Evaluation of catheter-directed thrombolysis for iliofemoral deep venous extensive thrombosis.
Evaluación de la trombolisis dirigida por catéter para el manejo de la trombosis venosa profunda iliofemoral extensa.
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Introduction: Iliofemoral extensive deep venous thrombosis (IFDVT) has an important clinical long-term impact when considering chronic venous insufficiency and related disability. Catheter-directed thrombolysis (CDT) might reduce IFDVT associated morbidity. Materials and methods: We performed a monographic follow-up registry of CDT treated patients at Fundación Santa Fe de Bogotá (FSFB) between 2008 and 2011. We described clinical characteristics, procedure aspects and short plus long-term outcomes. Results: CDT was performed in four patients for left IFDVT, three women and one man, with a median age of 58 years (range, 35-70). Three presented May-Thurner syndrome (MTS). Acute and subacute thromboses were characterized by ultrasonography each one in two patients. CDT was executed using alteplase and tenecteplase in one and three patients, respectively. All MTS cases were additionally managed with ballon angioplasty plus stenting (BAS), immediately after CDT. Complete thrombolytic success was evident in two acute cases and partial was evident in the two subacute cases. There was only one mayor but successfully controlled bleeding event in an elderly patient. Long-term venous patency by Doppler ultrasonography, without recurrent stenosis or thrombosis, was conserved in all. No postthrombotic syndrome was diagnosed after a minimum 6-month follow-up period. Conclusions: CDT for IFDVT is a valid option to be performed at FSFB, offering acceptable complication frequency, but most importantly, relevant long-term clinical benefits. In MTS associated IFDVT cases, venous patency was maintained by concomitant use of BAS during the whole follow-up.
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MeSH Database. Venous thrombosis. Bethesda, MD, EE. UU.: National Center for Biotechnology Information, U.S. National Library of Medicine 1999 [consultado el 05/jul/2012]. Disponible en: .
Center for Disease Control and Prevention. Venous thromboembolism in adult hospitalizations - United States, 2007-2009. MMWR Morb Mortal Wkly Rep. 2012;61:401-4.
White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I4-8.
Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet. 2012;379(9828):1835-46.
Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22-30.
Killewich LA, Macko RF, Cox K, Franklin DR, Benjamin ME, Lilly MP, et al. Regression of proximal deep venous thrombosis is associated with fibrinolytic enhancement. J Vasc Surg. 1997;26(5):861-8.
van Ramshorst B, van Bemmelen PS, Hoeneveld H, Faber JA, Eikelboom BC. Thrombus regression in deep venous thrombosis. Quantification of spontaneous thrombolysis with duplex scanning. Circulation. 1992;86(2):414-9.
Piovella F, Crippa L, Barone M, Vigano D’Angelo S, Serafini S, Galli L, et al. Normalization rates of compression ultrasonography in patients with a first episode of deep vein thrombosis of the lower limbs: association with recurrence and new thrombosis. Haematologica. 2002;87(5):515-22.
Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life. Ann Surg. 2004;239(1):118-26.
Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology. 1999;211(1):39-49.
AbuRahma AF, Perkins SE, Wulu JT, Ng HK. Iliofemoral deep vein thrombosis: conventional therapy versus lysis and percutaneous transluminal angioplasty and stenting. Ann Surg. 2001;233(6):752-60.
Kahn SR. The post-thrombotic syndrome. Hematology Am Soc Hematol Educ Program. 2010;2010:216-20.
Bergqvist D, Jendteg S, Johansen L, Persson U, Odegaard K. Cost of long-term complications of deep venous thrombosis of the lower extremities: an analysis of a defined patient population in Sweden. Ann Intern Med. 1997;126(6):454-7.
Akesson H, Brudin L, Dahlström JA, Eklöf B, Ohlin P, Plate G. Venous function assessed during a 5 year period after acute iliofemoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg. 1990;4(1):43-8.
Watson LI, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 2004;(4):CD002783.
Gogalniceanu P, Johnston CJ, Khalid U, Holt PJ, Hincliffe R, Loftus IM, et al. Indications for thrombolysis in deep venous thrombosis. Eur J Vasc Endovasc Surg. 2009;38(2):192-8.
Saharay M, Shields DA, Porter JB, Scurr JH, Coleridge Smith PD. Leukocyte activity in the microcirculation of the leg in patients with chronic venous disease. J Vasc Surg. 1997;26(2):265-73.
Schmid-Schonbein G. Molecular basis of venous insufficiency. En: Bergan JJ, editor. The vein book. Burlington, MA, EE. UU.: Elsevier; 2007. p. 67-79.
Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149(10):698-707.
Ziegler S, Schillinger M, Maca TH, Minar E. Post-thrombotic syndrome after primary event of deep venous thrombosis 10 to 20 years ago. Thromb Res. 2001;101(2):23-33.
Saarinen J, Kallio T, Lehto M, Hiltunen S, Sisto T. The occurrence of the post-thrombotic changes after an acute deep venous thrombosis. A prospective two-year follow-up study. J Cardiovasc Surg (Torino). 2000;41(3):441-6.
Prandoni P, Lensing AW, Prins MH, Frulla M, Marchiori A, Bernardi E, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med. 2004;141(4):249-56.
Brandjes DP, Büller HR, Heijboer H, Huisman MV, de Rijk M, Jagt H, et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet. 1997;349(9054):759-62.
Kahn SR, Azoulay L, Hirsch A, Haber M, Strulovitch C, Shrier I. Effect of graduated elastic compression stockings on leg symptoms and signs during exercise in patients with deep venous thrombosis: a randomized cross-over trial. J Thromb Haemost. 2003;1(3):494-9.
Kahn SR, Shbaklo H, Lamping DL, Holcroft CA, Shrier I, Miron MJ, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost. 2008;6(7):1105-12.
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S-94S.
Working Party on Thrombolysis in the Management of Limb Ischemia. Thrombolysis in the management of lower limb peripheral arterial occlusion--a consensus document. J Vasc Interv Radiol. 2003;14(9 Pt 2):S337-49.
Lansing AM, Davis WM. Five-year follow-up study of iliofemoral venous thrombectomy. Ann Surg. 1968;168(4):620-8.
Vedantham S, Millward SF, Cardella JF, Hofmann LV, Razavi MK, Grassi CJ, et al. Society of Interventional Radiology position statement: treatment of acute iliofemoral deep vein thrombosis with use of adjunctive catheter-directed intrathrombus thrombolysis. J Vasc Interv Radiol. 2006;17(4):613-6.
Raschke RA, Gollihare B, Peirce JC. The effectiveness of implementing the weight-based heparin nomogram as a practice guideline. Arch Intern Med. 1996;156(15):1645-9.
Lin PH, Zhou W, Dardik A, Mussa F, Kougias P, Hedayati N, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg. 2006;192(6):782-8.
Robertson BR, Nilsson IM, Nylander G. Value of streptokinase and heparin in treatment of acute deep venous thrombosis. A coded investigation. Acta Chir Scand. 1968;134(3):203-8.
Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology. 1994;191(2):487-94.
Verhaeghe R, Stockx L, Lacroix H, Vermylen J, Baert AL. Catheter-directed lysis of iliofemoral vein thrombosis with use of rtPA. Eur Radiol. 1997;7(7):996-1001.
Bjarnason H, Kruse JR, Asinger DA, Nazarian GK, Dietz CA Jr, Caldwell MD, et al. Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy. J Vasc Interv Radiol. 1997;8(3):405-18.
Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surg. 2002;24(3):209-14.
Enden T, Haig Y, Klow NE, Slagsvold CE, Sandvik L, Ghanima W, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 2012;379(9810):31-8.
Comerota AJ. The ATTRACT trial: rationale for early intervention for iliofemoral DVT. Perspect Vasc Surg Endovasc Ther. 2009;21(4):221-4.
Enden T, Kløw NE, Sandset PM. Catheter-directed thrombolysis for acute deep vein thrombosis--Authors’ reply. The Lancet. 2012;379(9828):1786-7.
Kahn SR. The post-thrombotic syndrome: progress and pitfalls. Br J Haematol. 2006;134(4):357-65.
Vedantham S, Grassi CJ, Ferral H, Patel NH, Thorpe PE, Antonacci VP, et al. Reporting standards for endovascular treatment of lower extremity deep vein thrombosis. J Vasc Interv Radiol. 2006;17(3):417-34.
Kahn SR, Partsch H, Vedantham S, Prandoni P, Kearon C. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost. 2009;7(5):879-83.
Villalta S, Bagatella P, Piccioli A, Lensing AW, Prins MH, Prandoni P. Assessment of validity and reproducibility of a clinical scale for the postthrombotic syndrome. Haemostasis. 1994;24(suppl 1):157.
Sugimoto K, Hofmann LV, Razavi MK, Kee ST, Sze DY, Dake MD, et al. The safety, efficacy, and pharmacoeconomics of lowdose alteplase compared with urokinase for catheter-directed thrombolysis of arterial and venous occlusions. J Vasc Surg. 2003;37(3):512-7.
Grunwald MR, Hofmann LV. Comparison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis. J Vasc Interv Radiol. 2004;15(4):347-52.
Red Nacional de Trombolisis. Otras indicaciones de tratamiento trombolítico. En: Castillo-Barrios GA, editor. Consenso Colombiano de Trombólisis y Terapias de Reperfusión. Bogotá: Ministerio de la Protección Social; 2008.
Hernández C, Gómez F, Mármol A, Escobar A, Duque J, Jiménez A, et al. Trombolisis selectiva y angioplastia con stent para el manejo de la trombolisis venosa profunda iliofemoral. Rev Colomb Cardiol. 2003;10(9):519.
Patiño JH, Cruz LA, León ME, Urbina CA, Cárdenas RA. Terapia fibrinolítica. Rev Colomb Radiol. 2003;14(4):1452-63.
Protack CD, Bakken AM, Patel N, Saad WE, Waldman DL, Davies MG. Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement. J Vasc Surg. 2007;45(5):992-7.
Kibbe MR, Ujiki M, Goodwin AL, Eskandari M, Yao J, Matsumura J. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39(5):937-43.
May R, Thurner J. [A vascular spur in the vena iliaca communis sinistra as a cause of predominantly left-sided thrombosis of the pelvic veins]. Z Kreislaufforsch. 1956;45(23-24):912-22.
Kim JY, Choi D, Guk Ko Y, Park S, Jang Y, Lee do Y. Percutaneous treatment of deep vein thrombosis in May-Thurner syndrome. Cardiovasc Intervent Radiol. 2006;29(4):571-5.
Cockett FB, Thomas ML, Negus D. Iliac vein compression.--Its relation to iliofemoral thrombosis and the post-thrombotic syndrome. BMJ. 1967;2(5543):14-9.
Baron HC, Shams J, Wayne M. Iliac vein compression syndrome: a new method of treatment. Am Surg. 2000;66(7):653-5.
García LF, Francisco A, Franco CA, Lechter A. Manejo endovascular en pacientes con síndrome de compresión iliocava: experiencia en 17 casos. Rev Colomb Cardiol. 2006;13:23-30.
Husmann MJ, Heller G, Kalka C, Savolainen H, Do DD, Schmidli J, et al. Stenting of common iliac vein obstructions combined with regional thrombolysis and thrombectomy in acute deep vein thrombosis. Eur J Vasc Endovasc Surg. 2007;34(1):87-91.
Fraser DG, Moody AR, Morgan PS, Martel A. Iliac compression syndrome and recanalization of femoropopliteal and iliac venous thrombosis: a prospective study with magnetic resonance venography. J Vasc Surg. 2004;40(4):612-9.
O’Sullivan GJ, Semba CP, Bittner CA, Kee ST, Razavi MK, Sze DY, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2000;11(7):823- 36.
Patel NH, Stookey KR, Ketcham DB, Cragg AH. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol. 2000;11(10):1297-302.
Heijmen RH, Bollen TL, Duyndam DA, Overtoom TT, Van Den Berg JC, Moll FL. Endovascular venous stenting in May-Thurner syndrome. J Cardiovasc Surg (Torino). 2001;42(1):83-7.
Kwak HS, Han YM, Lee YS, Jin GY, Chung GH. Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis: early and late results. J Vasc Interv Radiol. 2005;16(6):815-22.
Patterson BO, Hinchliffe R, Loftus IM, Thompson MM, Holt PJ. Indications for catheter-directed thrombolysis in the management of acute proximal deep venous thrombosis. Arterioscler Thromb Vasc Biol. 2010;30(4):669-74.
Hilleman DE, Razavi MK. Clinical and economic evaluation of the Trellis-8 infusion catheter for deep vein thrombosis. J Vasc Interv Radiol. 2008;19(3):377-83.
Kasirajan K, Gray B, Ouriel K. Percutaneous AngioJet thrombectomy in the management of extensive deep venous thrombosis. J Vasc Interv Radiol. 2001;12(2):179-85.
Parikh S, Motarjeme A, McNamara T, Raabe R, Hagspiel K, Benenati JF, et al. Ultrasound-accelerated thrombolysis for the treatment of deep vein thrombosis: initial clinical experience. J Vasc Interv Radiol. 2008;19(4):521-8.
Liu F, Lü P, Jin B. Catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis. Ann Vasc Surg. 2011;25(5):707-15.
