Document Detail


Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis: an alternative in patients with contraindications to thrombolysis.
MedLine Citation:
PMID:  19782528     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Venous lysis is usually reserved for symptomatic patients with acute deep vein thrombosis (DVT) and low risk for bleeding. This study reports the use of pharmacomechanical thrombectomy (PMT) in patients with contraindications to thrombolysis.
METHODS: A retrospective review of all patients with symptomatic DVT treated between 2007 and 2008 with PMT was performed. All patients were treated by a combination of local tissue plasminogen activator (tPA) with the Angiojet (Possis Medical, Minneapolis, Minn) or Trellis device (Bacchus Vascular, Santa Clara, Calif). Catheter-directed lysis was used sparingly.
RESULTS: Forty-three patients (mean age, 48.4 +/- 16.6 years) presented with symptoms averaging 13.6 +/- 9.6 days in duration. Nineteen (44%) had symptoms for >14 days, and 15 (35%) had a high risk for bleeding. Symptomatic subclavian thrombosis occurred in eight (19%), and 35 (81%) presented with disabling lower extremity DVT (4 phlegmasia) despite anticoagulation. Fifteen patients had a thrombosed indwelling permanent filter. Sixty-three percent were treated in one session, but 16 patients required a lytic infusion after suboptimal PMT. Iliac stenting was required in 35% of limbs treated. Successful lysis (>50%) was achieved in 95% of patients and symptom resolution in 93%. All patients became ambulatory with no or minimal limitation. There were no major systemic bleeding complications, but access site hematoma occurred in two patients and worsening of pre-existing rectus sheath hematoma requiring transfusion occurred in another two. Limb salvage was maintained in 100% of patients who presented with phlegmasia. Mean follow-up was 5.0 +/- 4.8 months. Freedom from DVT recurrence and reintervention was 95% at 9 months by life-table analysis.
CONCLUSIONS: PMT can be safely and effectively used for subacute iliocaval and iliofemoral DVT and in patients with contraindications for lytic therapy, resulting in improved functional outcomes relative to their debilitated state before the procedure.
Authors:
Atul S Rao; Gerhardt Konig; Steven A Leers; Jae Cho; Robert Y Rhee; Michel S Makaroun; Rabih A Chaer
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Publication Detail:
Type:  Journal Article     Date:  2009-09-26
Journal Detail:
Title:  Journal of vascular surgery     Volume:  50     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-02     Completed Date:  2009-11-12     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1092-8     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Combined Modality Therapy
Feasibility Studies
Female
Femoral Vein* / radiography
Fibrinolytic Agents / administration & dosage*,  contraindications
Hematoma / etiology
Hemorrhage / etiology
Humans
Iliac Vein* / radiography
Male
Middle Aged
Patient Selection
Phlebography
Practice Guidelines as Topic
Recurrence
Retrospective Studies
Risk Assessment
Thrombectomy / adverse effects,  instrumentation,  methods*
Thrombolytic Therapy* / contraindications
Time Factors
Tissue Plasminogen Activator / administration & dosage*,  contraindications
Treatment Outcome
Venous Thrombosis / drug therapy*,  radiography,  surgery*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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