European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2013
Treatment of chronic deep vein thrombosis using ultrasound accelerated catheter-directed thrombolysis.
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Dumantepe M, Tarhan I A, Ozler A
Аннотация
OBJECTIVE: To evaluate the feasibility, efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the delayed treatment of lower extremity deep venous thrombosis (DVT).
DESIGN: Twelve patients with unilateral iliofemoral or femoropopliteal DVT (mean symptom duration 92 ± 44 days) were prospectively investigated.
METHOD: UACDT was performed using recombinant human tissue plasminogen activator delivered using the EKOS EkoSonic system. Stents were deployed if indicated by post-procedure venography. Follow-up comprised weekly duplex ultrasound for 1 month and monthly thereafter.
RESULTS: Successful thrombolysis occurred in 11/12 limbs (92%; complete 6/12, partial 5/12) after a mean infusion time of 26 ± 7 hours. 2/12 patients required angioplasty and stent insertion. At a mean follow-up of 9 (6-15) months, 10/11 (91%) veins were patent whereas 1/11 re-occluded at 2 months (patient with protein-C deficiency). 2/11 limbs developed symptoms/signs of post-thrombotic syndrome and 3/11 had developed deep vein reflux (duplex ultrasound). 2/12 patients experienced peri-catheter bleeding but no major hemorrhage or symptomatic pulmonary embolism occurred.
CONCLUSIONS: This preliminary evidence suggests that UACDT may be a safe and effective option for the delayed treatment of lower limb DVT.
DESIGN: Twelve patients with unilateral iliofemoral or femoropopliteal DVT (mean symptom duration 92 ± 44 days) were prospectively investigated.
METHOD: UACDT was performed using recombinant human tissue plasminogen activator delivered using the EKOS EkoSonic system. Stents were deployed if indicated by post-procedure venography. Follow-up comprised weekly duplex ultrasound for 1 month and monthly thereafter.
RESULTS: Successful thrombolysis occurred in 11/12 limbs (92%; complete 6/12, partial 5/12) after a mean infusion time of 26 ± 7 hours. 2/12 patients required angioplasty and stent insertion. At a mean follow-up of 9 (6-15) months, 10/11 (91%) veins were patent whereas 1/11 re-occluded at 2 months (patient with protein-C deficiency). 2/11 limbs developed symptoms/signs of post-thrombotic syndrome and 3/11 had developed deep vein reflux (duplex ultrasound). 2/12 patients experienced peri-catheter bleeding but no major hemorrhage or symptomatic pulmonary embolism occurred.
CONCLUSIONS: This preliminary evidence suggests that UACDT may be a safe and effective option for the delayed treatment of lower limb DVT.
Предметные рубрики MeSH
AdultAngioplasty, BalloonCatheterization, PeripheralChronic DiseaseFeasibility StudiesFemaleFibrinolytic AgentsHumansLower ExtremityMaleMiddle AgedPhlebographyPostoperative ComplicationsProspective StudiesStentsThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeUltrasonography, InterventionalVascular PatencyVenous Thrombosis