TY - JOUR
T1 - Catheter-directed thrombolysis for lower extremity deep venous thrombosis
T2 - Report of a national multicenter registry
AU - Mewissen, Mark W.
AU - Seabrook, Gary R.
AU - Meissner, Mark H.
AU - Cynamon, Jacob
AU - Labropoulos, Nicos
AU - Haughton, Signe H.
PY - 1999/4
Y1 - 1999/4
N2 - PURPOSE: To evaluate catheter-directed thrombolysis for treatment of symptomatic lower extremity deep venous thrombosis (DVT). MATERIALS AND METHODS: From a registry of patients (n = 473) with symptomatic lower limb DVT, results of 312 urokinase infusions in 303 limbs of 287 patients (137 male and 150 female patients; mean age, 47.5 years) were analyzed. DVT symptoms were acute (≤10 days) in 188 (66%) patients, chronic (>10 days) in 45 (16%), and acute and chronic in 54 (19%). A history of DVT existed in 90 (31%). Lysis grades were calculated by using renographic results. RESULTS: Iliofemoral DVT (n = 221 [71%]) and femoral-popliteal DVT (n = 79 [25%]) were treated with urokinase infusions (mean, 7.8 million IU) for a mean of 53.4 hours. After thrombolysis, 99 lilac and five femoral vein lesions were treated with stents. Grade III (complete) lysis was achieved in 96 (31%) infusions; grade II (50%-99% lysis), in 162 (52%); and grade I (<50% lysis), in 54 (17%). For acute thrombosis, grade III lysis occurred in 34% of cases of acute and in 19% of cases of chronic DVT (P<.01). Major bleeding complications occurred in 54 (11%) patients, most often at the puncture site. Six patients (1%) developed pulmonary emboli. Two deaths (<1%) were attributed to pulmonary embolism and intracranial hemorrhage. At i year, the primary patency rate was 60%. Lysis grade was predictive of 1-year patency rate (grade III, 79%; grade II, 58%; grade I, 32%; P < .001). CONCLUSION: Catheter-directed thrombolysIs is safe and effective. These data can guide patient selection for this therapeutic technique.
AB - PURPOSE: To evaluate catheter-directed thrombolysis for treatment of symptomatic lower extremity deep venous thrombosis (DVT). MATERIALS AND METHODS: From a registry of patients (n = 473) with symptomatic lower limb DVT, results of 312 urokinase infusions in 303 limbs of 287 patients (137 male and 150 female patients; mean age, 47.5 years) were analyzed. DVT symptoms were acute (≤10 days) in 188 (66%) patients, chronic (>10 days) in 45 (16%), and acute and chronic in 54 (19%). A history of DVT existed in 90 (31%). Lysis grades were calculated by using renographic results. RESULTS: Iliofemoral DVT (n = 221 [71%]) and femoral-popliteal DVT (n = 79 [25%]) were treated with urokinase infusions (mean, 7.8 million IU) for a mean of 53.4 hours. After thrombolysis, 99 lilac and five femoral vein lesions were treated with stents. Grade III (complete) lysis was achieved in 96 (31%) infusions; grade II (50%-99% lysis), in 162 (52%); and grade I (<50% lysis), in 54 (17%). For acute thrombosis, grade III lysis occurred in 34% of cases of acute and in 19% of cases of chronic DVT (P<.01). Major bleeding complications occurred in 54 (11%) patients, most often at the puncture site. Six patients (1%) developed pulmonary emboli. Two deaths (<1%) were attributed to pulmonary embolism and intracranial hemorrhage. At i year, the primary patency rate was 60%. Lysis grade was predictive of 1-year patency rate (grade III, 79%; grade II, 58%; grade I, 32%; P < .001). CONCLUSION: Catheter-directed thrombolysIs is safe and effective. These data can guide patient selection for this therapeutic technique.
KW - Interventional procedures, complications
KW - Thrombolysis
KW - Veins, extremities
KW - Veins, thrombosis
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U2 - 10.1148/radiology.211.1.r99ap4739
DO - 10.1148/radiology.211.1.r99ap4739
M3 - Article
C2 - 10189452
AN - SCOPUS:0032938969
SN - 0033-8419
VL - 211
SP - 39
EP - 49
JO - Radiology
JF - Radiology
IS - 1
ER -