Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy.
OBJECTIVE
To evaluate the use of adjunctive mechanical thrombectomy (MT) with pharmacologic catheter-directed lower extremity venous thrombolysis.


METHODS
Catheter-directed thrombolysis with adjunctive MT was used to treat 28 symptomatic limbs in 20 patients (22 procedures) with lower extremity deep vein thrombosis (DVT) between August 1997 and July 2001. Procedural success, major bleeding, thrombolytic infusion time, and total thrombolytic agent dose were recorded.


RESULTS
Procedural success was achieved in 23 of 28 limbs (82%). Fifteen patients (18 limbs) received iliac vein stents. Major bleeding was observed after three of 22 procedures (14%) and resulted in transfusion in two patients and endometrial ablation in the third patient. Mean per-limb infusion time was 16.8 hours +/- 12.8. Mean per-limb total doses were lower than those reported in published studies of DVT thrombolysis: 2.67 million U +/- 1.60 urokinase, 18.4 mg +/- 10.7 tissue plasminogen activator, and 13.8 U +/- 6.9 reteplase. Venographic analysis demonstrated minimal thrombus removal (26.0% +/- 24.1) when using MT alone, compared with substantial thrombus removal (62.0% +/- 24.9) when using MT after pharmacologic thrombolytic agents had been administered (P =.006).


CONCLUSIONS
The use of adjunctive MT to augment pharmacologic catheter-directed DVT thrombolysis provides comparable procedural success and may reduce the required thrombolytic dose and infusion duration.
Vedantham
Suresh
S
Vascular and Interventional Radiology Section, Mallinckrodt Institute of Radiology, 510 South Kingshighway, Box 8131, St. Louis, Missouri 63110, USA. vedanthams@mir.wustl.edu
Vesely
Thomas M
TM
Parti
Naveen
N
Darcy
Michael
M
Hovsepian
David M
DM
Picus
Daniel
D
D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D010960:Plasminogen Activators / Q000008:administration & dosage; D012189:Retrospective Studies; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods; D015912:Thrombolytic Therapy / Q000009:adverse effects; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator