Pulmonary Vascular Disease |

Catheter Directed Thrombolysis Along With Mechanical Thromboaspiration in the Management of Proximal Lower Limb Deep Venous Thrombosis: A Prospective Study FREE TO VIEW

Soumya Patra, DM
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SJICR, Bangalore, India

Chest. 2014;146(4_MeetingAbstracts):828A. doi:10.1378/chest.1989354
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Catheter-directed thrombolysis (CDT) with assisted mechanical thrombolysis is now becoming the standard of medical care for deep vein thrombosis (DVT). The study was to describe the immediate & long term (six months) safety and effectiveness of CDT in patient with lower limb DVT.

METHODS: All 12-85 years old patients with recent (0-8 weeks) DVT were included. In CDT group, thrombus was aspirated mechanically and streptokinase was given along with unfractioned heparin (UFH). After 6 months, deep venous patency and post-thrombophlebitic syndrome (PTS) was assessed by using duplex ultrasound and Villalta scale, respectively.

RESULTS: In the last 2 years, 61 patients were admitted with lower limb DVT and among them 30 patients were treated with CDT. Mean age of the study patients was 41.7 +/- 15 years and M: F ratio was 1:1. Mean duration of illness was 13.3 +/- 12 days. The mean duration of thrombolysis was 4.5 +/- 1.3 days. Grade III (complete) lysis was achieved in 18 (60%) and grade II (50%-90%) lysis in 12 (40%) of patients. Four patients (13%) developed pulmonary embolism following CDT and among them 2 patients (6%) had died. Eleven patients had (37%) had minor bleeding or hematoma at local site, and 7 (23%) had anemia requiring blood transfusion and 4 (13%) patients had thrombocytopenia. After 6 months, iliofemoral patency was found in 24 (80%) and PTS was seen in 6 (20%) patients following CDT.

CONCLUSIONS: We conclude that CDT and conventional manual aspiration thrombectomy is an effective treatment for lower extremity DVT. Streptokinase infusion can be safely given up to 7 days.

CLINICAL IMPLICATIONS: CDT should be considered in proximal lower limb DVT with high thrombus burden. Further study is required to determine the role of IVC filter implantation before giving CDT with thromboaspiration as our study showed 6% mortality due to pulmonary embolism.

DISCLOSURE: The following authors have nothing to disclose: Soumya Patra

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