Ultrasonic Thrombolysis Catheter Treatment in Deep Vein Thrombosis

Abstract

Purpose: The study aimed to evaluate the utility and effectiveness of Ultrasonic Thrombolysis Catheter (UTC) in deep vein thrombosis (DVT). Material and Method: Recombinant human tissue plasminogen activator (alteplase) and EKOS EkoSonic® Endovascular System (EKOS Corporation, Bothell, Washington, USA) were used for the UTC treatment. After
the procedure, the treatment was evaluated with Venography and venous Doppler Ultrasonography (USG).
Results: Twenty-two patients who underwent UTC due to DVT were evaluated retrospectively. Thrombosis was in the femoral vein in 77.3 % (n=17) of the patients, in the iliac vein in 18.2% (n=4) and in the inferior Vena cava in 4.5% (n=1).The mean onset time for the symptoms was 21.8 days (range 3-72). Thrombolysis was successful in 77.3% (n=17) of the patients. In 50% (n=11) of the patients, full thrombolysis was achieved, and partial thrombolysis was achieved in 27.3% (n=6). None of the patients developed pulmonary embolism. In 2 patients, bleeding was
observed at the site of catheterization.

Conclusion: UTC treatment reduces the amount and duration of thrombolysis infusion and thus reduces the bleeding complications and prevents venous valve damage by ensuring early and effective thrombolysis. Consequently, it reduces the development of Post Thrombolytic Syndrome (PTS), which is a late complication of DVT. In conclusion, UTC is an easy-to-use choice of treatment with less systemic and local complications and higher success rate and effectiveness

Keywords

• Ultrasonic
• Thrombolysis
• Catheter

Derin Ven Trombozunda Ultrasonik Tomboliz Kateter Tedavisi

Abstract

Amaç: Biz çalışmamızda derin ven trombozunda (DVT) Ultrasonik Tromboliz Kateterinin (UTK) kullanılabilirliğini ve etkinliğini değerlendirmeyi amaçladık.
Materyal ve Metod: Mart 2011 ile Eylül 2013 tarihleri arasında Ultrasonografi (USG) ile DVT tanısı konmuş ve UTK tedavisi uygulanmış hastalar retrospektif olarak değerlendirildi. UTK tedavisinde rekombinant insan doku plazminojen aktivatörü (alteplase) ve EKOS EkoSonic® Endovascular System (EKOS Corporation, Bothell, Washington, USA) kullanıldı. İşlem sonrasında tedavi venografi ve venöz doppler ultrasonografi (USG) ile değerlendirildi.
Bulgular: UTK tedavisi uygulanan 22 hastanın %77.3’ünde (n=17) tromboz femoral vende, %18.2’sinde (n=4) iliak vende, %4.5’inde (n=1) vena kava inferiorda idi. Semptomların başlama zamanı ortalama 21.8 gün (3-72 ) idi. Hastaların %77.3’ünde (n=17) tromboliz başarılı oldu. Hastaların %50’sinde (n=11) tam tromboliz sağlanırken, %27,3 (n=6) hastada kısmi tromboliz elde edildi. Hiç bir hastada pulmoner emboli gözlenmedi. 2 hastada kateter takılma yerinde kanama gözlendi.
Sonuç: UTK tedavisi tromboliz infüzyon miktarını, zamanını ve buna bağlı olarak kanama komplikasyonu oranını azaltır ve erken ve etkili tromboliz sağlamasından dolayı venöz kapak hasarını önleyerek DVT'nin geç dönem komplikasyonu olan Post Trombolitik Sendromun (PTS) gelişmesini azaltır. Sonuç olarak DVT’de UTK tedavisi kullanımı kolay, sistemik ve lokal komplikasyonları az, etkili, başarı oranı yüksek bir tedavi seçeneğidir.

Keywords

• Derin
• Ven
• Trombozunda

References

1. White, RH. The epidemiology of venous thromboembolism. Circulation 2003; 107:14–18.
2. Patel NH, Plorde JJ, Meissner M. Catheter-directed thrombolysis in the treatmentof phlegmasia cerulea dolens. AnnVasc Surg 1998; 12:471–475.
3. Buller HR, Sohne M, Middledorp S. Treatmentof venous thromboembolism. J Thromb Haemost2005; 3:1554–1560
4. Tovey C, Wyatt S. Diagnosis, investigationand management of deep veinthrombosis. Br Med J 2003; 326:1190–1184.
5. Hirsh J, Guyatt G, Albers GW, et al. Executivesummary: American College ofChest Physicians evidence-based clinicalpractice guidelines (8th edition). Chest2008; 133:110–112.
6. Kahn SR, Ginsberg JS. The post-thromboticsyndrome: current knowledge, controversies,
7. and directions for future research.Blood Rev 2002; 16:155–165.
8. Mewissen MW, Seabrook GR, MeissnerMH, et al. Catheter directed thrombolysisfor lower extremity deep venous thrombosis:report of a national multicenterregistry. Radiology 1992; 211:39–49.

9. Parikh S, Motarjeme A, McNamara T, etal. Ultrasound-accelerated thrombolysisfor the treatment of deep vein thrombosis:initial clinical experience. J Vasc IntervRadiol 2008; 19:521–528.
10. Grommes J, Strijkers R, Greiner A, MahnkenAH, Wittens CH. Safety and feasibility of ultrasound-accelerated catheter-directedthrombolysis in deep vein thrombosis.Eur J Vasc Endovasc Surg 2011; 41:526–532.
11. Francis CW, Blinc A, Lee S, et al. Ultrasoundaccelerates transport of recombinanttissue plasminogen activator intoclots. Ultrasound Med Biol 1995; 21:419–424. 11. Doomernik DE, Schrijver AM, ZeebregtsCJ, de Vries JP, Reijnen MM. Advancements
12. in catheter-directed ultrasound-acceleratedthrombolysis. Endovasc Ther2011; 18:418–434.
13. Vedantham S, Grassi CJ, Ferral H, et al.Reporting standards for endovasculartreatment of lower extremity deep veinthrombosis. J Vasc Interv Radiol 2006;17:417–434.
14. Park YJ, Choi JY, Min SK, et al. Restorationof patency in iliofemoral deepvein thrombosis with catheter-directedthrombolysis does not always preventpost-thrombotic damage. Eur J Vasc EndovascSurg 2008; 36:725–730.
15. Prandoni P, Lensing AW, Cogo A, et al.The long-term clinical course of acutedeep venous thrombosis. Ann Intern Med1996; 125:1–7.
16. Sharafuddin MJ, Hicks ME, Jenson ML,Morris JE, Drasler WJ, Wilson GJ. Rheolyticthrombectomy with use of the AngioJet-F105 catheter: preclinical evaluationof safety. J Vasc Interv Radiol 1997;8:939–945.
17. Gu X, Sharafuddin MJ, Titus JL, et al.Acute and delayed outcomes of mechanicalthrombectomy with use of the steerableAmplatz thrombectomy device ina model of subacute inferior vena cavathrombosis. J Vasc Interv Radiol 1997;8:947–956.
18. Pianta MJ, Thomson KR. Catheter-directedthrombolysis of lower limb thrombosis.Cardiovasc Intervent Radiol 2011;34:25–36.
19. Motarjeme A. Ultrasound-enhancedthrombolysis. J Endovasc Ther 2007;14:251–256.
20. Elsharawy M, Elzayat E. Early results ofthrombolysis vs anticoagulation in iliofemoral
21. venous thrombosis. Eur J Vasc EndovascSurg 2002; 24:209–214.
22. Enden T, Klow NE, Sandvik L, et al.Catheter-directed thrombolysis vs. anticoagulant
23. therapy alone in deep veinthrombosis: results of an open randomized,controlled trial reporting on shorttermpatency. J Thromb Haemost 2009;7:1268–1275.
24. Markel A, Manzo RA, Bergelin RO, StrandnessDE Jr. Valvular reflux after deep vein thrombosis:incidence and time of occurrence. JVasc Surg 1992; 15:377–382.
25. Comerota AJ, Throm RC, Mathias SD,Haughton S, Mewissen M. Catheter-directed
26. thrombolysis for iliofemoral deepvenous thrombosis improves health-relatedquality of life. J Vasc Surg 2000;32:130–137.