A Prospective Randomized Trial of Catheter-Directed Thrombolysis With Additional Balloon Dilatation for Iliofemoral Deep Venous Thrombosis: A Single-Center Experience

Zhang, Xiaoqin; Ren, Qingshuai; Jiang, Xuemei; Sun, Jianming; Gong, Jianping; Tang, Bo; Chen, Yikuan

doi:10.1007/s00270-013-0747-3

Cited by 33 publications

(62 citation statements)

References 31 publications

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“…The patient sample in this study is very low; however, less reflux was seen in both deep and superficial veins, with greater preservation of valvular competence in those patients who had been treated with CDT in comparison to patients treated with systemic thrombolysis [74]. Various clinical trials have been conducted which compare CDT with adjunctive or assisting therapy such as CDT and balloon dilatation for acute IFDVT, which was unable to show a significant difference for Villalta scores between the groups [75, 76]. …”

Section: Endovascular Management Of Vtementioning

confidence: 91%

Pathogenesis of Thromboembolism and Endovascular Management

et al. 2017

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Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.

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Section: Endovascular Management Of Vtementioning

confidence: 91%

Pathogenesis of Thromboembolism and Endovascular Management

et al. 2017

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“…was a higher risk of hemorrhagic events upon prolonged CDT. Several other studies also failed to demonstrated a higher risk of major bleeding events upon extended infusion duration (20)(21)(22). Nevertheless, the Society of Interventional Radiology recommends 96 h as the maximum duration of thrombolytic therapy involving urokinase infusion, in order to reduce the occurrence of bleeding events (1).…”

Section: Discussionmentioning

confidence: 99%

“…Prior to thrombolytic therapy in the present study, subjects were stratified into high-and low-risk bleeding groups based on risk factors, and distinct rates of urokinase infusion were used. Patients older than 75 years and patients who experienced recent major or serious surgery, trauma or gastrointestinal bleeding are typically excluded from CDT therapy (5,16,22,25). The present study included six senile patients (aged >75 years) receiving 1x10 4 U/h urokinase with no bleeding events (either major or minor).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding

Chen

Shi

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study aimed to examine the feasibility of catheter-directed thrombolysis (CDT) using continuous infusion of low-dose urokinase in combination with low molecular weight heparin (LMWH) for acute iliofemoral venous thrombosis. This retrospective analysis included patients with symptomatic acute iliofemoral venous thrombosis who received CDT using continuous infusion of low-dose urokinase in combination with LMWH within the past four years. Urokinase was administered at 1x10 4 U/h and 2x10 4 U/h in patients at high-risk and low-risk of bleeding, respectively. Measurements included urokinase dosage, duration, clinical outcomes and CDT-related complications. A total of 46 patients were included (high-risk, n=17; low-risk, n=29). In the high-risk patients, 64.7% experienced dissolution of ≥50% thrombi after a median CDT duration of 8 days (range, 6-10 days) and median total urokinase dose of 1.92x10 6 units (range, 1.44-2.4x10 6 units). In the low-risk patients, 82.8% achieved dissolution of ≥50% thrombi after a median CDT duration of 7 days (range, 4-10 days) and a median total urokinase dose of 3.36x10 6 units (range, 1.92-4.80x10 6 units). Remission of clinical symptoms after CDT was achieved in 15 (88.2%) and 28 (96.6%) cases in high-risk and low-risk patients, respectively. No treatment-associated pulmonary embolism or major bleeding was observed. Three (6.5%) subjects (high-risk, n=1; low-risk, n=2) experienced minor bleeding. In conclusion, continuous infusion of low-dose urokinase via CDT in combination with LMWH is effective and safe for acute iliofemoral venous thrombosis in patients with one or more risk factor for bleeding.

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“…Deep vein thrombosis (DVT) is a common clinical disease that can lead to severe complications such as pulmonary embolism, post-thrombotic syndrome, venous ulcer, and chronic pulmonary artery hypertension [ 1 – 3 ]. Early detection of newly formed thrombus is important for timely thrombolytic therapy and minimizing the occurrence of life-threating pulmonary embolism [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular magnetic resonance black-blood thrombus imaging for the diagnosis of acute deep vein thrombosis at 1.5 Tesla

Chen

Xie

et al. 2018

Journal of Cardiovascular Magnetic Resonance

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BackgroundThe aim was to investigate the feasibility of a cardiovascular magnetic resonance (CMR) black-blood thrombus imaging (BBTI) technique, based on delay alternating with nutation for tailored excitation black-blood preparation and a variable flip angle turbo-spin-echo readout, for the diagnosis of acute deep vein thrombosis (DVT) at 1.5 T.MethodsBBTI was conducted in 15 healthy subjects and 30 acute DVT patients. Contrast-enhanced CMR venography (CE-CMRV) was conducted for comparison and only performed in the patients. Apparent contrast-to-noise ratios between the thrombus and the muscle/lumen were calculated to determine whether BBTI could provide an adequate thrombus signal for diagnosis. Two blinded readers assessed the randomized BBTI images from all participants and made independent decisions on the presence or absence of thrombus at the segment level. Images obtained by CE-CMRV were also randomized and assessed by the two readers. Using the consensus CE-CMRV as a reference, the sensitivity, specificity, positive and negative predictive values, and accuracy of BBTI, as well as its diagnostic agreement with CE-CMRV, were calculated. Additionally, diagnostic confidence and interobserver diagnostic agreement were evaluated.ResultsThe thrombi in the acute phase exhibited iso- or hyperintense signals on the BBTI images. All the healthy subjects were correctly identified from the participants based on the segment level. The diagnostic confidence of BBTI was comparable to that of CE-CMRV (3.69 ± 0.52 vs. 3.70 ± 0.47). High overall sensitivity (95.2%), SP (98.6%), positive predictive value (96.0%), negative predictive value (98.3%), and accuracy (97.7%), as well as excellent diagnostic and interobserver agreements, were achieved using BBTI.ConclusionBBTI is a reliable, contrast-free technique for the diagnosis of acute DVT at 1.5 T.

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A Prospective Randomized Trial of Catheter-Directed Thrombolysis With Additional Balloon Dilatation for Iliofemoral Deep Venous Thrombosis: A Single-Center Experience

Abstract: Subacute iliofemoral DVT patients lacking effective therapy during acute phase, might receive more benefits from CDT with additional balloon dilatation. However, CDT alone is highly effective for acute patients.

Cited by 33 publications

References 31 publications

Pathogenesis of Thromboembolism and Endovascular Management

Pathogenesis of Thromboembolism and Endovascular Management

Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding

Cardiovascular magnetic resonance black-blood thrombus imaging for the diagnosis of acute deep vein thrombosis at 1.5 Tesla

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