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Title: Transcatheter Intracavitary Fibrinolysis of Loculated Pleural Effusions: Experience in 102 Patients

Abstract

Purpose: To assess the efficacy of intrapleural urokinase instillation through small-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 aftermore » 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. Conclusion: 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.« less

Authors:
 [1];  [2]; ; ; ;  [1]
  1. Interventional Radiology Service, Hospital Clinico Universitario, C/ San Juan Bosco 15, E-50009 Zaragoza (Spain)
  2. Respiratory Service, Hospital Clinico Universitario, C/ San Juan Bosco 15, E-50009 Zaragoza (Spain)
Publication Date:
OSTI Identifier:
21080322
Resource Type:
Journal Article
Journal Name:
Cardiovascular and Interventional Radiology
Additional Journal Information:
Journal Volume: 22; Journal Issue: 2; Other Information: DOI: 10.1007/s002709900345; Copyright (c) 1999 Springer-Verlag New York Inc; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0174-1551
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEST; DIMERS; ETIOLOGY; FIBRINOLYSIS; IMAGES; PATIENTS; UROKINASE

Citation Formats

Gregorio, Miguel A. de, Ruiz, Carlos, Alfonso, Eduardo R, Fernandez, Jose A, Medrano, Joaquin, and Arino, Ignacio. Transcatheter Intracavitary Fibrinolysis of Loculated Pleural Effusions: Experience in 102 Patients. United States: N. p., 1999. Web. doi:10.1007/S002709900345.
Gregorio, Miguel A. de, Ruiz, Carlos, Alfonso, Eduardo R, Fernandez, Jose A, Medrano, Joaquin, & Arino, Ignacio. Transcatheter Intracavitary Fibrinolysis of Loculated Pleural Effusions: Experience in 102 Patients. United States. https://doi.org/10.1007/S002709900345
Gregorio, Miguel A. de, Ruiz, Carlos, Alfonso, Eduardo R, Fernandez, Jose A, Medrano, Joaquin, and Arino, Ignacio. 1999. "Transcatheter Intracavitary Fibrinolysis of Loculated Pleural Effusions: Experience in 102 Patients". United States. https://doi.org/10.1007/S002709900345.
@article{osti_21080322,
title = {Transcatheter Intracavitary Fibrinolysis of Loculated Pleural Effusions: Experience in 102 Patients},
author = {Gregorio, Miguel A. de and Ruiz, Carlos and Alfonso, Eduardo R and Fernandez, Jose A and Medrano, Joaquin and Arino, Ignacio},
abstractNote = {Purpose: To assess the efficacy of intrapleural urokinase instillation through small-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. Conclusion: 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.},
doi = {10.1007/S002709900345},
url = {https://www.osti.gov/biblio/21080322}, journal = {Cardiovascular and Interventional Radiology},
issn = {0174-1551},
number = 2,
volume = 22,
place = {United States},
year = {Mon Mar 15 00:00:00 EST 1999},
month = {Mon Mar 15 00:00:00 EST 1999}
}