The quantitative benefit of isolated, segmental, pharmacomechanical thrombolysis (ISPMT) for iliofemoral venous thrombosis
| Autor: | Sahira N. Kazanjian, Jorge L. Martinez Trabal, Anthony J. Comerota, Frankie B. LaPorte, Robert DiSalle, Deborah M. Sepanski |
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| Jazyk: | angličtina |
| Předmět: |
Adult
Male medicine.medical_specialty Percutaneous medicine.medical_treatment Femoral vein Iliac Vein law.invention Fibrinolytic Agents law Catheterization Peripheral medicine Humans Thrombolytic Therapy Thrombus Retrospective Studies Venous Thrombosis Ultrasonography Doppler Duplex business.industry Retrospective cohort study Phlebography Thrombolysis Femoral Vein Middle Aged medicine.disease Venous Obstruction Intensive care unit Surgery Venous thrombosis Treatment Outcome Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Journal of Vascular Surgery. (6):1532-1537 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2008.07.013 |
| Popis: | BackgroundEarly 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.MethodsForty-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.ResultsTreatment 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.ConclusionISPMT 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. |
| Databáze: | OpenAIRE |
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