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Laserassistierte Thrombolyse der tiefen Bein und Beckenvenenthrombose

Ein In-vitro-Experiment mit dem Chandler-Loop

Laser-assisted thrombolysis of deep vein thrombosis

An in vitro experiment with a Chandler loop

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Zusammenfassung

Hintergrund

Laserassistierte Thrombolyse ist eine neue mögliche Therapieoption bei der Behandlung der tiefen Venen Thrombose. Bei der Therapie der tiefen Bein- und Beckenvenenthrombose (TVT) dominiert nach wie vor der konservative Behandlungspfad. Neben der selten durchgeführten offen-operativen Thrombektomie liegt der Fokus der klinischen Praxis auf der therapeutischen Antikoagulation und der Thrombolyse. Dabei kommt es häufig lediglich zu einer Limitation des Thrombuswachstums und nicht zu einer vollständigen Auflösung thrombotischen Materials und damit einhergehender Prävention embolischer Ereignisse.

Fragestellung

Ziel der vorliegenden Arbeit ist es, in einem In-vitro-Experiment den Vorteil einer laserkatheterassistierten Thrombolyse gegenüber der alleinigen pharmakologischen Lyse zu demonstrieren.

Material und Methoden

Wir verwendeten das Chandler-Loop-System als extrakorporales Zirkulationsmodell zur Erzeugung roter Thromben. Es erfolgte eine Laserexposition der Thromben und anschließend eine Lyse mit „recombinant tissue-type plasinogen activator“ (rt-PA).

Ergebnisse

Das Thrombusgewicht der mit Laser und rt-PA behandelten Proben war signifikant geringer als das Thrombusgewicht der mit rt-PA behandelten Proben

Schlussfolgerungen

Aufgrund eines signifikant verringerten Thrombusgewichts im In-vitro-Experiment könnte die laserassistierte Thrombolyse zu einer gefäßschonenden und risikoarmen Alternative bei der Therapie der TVT werden.

Abstract

Background

A multidisciplinary approach is recommended for patients with chronic deep vein thrombosis. Disease management has up to now been dominated by conservative treatment whereby anticoagulation therapy and in a few instances thrombolysis have major priority but thrombectomy is only rarely performed. However, these types of treatment often only limit the progress of thrombus growth without disintegrating it and without preventing embolic events.

Objectives

The aim of this work is to demonstrate the advantage of a laser catheter-assisted thrombolysis compared with the sole pharmacological lysis in an in vitro experiment.

Material and methods

A Chandler loop was used as a model system, an established experimental platform for extracorporeal blood circulation. Laser-assisted thrombolysis was performed with a laser catheter utilizing ultraviolet light to vaporize the fibrin network. Subsequently, additional conventional lysis with recombinant tissue-type plasminogen activator (rt-PA) was performed. Conventional lysis therapy alone served as a control.

Results

The Thrombus weight treated with laser and rt-PA sample was significantly less than that of the thrombus-treated rt-PA sample.

Conclusions

The interventional procedure combining laser and lysis therapy proved to be more effective than conventional lysis alone with respect to thrombus weight and structure. Therefore, this innovative approach may offer new options in the treatment of chronic deep vein thrombosis which has to be confirmed by further studies.

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Einhaltung ethischer Richtlinien

R. Berndt, C. Heneweer, C. Riedel, J.P. Schäfer, R. Petzina, M. Marczynski-Bühlow, K. Hess, C. Röcken, J. Cremer, G. Lutter und J. Groß geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Herz- und Gefäßchirurgie, UKSH - Campus Kiel, Arnold- Heller Str. 3, 24105, Kiel, Deutschland

    R. Berndt, R. Petzina, M. Marczynski-Bühlow, J. Cremer, G. Lutter &  J. Groß

  2. Klinik für Radiologie und Neuroradiologie, UKSH - Campus Kiel, Kiel, Deutschland

    C. Heneweer, C. Riedel & J.P. Schäfer

  3. Institut für Pathologie, UKSH - Campus Kiel, Kiel, Deutschland

    K. Hess & C. Röcken

Authors
  1. R. Berndt
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  2. C. Heneweer
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  3. C. Riedel
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  4. J.P. Schäfer
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  5. R. Petzina
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  6. M. Marczynski-Bühlow
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  7. K. Hess
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  8. C. Röcken
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  9. J. Cremer
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  10. G. Lutter
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  11. J. Groß
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Corresponding author

Correspondence to J. Groß.

Additional information

Hr. Rouven Berndt (1) und Fr. Dr. Carola Heneweer (2) haben eine gleichberechtigte Erstautorenschaft, korrespondierender Autor ist Dr. Justus Groß.

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Berndt, R., Heneweer, C., Riedel, C. et al. Laserassistierte Thrombolyse der tiefen Bein und Beckenvenenthrombose. Gefässchirurgie 19, 226–231 (2014). https://doi.org/10.1007/s00772-014-1313-2

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  • DOI: https://doi.org/10.1007/s00772-014-1313-2

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