Transcatheter intracavitary fibrinolysis of loculated pleural effusions: Experience in 102 patients

Journal Article · Mon Mar 15 00:00:00 EST 1999 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S002709900345· OSTI ID:21414396

De Gregorio, Miguel A ^[1]; Ruiz, Carlos ^[2]; Alfonso, Eduardo R; Fernandez, Jose A; Medrano, Joaquin; Arino, Ignacio ^[1]

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1. Hospital Clinico Universitario, Interventional Radiology Service (Spain)
2. Hospital Clinico Universitario, Respiratory Service (Spain)

Purpose: To assess the efficacy of intrapleural urokinase instillation through smll-caliber catheters for the treatment of loculate and/or septate effusions.Methods: We inserted small-caliber catheters (8.2 Fr) in 102 patients with septate and/or loculate pleural effusions using ultrasonographic guidance. Urokinase (100,000 IU/2 hr, 3 times a day) was instilled through the catheter until the effusion resolved and D-dimer levels were <500 ng/ml. Patients were enrolled regardless of the etiology of the pleural effusion provided there were no contraindications for the use of urokinase. D-dimer levels were determined before and after treatment. Follow-up was performed by chest radiograph and sonography at 1 day, 7 days, and every 30 days thereafter for 6 months.Results: Successful catheter placement was achieved in all cases. The mean time catheters stayed in place was 5.7 days and the mean dose of drug instilled was 690,000 IU. Pleural effusion drainage was complete at the first assessment in all patients. Failure of the treatment, with recurrent effusion at 30 days, occurred in six patients (5.8%). Complete resolution without sequelae was observed in 19 patients (19.6%). In 75 cases (73.5%) resolution was partial, with pleural thickening (>2 mm). Two patients died from unrelated causes within 30 days after catheter placement. Complications were seen in 13 patients (12.74%): hydropneumothorax, nine cases (8.82%); infection of the puncture point, three cases (2.94%); and adverse reaction, one case (0.98%). No further treatment was required.Conclusions: The use of intrapleural fibrinolytic agents delivered through small-caliber catheters for the treatment of loculate and/or septate pleural effusion is a simple, effective, minimally invasive and inexpensive procedure that can prevent sequelae and shorten drainage time.

• OSTI ID: 21414396
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 22, Issue 2; Other Information: DOI: 10.1007/s002709900345; Copyright (c) 1999 Springer-Verlag; ISSN 0174-1551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
DIFFUSION
DRAINAGE
FAILURES
FIBRINOLYSIS
PROSTHESES
TUBES
ULTRASONOGRAPHY
UROKINASE
BLOOD COAGULATION FACTORS
CHEMICAL REACTIONS
DECOMPOSITION
DIAGNOSTIC TECHNIQUES
DRUGS
ENZYMES
FIBRINOLYTIC AGENTS
HEMATOLOGIC AGENTS
HYDROLASES
MEDICAL SUPPLIES
NONSPECIFIC PEPTIDASES
ORGANIC COMPOUNDS
PEPTIDE HYDROLASES
PROTEINS
PROTEOLYSIS