Catheter-directed thrombolysis for treatment of deep venous thrombosis in the upper extremities.
Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002-2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1-30); median duration of thrombolysis treatment, 70 h (range, 24-264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19-225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01-1.42). At follow-up (n = 29; median, 21 months; range, 5-58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.
Vik
Anders
A
Department of Medicine, University Hospital of North Norway, Tromsø, Norway. anders.vik@unn.no
Holme
Pål Andre
PA
Singh
Kulbir
K
Dorenberg
Eric
E
Nordhus
Kåre Christian
KC
Kumar
Satish
S
Hansen
John-Bjarne
JB
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D054070:Postthrombotic Syndrome / Q000517:prevention & control; D011677:Punctures; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D034941:Upper Extremity / Q000098:blood supply*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants