Catheter-Directed Thrombolysis for Treatment of Deep Venous Thrombosis in the Upper Extremities
- University Hospital of North Norway, Department of Medicine (Norway)
- Rikshospitalet University Hospital, Division of Haematology, Medical Department (Norway)
- University Hospital of North Norway, Department of Radiology (Norway)
- Rikshospitalet University Hospital, Department of Radiology (Norway)
Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002-2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1-30); median duration of thrombolysis treatment, 70 h (range, 24-264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19-225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01-1.42). At follow-up (n = 29; median, 21 months; range, 5-58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.
- OSTI ID:
- 21429093
- Journal Information:
- Cardiovascular and Interventional Radiology, Vol. 32, Issue 5; Other Information: DOI: 10.1007/s00270-009-9655-y; Copyright (c) 2009 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); ISSN 0174-1551
- Country of Publication:
- United States
- Language:
- English
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