The quantitative benefit of isolated, segmental, pharmacomechanical thrombolysis (ISPMT) for iliofemoral venous thrombosis.
BACKGROUND
Early thrombus removal in patients with iliofemoral deep venous thrombosis (IFDVT) reduces postthrombotic morbidity. Preserving valve function and relieving venous obstruction prevents deterioration of quality of life and loss of economic potential. The preferred method for treating IFDVT is catheter-directed thrombolysis (CDT). Recently, isolated segmental pharmacomechanical thrombolysis (ISPMT) has emerged as a treatment option for patients with extensive IFDVT. The purpose of our study is to determine whether there are advantages to using ISPMT as the primary treatment for patients with iliofemoral IFDVT and, if so, to quantify those advantages relative to CDT.


METHODS
Forty-three patients with IFDVT were treated with percutaneous CDT between May 2003 and June 2007. Twenty-one patients (27 limbs) were treated with CDT and 22 patients (25 limbs) were treated with ISPMT +/- CDT. Demographics, extent of thrombus, procedural details, and thrombus resolution were recorded.


RESULTS
Treatment time (55.4 vs 23.4 hours; P < .0001) and dose of rt-PA (59.3 vs 33.4 mg; P = .0009) were decreased and overall lytic success (60% vs 80%; P = .0016) increased with ISPMT. Adjunctive venoplasty and stenting, complications, hospital length-of-stay (LOS), and intensive care unit LOS were similar between groups.


CONCLUSIONS
ISPMT offers more effective thrombus removal in less time and with a reduced dose of thrombolytic agent. However, decreased treatment time did not translate into decreased hospital or ICU stay. Longer-term follow-up is required to determine whether improved thrombus resolution translates to better functional outcome and reduced postthrombotic morbidity.
Martinez Trabal
Jorge L
JL
Section of Vascular Surgery, Jobst Vascular Center, The Toledo Hospital, Toledo, Ohio 43606, USA.
Comerota
Anthony J
AJ
LaPorte
Frankie B
FB
Kazanjian
Sahira
S
DiSalle
Robert
R
Sepanski
Deborah M
DM
D000328:Adult; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D005268:Femoral Vein; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000175:diagnosis / Q000628:therapy*
D005343:Fibrinolytic Agents