Original approach for thrombolytic therapy in patients with Ilio-femoral deep vein thrombosis : 2 years follow-up
Tóm tắt
The aim of the study was to discuss the results of catheter-directed thrombolysis and complementary procedures to treat acute iliofemoral deep vein thrombosis (DVT) evaluating the safety and effectivness of an easy access such as the Great Saphenous Vein. A total of 22 consecutive patients with iliofemoral thrombosis and two patients with femoro-popliteal thrombosis on recent onset diagnosed with Ultrasound Doppler and contrast venography underwent intrathrombus drip infusion of urokinase while intravenous heparin was continued using saphenical access. Residual venous stenosis were treated in six patients by percutaneous balloon Angioplasty and stenting. All patients underwent routine venous duplex imaging at 30 days, 3 months, 6 months and every 6 months thereafter. Complete patency of thrombosed veins was restored in 22 patients (91 %) with prompt symptomatic relief. There were no major complications in the immediate outcomes. At follow-up, two patients reported a persistant slim iliac vein stenosis, two patients had post-thrombotic syndrome, and two patients showed Deep Vein Reflux. Local thrombolysis using saphenical access was a safe and effective approach for the treatment of acute iliofemoral deep vein thrombosis. It seems to be a valid, easy and safe alternative, reducing the risks of haematoma and venous lesions, which can be observed when using femoral, popliteal, and trans-jugular access.
Tài liệu tham khảo
Markel A, Manz RA, Bergelin RO, Strandness DE Jr. Valvular reflux after deep vein thrombosis: incidence and time of occurrence. J Vasc Surg. 1992;15(2):377–82.
Akesson H, Brudin L, Dahlstrom JA, Eklof B, Ohlin P, Plate G. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg. 1990;4(1):43–8.
Comerota AJ, Aldridge SC, Cohen G, Ball DS, Pliskin M, White JV. A strategy of aggressive regional therapy for acute iliofemoral venous thrombosis with contemporary venous thrombectomy or catheter-directed thrombosis. J Vasc Surg. 1994;20(2):244–54.
Lansing AM, Davis WM. Five-year follow-up study of iliofemoral venous thrombectomy. Ann Surg. 1968;168(4):620–287.
AbuRahma AF, Perkins SE, Wulu JT, Ng HK. Iliofemoral deep vein thrombosis: conventional therapy versus lysis and percutaneous transluminal angioplasty and stenting. Ann Surg. 2001;233(6):752–60.
Kakkos S, Daskalopoulou SS, Daskalopoulos ME, Nicolaides AN, Geroulakos G. Review on the value of graduated elastic compression stockings after deep vein thrombosis. Thromb Haemost. 2006;96(4):441–5.
Musani MH, Matta F, Yaekoub AY, Liang J, Hull RD, Stein PD. Venous compression for prevention of postthrombotic syndrome:a maeta-analysis. Am J Med. 2010;123(8):735–40.
Eklof B, Kistner RL. Is there a rule for thrombectomy in iliofemoral venous thrombosis? Semin Vasc Surg. 1996;9(1):34–45.
Cho JS, Martelli E, Mozes G, Miller VM, Gloviczki P. Effects of thrombolysis and venous thrombectomy on valvular competence, thrombogenicity, venous wall morphology, and function. J Vasc Surg. 1998;28(5):787–99.
Comerota AJ, Aldridge SC. Thrombolytic therapy for deep venous thrombosis: a clinical review. CJS. 1993;36(4):359–64.
Antani MR. Catheter-directed thrombolysis for the treatment of acute deep venous thrombosis. Supplement to Applied Radiology pp.29–35 (Jul.2001).
Grunwald MR, Hofman LV. Comparaison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis. J Vasc Interv Radiol. 2004;15(4):347–52.
Semba CP, Dake MD. Catheter-directed thrombolysis for iliofemoral venous thrombosis. Sem Vasc Surg. 1996;9(1):26–33.
Buckenham TM. Radiological management of venous thrombosis of the lower limb. Br J Radiol. 1998;71(844):353–6.
Saglio H, Caille JP, Vergoz L. Réflexions sur le sens du courant à travers les perforantes dans la varicose essentielle systématisée. Phlebologie. 1974;27(1):19–23.
Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology. 1994;191(2):487–94.
Grünewal M, Griesshammer M, Ellbrück D, Kuhn S, Seifried E, Osterhues H. Loco-regional thrombolysis for deep vein thrombosis: fact or fiction? A study of hemostatic parameters. Blood Coagul Fibrinolysis. 2000;11(6):529–36.
Vachani A, Arcasoy SM. Local and systemic thrombolytic therapy for acute venous thromboembolism. Clin Chest Med. 2003;24(1):73–91.
Bättler W, Heller G, Largiadèr J, Savolainen H, Gloor B, Schmidli J. Combined regional thrombolysis and surgical thrombectomy for treatment of iliofemoral vein thrombosis. J Vasc Surg. 2004;40(4):620–5.
Protack CD, Bakken AM, Patel N, Saad WE, Waldman DL, Davies MG. Long- term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava vein filter placement. J Vasc Surg. 2007;45(5):992–7.
Mewissen MW. Interim data report from the Data Collection Center. Catheter-directed thrombolytic therapy of the lower extremity. J Vasc Interven Radiol. 1997;8:50–1.
de Caen A. Venous access in the critically ill child: when the peripheral intravenous fails! Pediatr Emerg Care. 2007;23(6):422–4. quiz 425-6.