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Ultrasound-Enhanced Catheter-Directed Thrombolysis of Iliofemoral Deep Venous Thrombosis
Paul J. Riesenman, MD MS, James G. Reeves, MD, Karthikeshwar Kasirajan, MD, Luke P. Brewster, MD, PhD, Ravi K. Veeraswamy, MD, Joseph J. Ricotta II, MD, Mathew A. Corriere, MD, Thomas F. Dodson, MD.
Emory University, Atlanta, GA, USA.


Objective:
Post-thrombotic syndrome is a potential complication of iliofemoral deep venous thrombosis. Successful thrombus resolution with catheter-directed thrombolysis reduces the morbidity associated with this condition. Ultrasound-enhanced catheter-directed thrombolysis may favorably augment clot lysis compared to conventional catheter-directed thrombolysis.

Methods:
Between January 2009 and July 2011, 29 cases of ultrasound-enhanced catheter-directed thrombolysis were performed for the treatment of iliofemoral deep venous thrombosis. Thrombolysis was assessed to be technically successful if there was >50% clot resolution (complete lysis >90% and partial lysis 50-90%).

Results:
Nine patients reported a prior history of ipsilateral deep venous thrombosis. The mean time from onset of symptoms to intervention was 18.9 days (range 1-90 days). The mean tPA dose delivered was 19.7 mg and the mean duration of therapy was 30.1 hours. At the completion of thrombolytic therapy, clot lysis was successfully obtained in 22/29 (76%) of patients (complete 15/29; 52%, and partial 7/29; 24%). Additional venous interventions (percutaneous mechanical thrombectomy, angioplasty, and/or stent placement) to treat persistent venous stenosis or occlusion were performed in 83% (24/29). No patient experienced new pulmonary emboli, early rethrombosis, or bleeding complications during treatment. Three patients required either reduction or cessation of thrombolytic therapy secondary to acute decreases in serum fibrinogen (<150 mg/dL). The majority of patients (90%; 26/29) experienced clinical improvement in their lower extremity symptoms immediately following treatment.

Conclusions:
Ultrasound-enhanced catheter-directed thrombolysis is safe and effective form of therapy for the treatment of iliofemoral deep venous thrombosis.


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