title: Venous in-stent thrombosis treated by ultrasound accelerated catheter directed thrombolysis.
abstract: OBJECTIVE
  Stent placement in the venous system is an increasingly used treatment modality in chronic venous obstruction and as additional treatment after thrombolytic therapy in ilio-femoral deep vein thrombosis (DVT). Experience in treating in-stent thrombosis with ultrasound accelerated catheter directed thrombolysis (UACDT) is reported.
  
  
  METHODS
  A retrospective analysis of patients treated for venous stent occlusion, after percutaneous transluminal angioplasty (PTA) and stent placement for either chronic venous occlusive disease or persistent vein compression in patients with acute DVT was performed. Duration of occlusion and suspected clot age were assessed using patient complaints and typical findings on duplex ultrasonography (DUS). DUS and venography were used to assess patency and to determine the cause of re-occlusion. Acute treatment of occlusion was by UACDT. Additional procedures included PTA, stent placement, and creation of an arteriovenous (AV) fistula.
  
  
  RESULTS
  Eighteen patients (median age 43 years; 67% male), treated for occluded stent tracts with UACDT between January 2009 and July 2014, were identified. Indications for initial stenting were treatment of chronic venous obstructive disease (12 patients) and treatment of underlying obstruction after initial thrombolysis in acute DVT (six patients). Technical success was achieved in 11/18 (61%) patients. Primary patency in 8/11 patients was 73% at last follow up (median follow up 14 months [range 0-41 months]). Additional treatments after successful lysis were re-stenting (seven patients) and creation of an AV fistula (six patients).
  
  
  CONCLUSIONS
  Treatment with UACDT of recently occluded stent tracts is feasible and effective. Recanalization of the stent tract can be achieved in most cases. Additional interventions were frequently used after successful UACDT treatment. Suboptimal stent positioning caused the majority of the stent occlusions.
authors.affiliation: Department of Vascular Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands. Electronic address: rob.strijkers@gmail.com.
authors.forename: R H W
authors.initials: RH
authors.lastname: Strijkers
authors.affiliation: Department of Vascular Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands.
authors.forename: M A F
authors.initials: MA
authors.lastname: de Wolf
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands; Department of Radiology, Viecuri Hospital, 5912 BL, Venlo, The Netherlands.
authors.forename: C W K P
authors.initials: CW
authors.lastname: Arnoldussen
authors.affiliation: Department of Vascular Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands.
authors.forename: M J M
authors.initials: MJ
authors.lastname: Timbergen
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Laboratory for Clinical Thrombosis and Haemostasis and Laboratory of Haematology, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, 6202 AZ, Maastricht, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: ten Cate-Hoek
authors.affiliation: Department of Vascular Surgery and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands; Department of Vascular Surgery, University Hospital RWTH Aachen, 52074, Aachen, Germany.
authors.forename: C H A
authors.initials: CH
authors.lastname: Wittens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Deep venous thrombosis; Post-thrombotic syndrome; Stent placement; Ultrasound-accelerated catheter-directed thrombolysis