Back to Annual Meeting Program

OBJECTIVES: With the advent of recent mechanical devices and enhanced delivery systems for thrombolytic therapy in the treatment of significant deep vein thrombosis (DVT), the goal of this study was to evaluate the effectiveness of the varying modalities, including catheter directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), and pharmacomechanical thrombectomy (PhMT), which includes use of a thrombolytic agent in conjunction with a mechanical device.
METHODS: A retrospective chart review was performed of all patients who received thrombolysis for significant DVT, caval-iliofemoral and upper extremity, administered by one vascular surgeon at a single institution between 2000 and 2011. A total of 169 patients treated for extensive DVT with thrombolysis were included for statistical analysis. Collected data included hospital length of stay, patient comorbidities, concomitant illnesses, number of venograms, treatment results, treatment modality, and treatment duration.
RESULTS: There were 114 patients who received PhMT, 16 received only PMT, and 39 received CDT. CDT required 2.1 more venograms compared to PMT (p<.0001) and 1.1 more compared to PhMT (p<.0001). No significance was found in hospital length of stay. Overall mean drip duration for PhMT was 22.1 hours and 44.2 for CDT. PMT achieved 93.8% successful lysis, CDT 79.5%, and PhMT 99.1%. Overall successful lysis was 94.1%. Successful lysis was quantified as >50% reduction in clot burden. Two patients had no response to thrombolytic therapy, with findings of extensive chronic thrombus at time of procedure. AngioJet (Possis Medical, Minneapolis, Minnesota) used with CDT required 14.5 more hours of treatment than Trellis (Baccus Vascular, Santa Clara, California) used with CDT (p=.003). Trellis used in combination with EKOS (EKOS Corp, Bothell, Washington) showed reduced treatment time of 14.7 hours compared to AngioJet (p=.002). Out of those treated with Trellis (N=49), almost half did not require CDT. Successful lysis was achieved with AngioJet in 96.2% of patients, 100% with EKOS, 100% with Trellis, and 100% with Trellis and EKOS combined.
CONCLUSIONS: Thrombolytic therapy continues to be a safe modality for patients with significant comorbidities for symptomatic improvement of significant DVT. PMT devices used in conjunction with a thrombolytic agent have significantly improved treatment of DVT including decreased treatment duration and decreased number of venograms.