Pharmacomechanical thrombectomy of acute deep vein thrombosis with the Trellis-8 isolated thrombolysis catheter.
OBJECTIVE
To evaluate the performance of the Trellis-8 isolated thrombolysis catheter during single-session pharmacomechanical thrombectomy (PMT) combined with low-dose thrombolysis with tissue plasminogen activator (TPA) in the treatment of patients with acute deep vein thrombosis (DVT) and multiple comorbidities.


METHODS
Retrospective analysis was performed of 19 consecutive patients with acute above-knee DVT treated by PMT with the Trellis device followed by venous angioplasty and stent placement. Isolated thrombolysis with low-dose TPA was used with all patients. Concurrent therapies included retrievable inferior vena cava filter insertion (n = 4). The primary endpoint was restoration of rapid inline venous flow; the secondary endpoint was thrombus clearance.


RESULTS
Restoration of rapid inline venous flow was achieved in all cases; thrombus removal was less than 50% in one case (4%), 50%-95% in 18 cases (82%), and at least 95% in three cases (14%). The median administered dose of TPA was 13.4 mg per patient. The mean treatment time was 91 minutes per limb (range, 61-129 min), with a mean of 21 minutes per thrombosed segment (range, 8-31 min). There were no major complications. Primary patency rate of the treated venous segments at 2 days was 86% (n = 19) and the primary assisted patency rate was 100% at 30 days. Two patients died of advanced malignancy at 17 and 24 days.


CONCLUSIONS
The Trellis system was an effective method for the treatment of acute DVT. Based on the present data, the Trellis system could prove to be a safe and feasible single-session PMT method for the treatment of acute DVT in a broader patient population and warrants further investigation in a large-scale study.
O'Sullivan
Gerard J
GJ
Section of Interventional Radiology, Department of Radiology, University College Hospital, Newcastle Road, Galway, Ireland. gerard.osullivan@mailn.hse.ie
Lohan
Derek G
DG
Gough
Niall
N
Cronin
Carmel G
CG
Kee
Stephen T
ST
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D017130:Angioplasty; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014654:Vascular Patency; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator