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

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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.

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Authors and Affiliations

  1. Department of Medicine, University Hospital of North Norway, 9038, Tromsø, Norway

    Anders Vik & John-Bjarne Hansen

  2. Division of Haematology, Medical Department, Rikshospitalet University Hospital, 0027, Oslo, Norway

    Pål Andre Holme

  3. Department of Radiology, University Hospital of North Norway, 9038, Tromsø, Norway

    Kulbir Singh, Kåre Christian Nordhus & Satish Kumar

  4. Department of Radiology, Rikshospitalet University Hospital, 0027, Oslo, Norway

    Eric Dorenberg

  5. Center for Atherothrombotic Research in Tromsø, Department of Medicine, Institute of Clinical Medicine, University of Tromsø, 9038, Tromsø, Norway

    John-Bjarne Hansen

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  1. Anders Vik
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  2. Pål Andre Holme
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  3. Kulbir Singh
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  4. Eric Dorenberg
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  5. Kåre Christian Nordhus
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  6. Satish Kumar
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  7. John-Bjarne Hansen
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Correspondence to Anders Vik.

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Vik, A., Holme, P.A., Singh, K. et al. Catheter-Directed Thrombolysis for Treatment of Deep Venous Thrombosis in the Upper Extremities. Cardiovasc Intervent Radiol 32, 980–987 (2009). https://doi.org/10.1007/s00270-009-9655-y

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  • DOI: https://doi.org/10.1007/s00270-009-9655-y

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