Catheter-directed thrombolysis for lower extremity deep venous thrombosis: Report of a national multicenter registry

Mark W. Mewissen, Gary R. Seabrook, Mark H. Meissner, Jacob Cynamon, Nicos Labropoulos, Signe H. Haughton

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)39-49
Number of pages11
JournalRadiology
Volume211
Issue number1
StatePublished - Apr 1999

Fingerprint

Venous Thrombosis
Registries
Lower Extremity
Catheters
Urokinase-Type Plasminogen Activator
Femoral Vein
Intracranial Hemorrhages
Thigh
Embolism
Pulmonary Embolism
Punctures
Patient Selection
Stents
Thrombosis
Extremities
Hemorrhage
Lung
Therapeutics

Keywords

  • Interventional procedures, complications
  • Thrombolysis
  • Veins, extremities
  • Veins, thrombosis

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Mewissen, M. W., Seabrook, G. R., Meissner, M. H., Cynamon, J., Labropoulos, N., & Haughton, S. H. (1999). Catheter-directed thrombolysis for lower extremity deep venous thrombosis: Report of a national multicenter registry. Radiology, 211(1), 39-49.

Catheter-directed thrombolysis for lower extremity deep venous thrombosis : Report of a national multicenter registry. / Mewissen, Mark W.; Seabrook, Gary R.; Meissner, Mark H.; Cynamon, Jacob; Labropoulos, Nicos; Haughton, Signe H.

In: Radiology, Vol. 211, No. 1, 04.1999, p. 39-49.

Research output: Contribution to journalArticle

Mewissen, MW, Seabrook, GR, Meissner, MH, Cynamon, J, Labropoulos, N & Haughton, SH 1999, 'Catheter-directed thrombolysis for lower extremity deep venous thrombosis: Report of a national multicenter registry', Radiology, vol. 211, no. 1, pp. 39-49.
Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: Report of a national multicenter registry. Radiology. 1999 Apr;211(1):39-49.
Mewissen, Mark W. ; Seabrook, Gary R. ; Meissner, Mark H. ; Cynamon, Jacob ; Labropoulos, Nicos ; Haughton, Signe H. / Catheter-directed thrombolysis for lower extremity deep venous thrombosis : Report of a national multicenter registry. In: Radiology. 1999 ; Vol. 211, No. 1. pp. 39-49.
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abstract = "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.",
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AU - Mewissen, Mark W.

AU - Seabrook, Gary R.

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AU - Cynamon, Jacob

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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.

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KW - Thrombolysis

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KW - Veins, thrombosis

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