title: Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes.
abstract: OBJECTIVE
  To assess the clinical and economic benefits of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for lower-extremity deep vein thrombosis (DVT).
  
  
  METHODS
  Consecutive patients with acute iliofemoral DVT treated with CDT with urokinase between 1997 and 2003 were identified. Demographic characteristics and clinical and economic outcomes were compared between patients treated with CDT alone versus CDT plus PMT.
  
  
  RESULTS
  Twenty-six limbs in 23 patients received CDT with urokinase, whereas 19 limbs in 14 patients were treated with CDT plus PMT. Mean treatment duration for CDT was 56.5 +/- 27.4 hours, compared with 30.3 +/- 17.8 hours for CDT plus PMT (P = .001). Mean urokinase dose for CDT was 6.70 +/- 5.9 million U compared with 2.95 +/- 1.82 million U for CDT plus PMT (P = .011). Urokinase CDT achieved complete clot lysis in 80.7% of limbs (n = 21) compared with 84.2% of limbs (n = 16) treated with CDT plus PMT (P = .764). The incidences of major bleeding (CDT, 7.7%; CDT plus PMT, 5.3%; P = .749) and pulmonary embolism (CDT, 3.8%; CDT plus PMT, 5.3%; P = .818) were similar. The mean urokinase and PMT device cost for CDT alone was $10,127 compared with $5,128 for CDT plus PMT (P = .026).
  
  
  CONCLUSIONS
  Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute iliofemoral DVT but requires significantly shorter treatment and lower lytic agent dose, resulting in lower costs. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of DVT are warranted.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 545, Baltimore, MD 21287-4010, USA. sikhkim@jhmi.edu
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
authors.forename: Ajanta
authors.initials: A
authors.lastname: Patra
authors.forename: Ben E
authors.initials: BE
authors.lastname: Paxton
authors.forename: Jawad
authors.initials: J
authors.lastname: Khan
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D017131:Thrombectomy / Q000191:economics / Q000379:methods*; D015912:Thrombolytic Therapy / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator