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CardioVascular and Interventional Radiology

, Volume 29, Issue 6, pp 1003–1007 | Cite as

Catheter-Directed Thrombolysis with Percutaneous Rheolytic Thrombectomy Versus Thrombolysis Alone in Upper and Lower Extremity Deep Vein Thrombosis

  • Hyun S. KimEmail author
  • Ajanta Patra
  • Ben E. Paxton
  • Jawad Khan
  • Michael B. Streiff
CLINICAL INVESTIGATION

Abstract

Purpose

To compare the efficacy of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for upper and lower extremity deep vein thrombosis (DVT).

Methods

A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian DVT treated with urokinase CDT was identified, and a chart review was conducted. Demographic characteristics, treatment duration, total lytic dose, clot lysis rates and complications were compared in patients treated with urokinase CDT alone or combined CDT and rheolytic PMT.

Results

Forty limbs in 36 patients were treated with urokinase CDT alone. Twenty-seven limbs in 21 patients were treated with urokinase CDT and rheolytic PMT. The mean treatment duration for urokinase CDT alone was 48.0 ± 27.1 hr compared with 26.3 ± 16.6 hr for urokinase CDT and rheolytic PMT (p = 0.0004). The mean urokinase dose required for CDT alone was 5.6 ± 5.3 million units compared with 2.7 ± 1.8 million units for urokinase CDT with rheolytic PMT (p = 0.008). Complete clot lysis was achieved in 73% (29/40) of DVT treated with urokinase CDT alone compared with 82% (22/27) treated with urokinase CDT with rheolytic PMT.

Conclusion

Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute proximal extremity DVT but requires significantly shorter treatment duration and lower lytic doses. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of acute proximal extremity DVT are warranted.

Keywords

Angiojet Catheter-directed thrombolysis, CDT DVT Percutaneous mechanical thrombectomy, PMT Rheolytic thrombectomy Urokinase 

Notes

Acknowledgments

This manuscript is an invited paper, the abstract of which was presented at the Annual CIRSE Meeting in Nice, France, September 2005. There is no conflict of interest of the authors.

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Hyun S. Kim
    • 1
    • 3
    Email author
  • Ajanta Patra
    • 1
  • Ben E. Paxton
    • 1
  • Jawad Khan
    • 1
  • Michael B. Streiff
    • 2
  1. 1.Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA

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