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Popliteal ven tutulumu olmayan akut iliofemoral ven trombozunun ultrasonla hızlandırılmış kateter aracılı trombolitik tedavisi: erken ve orta dönem sonuçlar

Yıl 2019, Cilt: 44 Sayı: 2, 347 - 353, 30.06.2019
https://doi.org/10.17826/cumj.460307

Öz

Amaç: Derin ven trombozu hayatı tehdit
eden bir patoloji olup uzun dönemde post-trombotik sendrom gibi morbiditelere
sebep olmaktadır. Bu çalışmanın amacı popliteal veni açık olan ilio-femoral
derin trombozu nedeniyle ultrason ile hızlandırılmış kateter aracılı tromboliz
tedavisi yapılan hastaların erken ve orta dönem sonuçlarını değerlendirmektir.

Gereç ve Yöntem:  Kasım 2014-Aralık 2015
tarihleri arasında akut iliofemoral derin ven rombozu nedeniyle ultrason ile
hızlandırılmış kateter aracılı tromboliz tedavisi uygulanan 18 hasta (11 erkek,
7 bayan; ortalama yaş 51,89±16,29 yıl) 
retrospektif kesitsel olarak planlanan çalışmaya dahil edilmiştir.

Bulgular:  Hastaların
% 88,9 unda (16/18) komplet tromboliz, 2 hastada parsiyel tromboliz başarıyla
sağlanmıştır. Pulmoner embolism gözlenmedi. Bir hastada kateter yerinde kanama
gözlendi. Parsiyel lizis olan bir hastada altta yatan lezyon balon anjioplasti
ile başarılı olarak tedavi edilmiştir. Hastane mortalitesi veya ciddi bir
komplikasyon gözlenmemiştir. Ortalama takip süresi 31,56±3,35 aydır. Tüm
hastaların ultrason bulguları, aynı deneyimli bir radyolog tarafından
değerlendirilmiştir. Dopler ultrasonografi kontrolleri girişim sonrası 1 ve 6.
ay ile 1 ve 2. yılda yapılarak raporlanmıştır. İliak ven açıklık oranı % 100
saptandı. Fakat sırasıyla 5,6% (1 hasta), 11.1% (2 hasta),16,2% (3 hasta),
16,2% (3 hasta) yüzeyel femoral vende yetmezlik saptandı.







Sonuç:  Çalışmamızın
sonuçlarına göre, popliteal veni patent olup ilio-femoral derin ven trombozu
olan dikkatli seçilmiş hastalarda ultrason ile hızlandırılmış kateter aracılı
tromboliz tedavisi güvenli ve efektif bir metodtur. 

Kaynakça

  • 1. Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149:698-707.
  • 2. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-52.
  • 3. Kahn SR, Ginsberg JS. The post-thrombotic syndrome: Current knowledge, controversies, and directions for future research. Blood Rev. 2002;16: 155–65.
  • 4. Gutt CN, Oniu T, Wolkener F, Mehrabi A, Mistry S, Büchler MW. Prophylaxis and treatment of deep vein thrombosis in general surgery. Am J Surg. 2005;189: 14–22.
  • 5. Meissner MH, Manzo RA, Bergelin RO, Markel A, Strandness Jr DE. Deep venous insufficiency: the relationship between lysis and subsequent reflux. J Vasc Surg. 1993;18(4): 596-605.
  • 6. Dumantepe M, Tarhan A, Yurdakul I, Ozler A. US-accelerated catheter-directed thrombolysis for the treatment of deep venous thrombosis. Diagn Interv Radiol. 2012;doi:doi.org/10.5152/.
  • 7. Grommes J, Strijkers R, Greiner A, Mahnken AH, Wittens CH. Safety and feasibility of ultrasound-accelerated catheterdirected thrombolysis in deep vein thrombosis. Eur J Vasc Endovasc Surg. 2011;41(4):526-32.
  • 8. Meissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DE. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012;55: 1449–62.
  • 9. Haig Y, Enden T, Slagsvold CE, Sandvik L, Sandset PM, Klow NE. Residual rates of reflux and obstruction and their correlation to post-thrombotic syndrome in a randomized study on catheter-directed thrombolysis for deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2014;2:123-30.
  • 10. Karahan O, Kutas HB, Gurbuz O, Tezcan O, Caliskan A, Yavuz C, et al. Pharmacomechanical thrombolysis with a rotator thrombolysis device in iliofemoral deep venous thrombosis. Vascular. 2016;24(5):481-6.
  • 11. Li W, Chuanlin Z, Shaoyu M, Yeh CH, Liqun C, Zeju Z. Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis. Rev Lat Am Enfermagem. 2018;doi:10.1590/1518-8345.2309.2990.
  • 12. Kim YA, Yang SS, Yun WS. Does Catheter-Directed Thrombolysis Prevent Postthrombotic Syndrome? Vasc Specialist Int. 2018; Jun;34(2):26-30.
  • 13. Vedantham S, Goldhaber SZ, Kahn SR, Julian J, Magnuson E, Jaff MR, et al. Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 2013;165(4):523-30.
  • 14. Engelberger RP, Stuck A, Spirk D, Willenberg T, Haine A, Périard D, et al. Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis: 1-year follow-up data of a randomized-controlled trial. J Thromb Haemost. 2017;15(7):1351-60.
  • 15. Enden T, Resch S, White C, Wik HS, Kløw NE, Sandset PM. Cost-effectiveness of additional catheter-directed thrombolysis for deep vein thrombosis. J Thromb Haemost. 2013;11(6):1032-42.
  • 16. Perrier A, Bounameaux H. Catheter-directed thrombolysis for deep venous thrombosis might be cost-effective, but for whom? J Thromb Haemost. 2013;11(6):1029-31.
  • 17. Fleck D, Albadawi H, Shamoun F, Knuttinen G, Naidu S, Oklu R. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther. 2017;7:228-37.
  • 18. Strijkers RH, Grommes J, Arnoldussen CW, de Graaf R, Ten Cate AJ, Wittens CH. Ultrasound-accelerated catheter-directed thrombolysis in acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2013;1(3):225-30.
  • 19. Kristiansen A, Brandt L, Agoritsas T, Akl EA, Berge E, Flem Jacobsen A, et al. Applying new strategies for the national adaptation, updating, and dissemination of trustworthy guidelines: results from the Norwegian adaptation of the Antithrombotic Therapy and the Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2014;146(3):735-61.
  • 20. Kelley D, Wright L, Ohman K, Ferreira J. Safety and effectiveness of direct oral anticoagulants following ultrasound-assisted catheter directed thrombolysis for venous thromboembolism. J Thromb Thrombolysis. 2018;46(1):58-61.
  • 21. EINSTEIN–PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012; 366:1287–97.
  • 22. Avgerinos ED, Hager ES, Jeyabalan G, Marone L, Makaroun MS, Chaer RA. Inferior vena cava filter placement during thrombolysis for acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2014;2(3):274-81.
  • 23. Protack CD, Bakken AM, Patel N, Saad WE, Waldman DL, Davies MG. Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement. J Vasc Surg. 2007;45(5):992-7.
  • 24. Miller DJ, Simpson JR, Silver B. Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies. Neurohospitalist. 2011;1:138-47.
  • 25. Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2014;(1):1-84.

Ultrasound accelerated catheter directed thrombolysis for treatment of acute iliofemoral deep venous thrombosis without popliteal vein thrombosis: early and midterm results

Yıl 2019, Cilt: 44 Sayı: 2, 347 - 353, 30.06.2019
https://doi.org/10.17826/cumj.460307

Öz

Purpose: Deep vein thrombosis is a life-threatening pathology which can lead to long-term morbidity due to post-thrombotic syndrome. The aim of this study was to assess early and midterm results of the patients undergoing ultrasound-accelerated catheter-directed thrombolysis for the treatment of acute iliofemoral deep venous thrombosis without popliteal vein thrombosis.

Materials and Methods: A total of 18 patients (11 males, 7 females; mean age: 51.89±16.29 years; range, 16 to 72 years) who were diagnosed with acute iliofemoral deep vein thrombosis between November 2014 and December 2015 were included in this retrospective cross-sectional study. 

Results:  Complete thrombolysis was successful in 88.9% (n=16) and in % 11.1 (n=2) patients with partial clot lysis. No pulmonary embolism was seen, while bleeding at the catheter-insertion site was observed in one patient. In another patient, underlying lesions were successfully treated with balloon angioplasty. No in-hospital mortality or severe complications were observed. The mean follow-up was 31.56±3.35 (range, 25 to 37 months). Ultrasound findings of all the patients were evaluated by a single experienced radiologist. Duplex ultrasound was performed at one month, six months, one year, and two years following intervention and the iliac vein patency rate was found to be 100%, while superficial femoral vein insufficiency was in 5.6% (n=1), 11.1% (n=2), 16.2% (n=3), and 16.2% (n=3), respectively.

Conclusion: Based on our findings, ultrasound-accelerated catheter-directed thrombolysis is a safe and effective method for carefully selected patients with acute iliofemoral deep vein thrombosis without popliteal vein thrombosis


Kaynakça

  • 1. Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149:698-707.
  • 2. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-52.
  • 3. Kahn SR, Ginsberg JS. The post-thrombotic syndrome: Current knowledge, controversies, and directions for future research. Blood Rev. 2002;16: 155–65.
  • 4. Gutt CN, Oniu T, Wolkener F, Mehrabi A, Mistry S, Büchler MW. Prophylaxis and treatment of deep vein thrombosis in general surgery. Am J Surg. 2005;189: 14–22.
  • 5. Meissner MH, Manzo RA, Bergelin RO, Markel A, Strandness Jr DE. Deep venous insufficiency: the relationship between lysis and subsequent reflux. J Vasc Surg. 1993;18(4): 596-605.
  • 6. Dumantepe M, Tarhan A, Yurdakul I, Ozler A. US-accelerated catheter-directed thrombolysis for the treatment of deep venous thrombosis. Diagn Interv Radiol. 2012;doi:doi.org/10.5152/.
  • 7. Grommes J, Strijkers R, Greiner A, Mahnken AH, Wittens CH. Safety and feasibility of ultrasound-accelerated catheterdirected thrombolysis in deep vein thrombosis. Eur J Vasc Endovasc Surg. 2011;41(4):526-32.
  • 8. Meissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DE. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012;55: 1449–62.
  • 9. Haig Y, Enden T, Slagsvold CE, Sandvik L, Sandset PM, Klow NE. Residual rates of reflux and obstruction and their correlation to post-thrombotic syndrome in a randomized study on catheter-directed thrombolysis for deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2014;2:123-30.
  • 10. Karahan O, Kutas HB, Gurbuz O, Tezcan O, Caliskan A, Yavuz C, et al. Pharmacomechanical thrombolysis with a rotator thrombolysis device in iliofemoral deep venous thrombosis. Vascular. 2016;24(5):481-6.
  • 11. Li W, Chuanlin Z, Shaoyu M, Yeh CH, Liqun C, Zeju Z. Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis. Rev Lat Am Enfermagem. 2018;doi:10.1590/1518-8345.2309.2990.
  • 12. Kim YA, Yang SS, Yun WS. Does Catheter-Directed Thrombolysis Prevent Postthrombotic Syndrome? Vasc Specialist Int. 2018; Jun;34(2):26-30.
  • 13. Vedantham S, Goldhaber SZ, Kahn SR, Julian J, Magnuson E, Jaff MR, et al. Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J. 2013;165(4):523-30.
  • 14. Engelberger RP, Stuck A, Spirk D, Willenberg T, Haine A, Périard D, et al. Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis: 1-year follow-up data of a randomized-controlled trial. J Thromb Haemost. 2017;15(7):1351-60.
  • 15. Enden T, Resch S, White C, Wik HS, Kløw NE, Sandset PM. Cost-effectiveness of additional catheter-directed thrombolysis for deep vein thrombosis. J Thromb Haemost. 2013;11(6):1032-42.
  • 16. Perrier A, Bounameaux H. Catheter-directed thrombolysis for deep venous thrombosis might be cost-effective, but for whom? J Thromb Haemost. 2013;11(6):1029-31.
  • 17. Fleck D, Albadawi H, Shamoun F, Knuttinen G, Naidu S, Oklu R. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther. 2017;7:228-37.
  • 18. Strijkers RH, Grommes J, Arnoldussen CW, de Graaf R, Ten Cate AJ, Wittens CH. Ultrasound-accelerated catheter-directed thrombolysis in acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2013;1(3):225-30.
  • 19. Kristiansen A, Brandt L, Agoritsas T, Akl EA, Berge E, Flem Jacobsen A, et al. Applying new strategies for the national adaptation, updating, and dissemination of trustworthy guidelines: results from the Norwegian adaptation of the Antithrombotic Therapy and the Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2014;146(3):735-61.
  • 20. Kelley D, Wright L, Ohman K, Ferreira J. Safety and effectiveness of direct oral anticoagulants following ultrasound-assisted catheter directed thrombolysis for venous thromboembolism. J Thromb Thrombolysis. 2018;46(1):58-61.
  • 21. EINSTEIN–PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012; 366:1287–97.
  • 22. Avgerinos ED, Hager ES, Jeyabalan G, Marone L, Makaroun MS, Chaer RA. Inferior vena cava filter placement during thrombolysis for acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2014;2(3):274-81.
  • 23. Protack CD, Bakken AM, Patel N, Saad WE, Waldman DL, Davies MG. Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement. J Vasc Surg. 2007;45(5):992-7.
  • 24. Miller DJ, Simpson JR, Silver B. Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies. Neurohospitalist. 2011;1:138-47.
  • 25. Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2014;(1):1-84.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma
Yazarlar

Emre Kubat 0000-0002-9884-8565

Celal Selçuk Ünal 0000-0003-4286-8062

Aydın Keskin Bu kişi benim 0000-0002-0622-297X

Erdem Çetin 0000-0002-4065-9016

Yayımlanma Tarihi 30 Haziran 2019
Kabul Tarihi 29 Kasım 2018
Yayımlandığı Sayı Yıl 2019 Cilt: 44 Sayı: 2

Kaynak Göster

MLA Kubat, Emre vd. “Ultrasound Accelerated Catheter Directed Thrombolysis for Treatment of Acute Iliofemoral Deep Venous Thrombosis Without Popliteal Vein Thrombosis: Early and Midterm Results”. Cukurova Medical Journal, c. 44, sy. 2, 2019, ss. 347-53, doi:10.17826/cumj.460307.