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Vascular and Interventional Radiology |
1 From the Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee (M.W.M., G.R.S., S.H.H.); the Department of Vascular Surgery, University of Washington Harborview Medical Center, Seattle, (M.H.M.); the Department of Radiology, Montefiore Medical Center, Bronx, NY (J.C.); and the Department of Vascular Surgery, Loyola University Medical Center, Maywood, Ill (N.L.). From the 1997 RSNA scientific assembly. Received May 29, 1998; revision requested July 16; final revision received August 25; accepted October 13. Address reprint requests to M.W.M., Wisconsin Heart and Vascular Clinic, Ste 575, 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215.
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 (
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 IU) 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.
Index terms: Interventional procedures, complications, 93.1265 • Thrombolysis, 93.1265 • Veins, extremities • Veins, thrombosis, 93.751
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