Popliteal Vein Puncture Technique Based on Bony Landmark Positioning in Catheter-Directed Thrombolysis of Deep Venous Thrombosis: A Retrospective Review.
BACKGROUND
Catheter-directed thrombolysis (CDT) is an effective method for the treatment of deep venous thrombosis (DVT). The most widely used puncture technique involves the popliteal vein of the affected leg. We introduce a new puncture technique based on bony landmark positioning.


METHODS
Between May 2012 and December 2014, we performed CDT in 96 cases of DVT using the puncture technique. The procedure is performed with the patient in the prone position on the angiography table. The popliteal vein is punctured according to tibial bony landmarks under fluoroscopic guidance. The needle puncture is made from the popliteal crease, along the direction of tibial lateral intercondylar eminence and parallel to the vertical axis. An introducer sheath is inserted after successful puncture followed by placement of a perfusion catheter of appropriate length in the thrombus.


RESULTS
Technical success was achieved in 83 cases, with a success rate of 86.46% (83/96). The mean operation time was 38.6 ± 16.8 min, the mean fluoroscopy time was 11.3 ± 4.9 min, the mean effective dose (ED) was 77.2 ± 25.4 mGy, the mean dose-area product (DAP) was 3,927.5 ± 1,261 cGy cm(2). Compared with catheterization via incised ipsilateral small saphenous and contralateral femoral veins, the technique significantly shortened the operation and the X-ray exposure and reduced the dosage of ED and DAP.


CONCLUSIONS
Popliteal vein puncture technique based on bony landmark positioning is a user-friendly alternative to CDT, especially in the absence of ultrasound localization.
Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China.
Haijie
H
Che
Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China.
Juwen
J
Zhang
Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China.
Guifeng
G
Sang
Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China.
Jun
J
Yong
Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China.
Lubin
L
Li
Department of Vascular Surgery, YanTai Yuhuangding Hospital, YanTai, ShanDong, China. Electronic address: yangmuvascular@163.com.
Mu
M
Yang
D000328:Adult; D059925:Anatomic Landmarks; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011152:Popliteal Vein / Q000000981:diagnostic imaging; D016684:Prone Position; D011677:Punctures; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D055815:Young Adult
D005343:Fibrinolytic Agents