A Retrospective Comparison of Ultrasound-Assisted Catheter-Directed Thrombolysis and Catheter-Directed Thrombolysis Alone for Treatment of Proximal Deep Vein Thrombosis

Abstract

BackgroundRecent studies have suggested that catheter-directed thrombolysis (CDT) reduces development of post-thrombotic syndrome (PTS). Ultrasound-assisted CDT (USCDT) might enhance the efficiency of thrombolysis. We aimed to compare USCDT with CDT on efficacy, safety, development of PTS, and quality of life after long-term follow-up.MethodsWe describe a retrospective case series of 94 consecutive patients admitted with iliofemoral or more proximal deep vein thrombosis (DVT) to the University Hospital from 2002 to 2011, treated either with CDT or USCDT. Scheduled follow-up visits took place between April 2013 and January 2014. Venography measured the degree of residual luminal obstruction of the affected veins. Each patient completed the Short Form 36-item health survey assessment and the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms questionnaires. PTS was assessed using the Villalta scale.ResultsRisk factors of DVT were equally distributed between groups. In the USCDT group, we observed a significant decline in the duration of thrombolytic treatment (<48 h: 27 vs. 10 %), shortened hospital stay (median 6.0 days (IQR 5.0–9.0) vs. 8.0 (IQR 5.8–12.0)), and less implantation of (intravenous) stents (30 vs. 55 %). There was no difference in patency (76 vs. 79 % fully patent), prevalence of PTS (52 vs. 55 %), or quality of life between groups after long-term follow-up (median 65 months, range: 15–141).ConclusionsIn this observational study, USCDT was associated with shortened treatment duration, shorter hospital stay, and less intravenous stenting, compared to CDT alone without affecting the long-term prevalence of PTS or quality of life.

Recurrent Venous Thromboembolism- Its Causes, Prevention and Management

“…The occurrence of severe post thrombotic syndrome after primary treatment with isolated-pharmaco-mechanical thrombolysis device is low [33]. But others have not confirmed these findings [34]. In a Cochrane review reduced incidence of post-thrombotic syndrome (by 1/3 rd ), similar effectiveness was seen with systemic thrombolytic therapy and catheter directed thrombolysis [35].…”

Successful recanalization of the occluded vessel with the assistance of Targeted Adjustable Pharmaceutical Application System (TAPAS) in a patient with an acute deep vein thrombosis and May-Thurner syndrome

“…CDT was preferred because no intracranial bleeding was reported in the landmark prospective trial (CaVenT) [7] . Moreover, there were no differences in the safety outcomes of major and minor bleeding events between the traditional CDT and the USCDT groups with acute DVT [8] . USCDT has the additional benefits of shorter intervention duration, shorter hospitalization time, and fewer stent implantations.…”

Editor's Choice – Factors Associated with Long-Term Outcome in 191 Patients with Ilio-Femoral DVT Treated With Catheter-Directed Thrombolysis

“…The most recent studies and large scale trials have used the continuous infusion technique. 4,5,14,16 However, no comparative studies have Figure 1. Cumulative rate of patent deep venous system without reflux (Kaplan-Meier).…”

“…Even though the rate of stent insertion was slightly lower than in other studies, the present outcomes are comparable or even better than previously reported. 4,14,16,19,20 Moreover, the high number (79%) of patients with patent deep veins without reflux at 7 years suggests that a sufficient number of stents were inserted. Unfractionated heparin and LMWH was equally effective as a concomitant anticoagulant during CDT (data not shown).…”