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Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy.
Suresh Vedantham1, Thomas M Vesely, Naveen Parti
1Vascular and Interventional Radiology Section, Mallinckrodt Institute of Radiology, 510 South Kingshighway, Box 8131, St. Louis, Missouri 63110, USA. vedanthams@mir.wustl.edu
Journal of Vascular and Interventional Radiology : JVIR
|October 25, 2002
Summary
Adjunctive mechanical thrombectomy (MT) with catheter-directed lower extremity deep vein thrombosis (DVT) thrombolysis shows high procedural success. This combined approach may reduce thrombolytic agent dose and infusion time for DVT treatment.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Deep vein thrombosis (DVT) of the lower extremities poses significant risks.
- Pharmacologic catheter-directed thrombolysis is a treatment option for DVT.
- Adjunctive mechanical thrombectomy (MT) may enhance thrombolysis efficacy.
Purpose of the Study:
- To evaluate the efficacy and safety of adjunctive mechanical thrombectomy (MT) combined with pharmacologic catheter-directed lower extremity venous thrombolysis.
- To assess procedural success rates, bleeding complications, and thrombolytic agent requirements.
Main Methods:
- A retrospective analysis of 28 symptomatic limbs in 20 patients treated with catheter-directed thrombolysis and adjunctive MT.
- Data collected included procedural success, major bleeding events, thrombolytic infusion time, and total thrombolytic agent dose.
- Venographic analysis compared thrombus removal with MT alone versus MT after pharmacologic thrombolysis.
Main Results:
- Procedural success was achieved in 82% of treated limbs.
- Major bleeding occurred in 14% of procedures.
- Adjunctive MT after pharmacologic thrombolysis resulted in significantly greater thrombus removal (62%) compared to MT alone (26%).
- Mean thrombolytic agent doses and infusion times were lower than previously reported.
Conclusions:
- Adjunctive mechanical thrombectomy is a viable option to enhance pharmacologic catheter-directed DVT thrombolysis.
- This combined approach offers comparable procedural success while potentially reducing thrombolytic agent dose and duration.
- Further research may explore optimizing this combined DVT treatment strategy.