US-accelerated catheter-directed thrombolysis for the treatment of deep venous thrombosis

Dumantepe, Mert; Tarhan, Arif; Yurdakul, Ilhan; Özler, Azmi

doi:10.5152/dir.2012.004

Cited by 19 publications

(29 citation statements)

References 37 publications

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“…37 Our results compared favorably in relation to other published works using EKOS for acceptable thrombolysis candidates (►Table 5). [36][37][38][39][40] Our study contained a larger patient population than most reporting the use of UAT and additionally looked at midterm patency over 1 year. Complete thrombolysis was achieved in 79% of patients with the remaining having achieved partial thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

EkoSonic Thrombolysis as a Therapeutic Adjunct in Venous Occlusive Disease

2016

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The use of ultrasound waves in conjunction with local thrombolysis may accelerate clot resolution and serve as an important therapeutic adjunct in the treatment of venous occlusive disease. Our goal was to provide a larger sample population over a 5-year period to evaluate our experience with the EkoSonic endovascular system (EKOS, EKOS Corporation, Bothell, WA). We suspected that ultrasound-accelerated thrombolysis (UAT) using EKOS would provide excellent thrombolysis and midterm patency rates with minimal thrombolytic complications. A retrospective study was conducted to provide a case series with UAT using EKOS. Data were collected over a 5-year period. Primary end points included degree of thrombolysis. Secondarily, we analyzed thrombolytic usage, complication rates, and midterm patency, over a 1-year period. A total of 48 limbs were treated with UAT. Forty cases were diagnosed as acute, whereas the remaining 8 were chronic. Complete thrombolysis was successful in 38/48 (79%) of patients, and partial thrombolysis was accomplished in 10/48 (21%) of patients. Overall mean infusion time was 22.4 hours ±3.6. There were a total of three complications (6%), all of which were minor bleeding. One-year patency was shown to be 87% with no signs of valvular reflux. UAT using EKOS demonstrated effective rates of thrombolysis with very few complications. In addition, our 1-year patency rates were comparable to published data using conventional catheter-directed thrombolysis. UAT provides lytic therapy by utilizing the benefits of ultrasonic waves to help augment the fibrinolytic process. Our institution currently favors the use of EKOS as the treatment of choice in patients that are appropriate thrombolytic candidates.

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Section: Discussionmentioning

confidence: 99%

EkoSonic Thrombolysis as a Therapeutic Adjunct in Venous Occlusive Disease

2016

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“…8,21 In addition to hemorrhage, procedure-related complications include rethrombosis, vascular dissection, or even rupture. 22 Ultrasound-accelerated thrombolysis is emerging as a promising tool in many vascular beds, including in peripheral arterial, 23 venous, 24 portal, 25 pulmonary, 25,26 and even in intracerebral vasculature. 27 High-frequency ultrasound waves synergistically enhance the fibrinolytic effects of the thrombolytic due to direct-mechanical acoustic streaming, improving clot permeability via creation of micropores and thus potentially reducing tPA doses and infusion rates.…”

Section: Treatment Of Hepatic Artery Thrombosismentioning

confidence: 99%

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Pereira

Salsamendi²,

Dalal

et al. 2016

Exp Clin Transplant

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Objectives: Hepatic artery thrombosis remains a major complication after orthoptic liver transplant. Treatment of hepatic artery thrombosis is complex and requires a multidisciplinary approach. Retransplant is the procedure of choice. In nonsurgical candidates, endovascular options are evolving. Materials and Methods: Based on our experience at a busy transplant center, we discuss 4 representative cases to explain the potential role of endovascular treatment beyond just attempts at recanalization. From our experience, as well as a review of the literature, we propose a clinical practice algorithm for optimal treatment of hepatic artery thrombosis after orthoptic liver transplant. Results: The primary traditional endovascular interventional options remain thrombectomy, balloon angioplasty, and use of stents with the aim of revascularization. However, these methods have not proven to be effective. Ultrasonography-assisted thrombolysis, which has thus far been relatively less described in the hepatic vasculature, has the potential of producing the same angiographic results but at lower doses of the thrombolytic agent, thus decreasing the potential for hemorrhagic complications. The adjunctive use of splenic artery embolization and prompt treatment of biliary complications are in our opinion useful in "buying time" to allow adequate development of collateral "neovascularization of the liver," thus preventing further ischemia. Conclusions: Although surgical retransplant still remains the standard treatment for hepatic artery thrombosis, organ shortages and high mortality still exist. Endovascular techniques are rapidly evolving, but these techniques are dependent on expertise available and, even in the best hands, have not proven to be effective at reversing hepatic artery thrombosis. The use of a multimodality endovascular approach could salvage the liver allografts, thereby preventing retransplant or facilitating transplant at a more elective setting.

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“…Catheter-directed thrombolysis, in contradistinction to systemic thrombolysis, targets the clot burden directly, and often reveals an underlying culprit lesion which may also be treated with endovascular techniques. The use of ultrasound to accelerate thrombolysis has been demonstrated to be safe and effective in multiple in vitro models [5,6] and is commonly used to treat venous thromboembolic events [7].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Accelerated Thrombolysis has Higher Success and Limb Salvage Rates and Similar Costs Compared to Catheter-Directed Thrombolysis for Acute Limb Ischemia

2016

JCCR

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Objectives: Ultrasound-accelerated thrombolysis (UAT) has become an alternative to catheter-directed thrombolysis (CDT) for the treatment of acute limb ischemia. The purpose of this study was to compare outcomes and hospital costs for these two treatments. Methods:The records of all patients treated with UAT (using the EkoSonic Endovascular System, EKOS Corp, Bothell, Washington) and CDT (standard sidehole catheter) at a single institution from January 2007 through December 2010 were reviewed. Patient demographics, treatment times, procedural outcomes, complications, lengths of stay, and hospital economic data were analyzed.Results: A total of 85 patients were treated; 43 underwent UAT and 42 had CDT. Both treatment groups had similar comorbidities and prior vascular procedures. Overall, 85.9% had a previous vascular procedure with 52 prosthetic bypass grafts. UAT was successful in 41/43 patients (95.3%), whereas CDT was successful in 28/42 (66.7%, P=.0019). Median total treatment time for the UAT group was 21.29 hours versus 56.53 hours for the CDT group (P=.000). Length of stay was also less for the UAT group (5.65 vs 8.26 days, P=.027). 30-d amputation rate was significantly higher in the CDT group (42.9% vs 18.6%, P<.01). There was a significantly higher bleeding rate in the CDT (23.8% vs 4.7%, P<.01). Total procedural costs were similar for both groups ($18,270 for UAT vs $16,650 for CDT, P=.366), as were total admission direct costs ($19,556 for UAT vs $18,520 for CDT, P=.685). Conclusion:UAT has higher success rates, shorter treatment times, higher limb salvage, less bleeding complications, and shorter lengths of stay than patients undergoing CDT. Despite the favorable clinical outcome for UAT, total procedural costs and total admission direct costs remain similar. Our institution has chosen to employ standardized techniques using UAT in order to improve outcomes and decrease complications in the future.

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US-accelerated catheter-directed thrombolysis for the treatment of deep venous thrombosis

Cited by 19 publications

References 37 publications

EkoSonic Thrombolysis as a Therapeutic Adjunct in Venous Occlusive Disease

EkoSonic Thrombolysis as a Therapeutic Adjunct in Venous Occlusive Disease

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Ultrasound-Accelerated Thrombolysis has Higher Success and Limb Salvage Rates and Similar Costs Compared to Catheter-Directed Thrombolysis for Acute Limb Ischemia

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