Pharmacomechanical thrombolysis and early stent placement for iliofemoral deep vein thrombosis.
OBJECTIVE
To evaluate an approach to the treatment of iliofemoral deep vein thrombosis (DVT) that included pharmacomechanical catheter-directed thrombolysis with reteplase and the Helix mechanical thrombectomy device, followed by early stent placement.


METHODS
During 3-year period, 23 symptomatic limbs in 18 patients with iliofemoral DVT were treated with reteplase catheter-directed thrombolysis. After an initial infusion of 8 to 16 hours, any residual acute thrombus over a long segment (> 10 cm) was treated by maceration with use of the Helix thrombectomy device. Residual short-segment (< 10 cm) iliac vein thrombus and/or stenosis were treated with stent placement. Technical success, clinical success, complications, thrombolytic infusion time, total thrombolytic agent dose, fibrinogen level changes, and late limb status were retrospectively analyzed.


RESULTS
Technical success was achieved in 23 of 23 limbs (100%). Clinical success was achieved in 22 of 23 limbs (96%). Complete or partial thrombolysis was observed in 19 of 23 limbs (83%). Major bleeding was observed in one patient (6%) and necessitated blood transfusion. Mean per-limb thrombolytic infusion time and total dose were 19.6 hours +/- 8.1 and 13.8 U +/- 5.3 reteplase, respectively. Mean serum fibrinogen nadir and percentage drop in serum fibrinogen were 282 mg/dL +/- 167 and 47% +/- 24%, respectively. Late (mean, 19.8 +/- 11.6 months) modified Venous Disability Scores were 0 (none) for six limbs, 1 (mild) for 10 limbs, 2 (moderate) for two limbs, and 3 (severe) for no limbs.


CONCLUSIONS
In a preliminary experience, pharmacomechanical catheter-directed iliofemoral DVT thrombolysis with early stent placement was safe and effective.
Vedantham
Suresh
S
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA. vendanthams@mir.wustl.edu
Vesely
Thomas M
TM
Sicard
Gregorio A
GA
Brown
Daniel
D
Rubin
Brian
B
Sanchez
Luis A
LA
Parti
Naveen
N
Picus
Daniel
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral; D003131:Combined Modality Therapy; D005260:Female; D005268:Femoral Vein; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007084:Iliac Vein; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D015607:Stents; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000628:therapy*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator