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Catheter-Directed Thrombolysis Versus Pharmacomechanical Thrombectomy for Upper Extremity Deep Venous Thrombosis: A
Osman Mahmoud1, Pirkka Vikatmaa2, Jari Räsänen3
1Department of Vascular Surgery, Helsinki University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Vascular Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
Insights
Pharmacomechanical thrombolysis (PMT) offers similar clinical outcomes to catheter-directed thrombolysis (CDT) for upper extremity deep vein thrombosis (UEDVT) but with significantly lower costs and shorter hospital stays.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Upper extremity deep vein thrombosis (UEDVT) accounts for 2-3% of all deep vein thrombosis cases.
- Catheter-directed thrombolysis (CDT) has been largely replaced by pharmacomechanical thrombolysis (PMT) in clinical practice.
Purpose of the Study:
- To compare the immediate and 1-year outcomes of CDT versus PMT for UEDVT treatment.
- To evaluate the total hospital costs associated with each treatment modality.
Main Methods:
- A cohort of 55 UEDVT patients treated between 2006-2013 at Helsinki University Hospital were analyzed.
- Patients received either CDT (n=24) or PMT using a Trellis™ device (n=19).
- Follow-up included clinical evaluation and vein patency assessment (phlebography or ultrasound) at 1 year.
Main Results:
- Immediate technical success rates were high for both groups (91.7% CDT, 100% PMT).
- 1-year primary assisted patency rates were similar (91.7% CDT, 94.7% PMT) with no DVT recurrences.
- PMT demonstrated significantly shorter thrombolytic times and lower acute hospitalization costs (€5,975 vs. €11,476).
Conclusions:
- Both CDT and PMT yield similar clinical results for UEDVT treatment.
- PMT is associated with reduced hospital stay and surveillance needs.
- PMT offers a more cost-effective treatment option for UEDVT.
Background:
Upper extremity deep vein thrombosis represents (UEDVT) 2-3% of all deep vein thrombosis. Catheter directed thrombolysis (CDT) was replaced largely by pharmacomechanical thrombolysis (PMT) in our institution. In this study we compared the immediate and 1-year results as well as the total hospital costs between CDT and PMT in the treatment of UEDVT.
Methods:
From 2006 to 2013, 55 patients with UEDVT were treated with either CDT or PMT at Helsinki University Hospital. Of them, 43 underwent thoracoscopic rib resection later to relieve phlebography-confirmed vein compression. This patient cohort was prospectively followed up with repeated phlebographies. CDT was performed to 24 patients, and 19 had PMT with a Trellis™ device. Clinical evaluation and vein patency assessment were performed with either phlebography or ultrasound 1 year after the thrombolysis. Primary outcomes were immediate technical success, 1-year vein patency, and costs of the initial treatment.
Results:
The immediate overall technical success rate, defined as recanalization of the occluded vein and removal of the fresh thrombus, was 91.7% in the CDT group and 100% in the PMT group (n.s.). The median thrombolytic time was significantly longer in CDT patients than that in PMT patients (21.1 vs. 0.33 hr, P < 0.00001). There were no procedure-related complications. The 1-year primary assisted patency rate was similar in both the groups (91.7% and 94.7%). There were no recurrences of clinical DVT. The hospital costs for the acute period were significantly lower in the PMT group than those in the CDT group (medians: 11,476 € and 5,975 € in the CDT and PMT groups, respectively [P < 0.00001]).
Conclusions:
The clinical results of the treatment of UEDVT with CDT or PMT were similar. However, PMT required shorter hospital stay and less intensive surveillance, leading to lower total costs.
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