Evaluation of thrombolysis in a porcine model of chronic deep venous thrombosis: an endovascular model.
OBJECTIVE
The advancement of catheter-based interventions for vascular recanalization has underscored the need for an experimental animal model of vascular thrombosis that can be used for the evaluation of interventional therapies. In this model, a porcine model of deep venous thrombosis with a novel endovascular technique was described, and the efficacy of thrombolytic therapy with urokinase was evaluated.


METHODS
An endovascular device that consisted of a tapered polytetrafluoroethylene graft attached within a self-expanding nitinol stent was delivered to bilateral common iliac veins in 20 pigs. Venous thrombosis occurred as a result of flow stasis created by the intrastent stenosis. Catheter-directed pulse-spray thrombolysis with urokinase (250,000 units) and heparin (5000 IU) was performed on one limb while the contralateral limb received control saline solution. Thrombolysis was performed in 1 hour (n = 4), 8 hours (n = 4), 3 days (n = 4), 7 days (n = 4), and 14 days (n = 4) after the stent-graft deployment. Venography and intravascular ultrasound were used to evaluate the efficacy of thrombolysis. Light microscopy was used for histologic analysis of the thrombus.


RESULTS
Complete thrombolysis was achieved in groups with deep vein thrombosis that were younger than 1 day. Angioplasty of the tapered stent-grafts in the completely thrombolysed iliac vein was successful in restoring venous flow. The efficacy of thrombolysis in 3-day, 7-day, and 14-day groups was 86% +/- 7%, 73% +/- 13%, and 42% +/- 23%, respectively. The thrombolytic efficacy was enhanced to 92% +/- 16% and 86% +/- 18% (P <.05) in 3-day and 7-day groups, respectively, when doses of the pulse-spray thrombolysis were doubled. Increased dosages of the thrombolytic agent, however, did not significantly enhance the thrombus dissolution in the 14-day group.


CONCLUSIONS
The thrombolytic efficacy of urokinase correlated with the chronicity of deep venous thrombosis in our model. An increased dose of urokinase may be used to enhance the efficacy of thrombolysis in a 1-week-old thrombus.
Department of Surgery, Division of Vascular Surgery, Emory University School of Medicine, Atlanta, GA, USA.
P H
PH
Lin
C
C
Chen
S M
SM
Surowiec
B
B
Conklin
R L
RL
Bush
A B
AB
Lumsden
D000818:Animals; D002406:Catheterization, Peripheral; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D006493:Heparin / Q000008:administration & dosage; D007084:Iliac Vein / Q000187:drug effects / Q000473:pathology; D015607:Stents; D013552:Swine; D015912:Thrombolytic Therapy; D013924:Thrombophlebitis / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator