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CardioVascular and Interventional Radiology

, Volume 32, Issue 5, pp 980–987 | Cite as

Catheter-Directed Thrombolysis for Treatment of Deep Venous Thrombosis in the Upper Extremities

  • Anders VikEmail author
  • Pål Andre Holme
  • Kulbir Singh
  • Eric Dorenberg
  • Kåre Christian Nordhus
  • Satish Kumar
  • John-Bjarne Hansen
Clinical Investigation

Abstract

Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002–2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1–30); median duration of thrombolysis treatment, 70 h (range, 24–264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19–225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01–1.42). At follow-up (n = 29; median, 21 months; range, 5–58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.

Keywords

Upper extremity deep venous thrombosis Catheter-directed thrombolysis Postthrombotic syndrome 

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Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2009

Authors and Affiliations

  • Anders Vik
    • 1
    Email author
  • Pål Andre Holme
    • 2
  • Kulbir Singh
    • 3
  • Eric Dorenberg
    • 4
  • Kåre Christian Nordhus
    • 3
  • Satish Kumar
    • 3
  • John-Bjarne Hansen
    • 1
    • 5
  1. 1.Department of MedicineUniversity Hospital of North NorwayTromsøNorway
  2. 2.Division of Haematology, Medical DepartmentRikshospitalet University HospitalOsloNorway
  3. 3.Department of RadiologyUniversity Hospital of North NorwayTromsøNorway
  4. 4.Department of RadiologyRikshospitalet University HospitalOsloNorway
  5. 5.Center for Atherothrombotic Research in Tromsø, Department of Medicine, Institute of Clinical MedicineUniversity of TromsøTromsøNorway

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