Temporary vena cava filters and ultrahigh streptokinase thrombolysis therapy: a clinical study.
OBJECTIVE
To assess the efficacy of temporary vena cava filters in patients undergoing ultrahigh-dose streptokinase thrombolysis for iliocaval thrombosis and to determine therapy success and filter and therapy complications.


METHODS
Forty-five patients were studied regarding extension and characteristics of thrombosis, duration, success, and complications of thrombolysis therapy, filter type, access route, pulmonary embolisms, and filter complications.


RESULTS
Complete recanalization was achieved in 57% of cases. Filters were inserted predominantly via a transbrachial route. One fatal pulmonary embolism (2%) occurred 1 day after starting thrombolysis. No other pulmonary embolism was noted. Other complications were induced by thrombolysis alone (n = 12), thrombolysis and filter (n = 9), and filter alone (n = 11).


CONCLUSIONS
Fatal pulmonary embolisms as a complication of ultrahigh-dose treatment of pelvic or caval thrombosis can not safely be prevented by the temporary vena cava filters currently available. Filter design needs to be improved.
Lorch
H
H
Department of Radiology, Medical University of Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany. lorch@medinf.mu-luebeck.de
Zwaan
M
M
Siemens
H J
HJ
Wagner
T
T
Kagel
C
C
Weiss
H D
HD
D000293:Adolescent; D000328:Adult; D004867:Equipment Design; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007084:Iliac Vein; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011655:Pulmonary Embolism / Q000517:prevention & control; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D018608:Ultrasonography, Doppler; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000175:diagnosis / Q000628:therapy*
D005343:Fibrinolytic Agents; D013300:Streptokinase