Evaluación de la trombolisis dirigida por catéter para el manejo de la trombosis venosa profunda iliofemoral extensa.
Evaluation of catheter-directed thrombolysis for iliofemoral deep venous extensive thrombosis.
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Introducción: La trombosis venosa profunda iliofemoral extensa (TVPIF) tiene un importante impacto a largo plazo en términos de insuficiencia venosa crónica e incapacidad secundaria. La trombolisis dirigida por catéter (TDC) puede reducir la morbilidad asociada a este evento. Materiales y métodos: Se diseñó y proyectó un registro monográfico de seguimiento, que incluyó una serie de pacientes tratados con TDC en la Fundación Santa Fe de Bogotá (FSFB) entre el 2008 y 2011. Se describieron las características clínicas de los pacientes, el procedimiento y los desenlaces a corto y a largo plazo. Resultados: La TDC se realizó en cuatro pacientes con TVPIF izquierda, tres mujeres y un hombre; la mediana de edad fue 58 años (rango 35 a 70). En tres casos, se documentó un síndrome de May-Thurner asociado (SMT). Las trombosis agudas y subagudas, caracterizadas por ultrasonografía, se encontraron cada una en dos pacientes. La TDC se llevó a cabo utilizando alteplase y tenecteplase en uno y tres pacientes, respectivamente. Al finalizar la TDC, todos los casos catalogados con SMT fueron manejados con angioplastia por balón más stent (ABS). El éxito trombolítico fue completo en los dos casos de TVPIF aguda, y parcial en los dos casos de TVPIF subaguda. Solo hubo un evento hemorrágico mayor y la permeabilidad del vaso a largo plazo se mantuvo en los cuatro pacientes, sin eventos trombóticos reincidentes o reestenosis. No se diagnosticó síndrome postrombótico en ninguno después de seis meses de seguimiento. Conclusiones: La TDC para la TVPIF es un procedimiento factible de efectuar en nuestra institución, ofreciendo una frecuencia aceptable de complicaciones con importantes beneficios clínicos a largo plazo. En los casos de TVPIF y SMT, el uso concomitante de ABS pudo mantener la permeabilidad venosa durante el tiempo de seguimiento.
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