Catheter-directed thrombolysis and/or thrombectomy with selective endovascular stenting as alternatives to systemic anticoagulation for treatment of acute deep vein thrombosis.
OBJECTIVE
To evaluate thrombolysis and/or thrombectomy and selective endovascular stent placement in treating acute deep vein thrombosis (DVT).


METHODS
During a 5-year period, 28 patients were treated with catheter-directed thrombolytics and/or thrombectomy with endovascular stent placement. Seventy-two percent (n = 20) of patients had symptoms for less < or = 14 days; 14% (n = 4) had symptoms for > 14 days. Fourteen percent (n = 4) had recurrent symptoms; 43% (n = 12) had ileofemoral DVT, and 57% (n = 16) had common femoral, superficial femoral, and/or popliteal DVT; and 11% (n = 3) had thrombus extending into the inferior vena cava.


RESULTS
Eighteen percent (n = 5) of patients had complete thrombolysis of the thrombus; 72% (n = 20) had partial thrombolysis. Twenty-two stents were also placed in 12 patients. Average follow-up was 15.5 months; 80% had long-term patency.


CONCLUSIONS
Catheter-directed thrombolysis and/or thrombectomy and selective stent placement are effective alternatives to systemic anticoagulation in the treatment of DVT. More studies are needed to determine specific indications and to validate long-term efficacy.
Jackson
La Scienya M
LS
Department of Surgery, St. Mary's Hospital, 56 Franklin St., Waterbury, CT 06706, USA. lascienyajackson@hotmail.com
Wang
Xiu-Jie
XJ
Dudrick
Stanley J
SJ
Gersten
Gregory D
GD
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002404:Catheterization / Q000295:instrumentation; D004359:Drug Therapy, Combination; D005260:Female; D005268:Femoral Vein; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011152:Popliteal Vein; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator