title: Catheter-directed thrombolysis with percutaneous rheolytic thrombectomy versus thrombolysis alone in upper and lower extremity deep vein thrombosis.
abstract: OBJECTIVE
  To compare the efficacy of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for upper and lower extremity deep vein thrombosis (DVT).
  
  
  METHODS
  A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian DVT treated with urokinase CDT was identified, and a chart review was conducted. Demographic characteristics, treatment duration, total lytic dose, clot lysis rates and complications were compared in patients treated with urokinase CDT alone or combined CDT and rheolytic PMT.
  
  
  RESULTS
  Forty limbs in 36 patients were treated with urokinase CDT alone. Twenty-seven limbs in 21 patients were treated with urokinase CDT and rheolytic PMT. The mean treatment duration for urokinase CDT alone was 48.0 +/- 27.1 hr compared with 26.3 +/- 16.6 hr for urokinase CDT and rheolytic PMT (p = 0.0004). The mean urokinase dose required for CDT alone was 5.6 +/- 5.3 million units compared with 2.7 +/- 1.8 million units for urokinase CDT with rheolytic PMT (p = 0.008). Complete clot lysis was achieved in 73% (29/40) of DVT treated with urokinase CDT alone compared with 82% (22/27) treated with urokinase CDT with rheolytic PMT.
  
  
  CONCLUSIONS
  Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute proximal extremity DVT but requires significantly shorter treatment duration and lower lytic doses. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of acute proximal extremity DVT are warranted.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, 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: D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002404:Catheterization; D003131:Combined Modality Therapy; D005260:Female; D005268:Femoral Vein / Q000187:drug effects / Q000601:surgery; D018056:Hemorheology; D006801:Humans; D007084:Iliac Vein / Q000187:drug effects / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications / Q000209:etiology; D012107:Research Design; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000187:drug effects / Q000601:surgery; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014654:Vascular Patency / Q000187:drug effects; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D015415:Biomarkers; D014568:Urokinase-Type Plasminogen Activator