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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Endovascular management of proximal lower limb deep venous thrombosis - A prospective study with six-month follow-up
S Patra1, B C Srinivas2, C M Nagesh2
1Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India dr_soumyapatra@rediffmail.com.
Insights
Catheter-directed thrombolysis effectively treated proximal deep vein thrombosis, achieving good short-term and intermediate outcomes. This procedure demonstrated significant venous patency and reduced post-thrombotic syndrome rates at six months.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Catheter-directed thrombolysis with mechanical assistance is standard care for proximal deep vein thrombosis (DVT).
- This study evaluated the safety and effectiveness of this treatment for lower limb DVT.
Purpose of the Study:
- To assess the immediate and six-month safety and effectiveness of catheter-directed thrombolysis for proximal lower limb DVT.
Main Methods:
- Thirty patients with proximal lower limb DVT underwent catheter-directed thrombolysis using streptokinase and mechanical thromboaspiration.
- Heparin was administered concurrently. Outcomes were assessed at six months using the Villalta scale for post-thrombotic syndrome and duplex ultrasound for venous patency.
Main Results:
- Complete lysis (Grade III) was achieved in 33% and partial lysis (Grade II) in 67% of patients.
- Following lysis, 72% of patients showed iliofemoral patency at six months, with 21% experiencing post-thrombotic syndrome.
- Complications included pulmonary embolism (13%), minor bleeding (37%), anemia (23%), and thrombocytopenia (13%).
Conclusions:
- Catheter-directed thrombolysis is an effective treatment for proximal lower extremity DVT.
- The procedure offers good short-term and intermediate outcomes regarding venous patency and symptom reduction.
Background:
Catheter-directed thrombolysis with assisted mechanical thrombolysis is the standard of medical care for proximal deep vein thrombosis. We studied the immediate and intermediate (six months) safety and effectiveness of catheter-directed thrombolysis in patients with proximal lower limb deep vein thrombosis.
Methodology:
Thirty consecutive patients aged between 20 and 70 years with proximal lower limb deep vein thrombosis formed the study group. Catheter-directed thrombolysis was done with streptokinase infuse through a catheter kept in the ipsilateral popliteal vein. Unfractionated heparin was given along with streptokinase. Mechanical thromboaspiration using guiding catheter was performed in addition to thrombolytic therapy. After six months, post-thrombotic syndrome and deep venous patency were assessed by using Villalta scale and duplex ultrasound, respectively.
Results:
Thirty patients with proximal lower limb deep vein thrombosis were treated with catheter-directed thrombolysis. Mean age of the study patients was 41.7 ± 15 years. Mean duration of illness was 13.3 ± 12 days. The mean duration of thrombolysis was 4.5 ± 1.3 days. Grade III (complete) lysis was achieved in 10 (33%) and Grade II (50-90%) lysis in 20 (67%) of patients. Patients with significant residual lesion in Grade II lysis following catheter-directed thrombolysis underwent percutaneous transluminal angioplasty alone (12/20) or venous stenting (8/20). All patients improved clinically following catheter-directed thrombolysis or assisted catheter-directed thrombolysis. Four patients (13%) developed pulmonary embolism during course of hospital stay and among them two (6.5%) patients died. Eleven patients (37%) had minor bleeding or hematoma at local site, and seven (23%) developed anemia requiring blood transfusion and four (13%) patients had thrombocytopenia. After six months, iliofemoral patency was found in 20 (72%) and post-thrombotic syndrome was seen in six (21%) patients. Two (6.5%) patients died during follow-up due to nephrotic syndrome and carcinoma breast.
Conclusion:
Catheter-directed thrombolysis and conventional manual aspiration thrombectomy are an effective treatment for proximal lower extremity deep vein thrombosis with good short and intermediate outcome.
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