Ultrasound-accelerated thrombolysis for the treatment of deep vein thrombosis: initial clinical experience.
OBJECTIVE
To evaluate the success of lysis and clinical outcomes in patients treated with ultrasound (US)-accelerated thrombolysis for deep vein thrombosis (DVT).


METHODS
Forty-seven patients with 53 cases of DVT were treated with US-accelerated thrombolysis at eight centers in the United States. Sixty percent of the occlusions were in the lower extremity, 36% were in the upper extremity, and 4% were hepatic. The clot was acute (< or =14 days) in 47% of cases, subacute (15-28 d) in 8%, chronic (>28 d) in 17%, acute-on-chronic in 17%, and not specified in 11%. Patients were treated with urokinase (UK), tissue plasminogen activator (tPA), recombinant plasminogen activator (rPA), or tenecteplase.


RESULTS
Complete lysis (> or =90%) was seen in 37 of 53 cases (70%) and overall lysis (complete plus partial) was seen in 48 (91%). No lysis occurred in five cases (9%), four of which were chronic. The median thrombolysis infusion time was 22.0 hours. Major complications (hematoma at site of earlier surgery) occurred in only two patients (3.8%), with no incidence of intracranial or retroperitoneal hemorrhage. US-accelerated thrombolysis exhibited comparable or better lysis with a lower average drug dose and shorter median treatment times than reported in the National Venous Registry and a more recently published study of standard catheter-directed thrombolysis.


CONCLUSIONS
US-accelerated thrombolysis was shown to be a safe and efficacious treatment for DVT in this multicenter experience. The addition of US reduces total infusion time and provides a greater incidence of complete lysis with a reduction in bleeding rates.
Parikh
Sanjiv
S
Department of Interventional Radiology, Swedish Medical Center-Cherry Hill Campus, Seattle, WA 98122, USA. sparikh@radiax.com <sparikh@radiax.com>
Motarjeme
Amir
A
McNamara
Thomas
T
Raabe
Rodney
R
Hagspiel
Klaus
K
Benenati
James F
JF
Sterling
Keith
K
Comerota
Anthony
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012449:Safety; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
D000925:Anticoagulants