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Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 1999 Apr;211(1):39-49

Date

04/06/1999

Pubmed ID

10189452

DOI

10.1148/radiology.211.1.r99ap4739

Scopus ID

2-s2.0-0032938969   690 Citations

Abstract

PURPOSE: To evaluate catheter-directed thrombolysis for treatment of symptomatic lower extremity deep venous thrombosis (DVT).

MATERIALS AND METHODS: From a registry of patients (n = 473) with symptomatic lower limb DVT, results of 312 urokinase infusions in 303 limbs of 287 patients (137 male and 150 female patients; mean age, 47.5 years) were analyzed. DVT symptoms were acute (< or = 10 days) in 188 (66%) patients, chronic (> 10 days) in 45 (16%), and acute and chronic in 54 (19%). A history of DVT existed in 90 (31%). Lysis grades were calculated by using venographic results.

RESULTS: Iliofemoral DVT (n = 221 [71%]) and femoral-popliteal DVT (n = 79 [25%]) were treated with urokinase infusions (mean, 7.8 million i.u.) for a mean of 53.4 hours. After thrombolysis, 99 iliac and five femoral vein lesions were treated with stents. Grade III (complete) lysis was achieved in 96 (31%) infusions; grade II (50%-99% lysis), in 162 (52%); and grade I (< 50% lysis), in 54 (17%). For acute thrombosis, grade III lysis occurred in 34% of cases of acute and in 19% of cases of chronic DVT (P < .01). Major bleeding complications occurred in 54 (11%) patients, most often at the puncture site. Six patients (1%) developed pulmonary emboli. Two deaths (< 1%) were attributed to pulmonary embolism and intracranial hemorrhage. At 1 year, the primary patency rate was 60%. Lysis grade was predictive of 1-year patency rate (grade III, 79%; grade II, 58%; grade I, 32%; P < .001).

CONCLUSION: Catheter-directed thrombolysis is safe and effective. These data can guide patient selection for this therapeutic technique.

Author List

Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH

Author

Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Female
Femoral Vein
Humans
Iliac Vein
Male
Middle Aged
Plasminogen Activators
Popliteal Vein
Prospective Studies
Radiography
Registries
Stents
Thrombolytic Therapy
Treatment Outcome
Urokinase-Type Plasminogen Activator
Vascular Patency
Venous Thrombosis
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