 hr for urokinase CDT and rheolytic PMT (p = 0.0004). The mean urokinase dose required for CDT alone was 5.6 ± 5.3 million units compared with 2.7 ± 1.8 million units for urokinase CDT with rheolytic PMT (p = 0.008). Complete clot lysis was achieved in 73% (29/40) of DVT treated with urokinase CDT alone compared with 82% (22/27) treated with urokinase CDT with rheolytic PMT.

Conclusion

Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute proximal extremity DVT but requires significantly shorter treatment duration and lower lytic doses. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of acute proximal extremity DVT are warranted.

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References

  1. Heit JA, Silverstein MD, Mohr DN, et al. (2001) The epidemiology of venous thromboembolism in the community. Thromb Haemost 86:452–463

    PubMed  CAS  Google Scholar 

  2. Prandoni P, Lensing AWA, Prins MH, et al. (2002) Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med 137:955–960

    PubMed  Google Scholar 

  3. Prandoni P, Lensing AWA, Cogo A, et al. (1996) The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 125:1–7

    PubMed  CAS  Google Scholar 

  4. Comerota AJ, Throm RC, Mathias SD, Haughton S, Mewissen M (2000) Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg 32:130–137

    Article  PubMed  CAS  Google Scholar 

  5. Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH (1999) Catheter-directed thrombolysis for lower extremity deep venous thrombosis: Report of a national multicenter registry. Radiology 211:39–49

    PubMed  CAS  Google Scholar 

  6. Bush RL, Lin PH, Bates JT, Mureebe L, Zhou W, Lumsden AB (2004) Pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis: safety and feasibility study. J Vasc Surg 40:965–970

    Article  PubMed  Google Scholar 

  7. Delomex M, Beregi J, Willoteaux S, et al. (2001) Mechanical thrombectomy in patients with deep venous thrombosis. Cardiovasc Intervent Radiol 24:42–48

    Article  Google Scholar 

  8. Kasirajan K, Gray B, Ouriel K (2001) Percutaneous AngioJet thrombectomy in the management of extensive deep venous thrombosis. J Vasc Interv Radiol 12:179–185

    PubMed  CAS  Google Scholar 

  9. Vedantham S, Vesely TM, Parti N, Darcy M, Hovsepian DM, Picus D (2002) Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol 13:1001–1008

    PubMed  Google Scholar 

  10. Vedantham S, Vesely TM, Sicard GA, et al. (2004) Pharmacomechanical thrombolysis and early stent placement for iliofemoral deep vein thrombosis. J Vasc Interv Radiol 15:565–574

    PubMed  Google Scholar 

  11. Omary RA, Bettmann MA, Cardella JF, et al. (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14:S293–295

    PubMed  Google Scholar 

  12. Rhodes JM, Cho JS, Gloviczki P, Mozes G, Rolle R, Miller VM (2000) Thrombolysis for experimental deep venous thrombosis maintains valvular competence and vasoreactivity. J Vasc Surg 31:1193–1205

    PubMed  CAS  Google Scholar 

  13. Sharafuddin M, Hicks M, Jenson M, Morris J, Drasler W, Wilson G (1997) Rheolytic thrombectomy with use of the AngioJet-F105 catheter: Preclinical evaluation of safety. J Vasc Interv Radiol 8:939–945

    Article  PubMed  CAS  Google Scholar 

  14. Laiho M, Oinonenb A, Suganob N, et al. (2004) Preservation of venous valve function after catheter-directed and systemic thrombolysis for deep venous thrombosis. Eur J Vasc Endovasc Surg 28:391

    Article  PubMed  CAS  Google Scholar 

  15. Ouriel K, Gray B, Clair DG, Olin J (2000) Complications associated with the use of urokinase and recombinant tissue plasminogen activator for catheter-directed peripheral arterial and venous thrombolysis. J Vasc Interv Radiol 11:295–298

    PubMed  CAS  Google Scholar 

  16. Muller-Hulsbeck S, Grimm J, Leidt J, Heller M (2002) In vitro effectiveness of mechanical thrombectomy devices for large vessel diameter and low-pressure fluid dynamic applications. J Vasc Interv Radiol 13:831–839

    PubMed  Google Scholar 

  17. Prandoni P, Lensing AWA, Piccioli A, et al. (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100:3484–3488

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This manuscript is an invited paper, the abstract of which was presented at the Annual CIRSE Meeting in Nice, France, September 2005. There is no conflict of interest of the authors.

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Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Hyun S. Kim, Ajanta Patra, Ben E. Paxton & Jawad Khan

  2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Michael B. Streiff

  3. Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 545, Baltimore, MD, 21287-4010, USA

    Hyun S. Kim

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  1. Hyun S. Kim
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  2. Ajanta Patra
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  3. Ben E. Paxton
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  4. Jawad Khan
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  5. Michael B. Streiff
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Correspondence to Hyun S. Kim.

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Kim, H.S., Patra, A., Paxton, B.E. et al. Catheter-Directed Thrombolysis with Percutaneous Rheolytic Thrombectomy Versus Thrombolysis Alone in Upper and Lower Extremity Deep Vein Thrombosis. Cardiovasc Intervent Radiol 29, 1003–1007 (2006). https://doi.org/10.1007/s00270-005-0341-4

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