Efficiency of regional catheter-guided thrombolysis in treatment of late total and subtotal deep vein thrombosis

The  OBJECTIVE   was   to  assess the  effectiveness  of  the  developed  method  for  treating   DVT  with  fibrinolytic agent injection  via  a  catheter with  multiple  openings along  the  length  of  entire  thrombus.

METHODS  AND MATERIALS. The  analysis of treatment efficacy  of 40  patients with late  total  and  subtotal deep  vein thrombosis was  carried  out.  The  patients were  divided  into two statistically  valid groups. The  first group  of patients weretreated using  regional   thrombolysis by  injection  of  Urokinase into  the  popliteal  vein.  The  second group  had  fibrinolytic agent injection  via  a  catheter with  multiple  openings passed  along   the  entire   length   of  thrombosed venous segment. Patients were  given  Rivaroxaban before, during,  and  after  the  therapy  continuously for  6  months.

RESULTS.   After 1  year  in the  second group,  compared to  the  first group,  the  excellent and  good  results were  higher by  10  %  and  5  %  respectively. Satisfactory and  unsatisfactory results decreased  by  10  and  5  %  respectively.  While using  background Rivaroxaban, the  thromboembolic complications were  not  registered. Hemorrhagic complications were found  in  10  %  of  both  group  patients with  equal   rate.

CONCLUSION.  Injection  of a  fibrinolytic agent via a  catheter with multiple  openings along  the  length  of entire  thrombus is  efficient  and  pathogenetically substantiated.

1. Rossijskie klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslozhnenij (VTEO). Flebologiya. 2015;9(4):4–52 (In Russ.).

2. Rossijskie klinicheskie rekomendacii po diagnostike i lecheniyu hronicheskih zabolevanij ven. Flebologiya. 2018;12(3):146–240. (In Russ.).

3. Kahn S., Comerota A., Cushman M., Evans N. S., Ginsberg J. S., Goldenberg N. A., Gupta D. K., Prandoni P., Vedantham S., Walsh M. E., Weitz J. I. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies. Circulation. 2014;130(18):1636−1661. Doi: 10.1161/cir.0000000000000130.

4. Kuznecov M. R., Sapelkin S. V., Boldin B. V., Leont’ev S. G., Neskhodimov L. A. Rekanalizaciya glubokih ven nizhnih konechnostej kak pokazatel’ effektivnosti lecheniya ostrogo venoznogo tromboza. Angiologiya i sosudistaya khirurgiya. 2016;22(3):82–87. (In Russ.).

5. Shajdakov E. V., Carev O. I. Trombolizis v lechenii ostrogo tromboza glubokih ven. Novosti khirurgii. 2011;19(5):128–135. (In Belarus.).

6. Taha M. A., Busuttil A., Bootun R., Davies A. H. A systematic review of paediatric deep venous thrombolysis. Phlebology. 2019 Apr;34(3):179–190. Doi: 10.1177/0268355518778660.

7. Ascher E., Chait J., Pavalonis A., Marks N., Hingorani A., Kibrik P. Fast-track thrombolysis protocol: A single-session approach for acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2019 Nov;7(6):773–780. Doi: 10.1016/j.jvsv.2019.06.018.

8. Weinberg I., Vedantham S., Salter A., Hadley G., Al-Hammadi N., Kearon C., Julian J. A., Razavi M. K., Gornik H. L., Goldhaber S. Z., Comerota A. J., Kindzelski A. L., Schainfeld R. M., Angle J. F., Misra S., Schor J. A., Hurst D., Jaff M. R. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019 Oct;24(5):442–451. Doi: 10.1177/1358863X19862043.

9. Christopher R. L., Kalodiki E., Mustapha A., Geroulakos G. Validation of the Villalta scale in assessing post-thrombotic syndrome using clinical, duplex, and hemodynamic comparators. Journal of vascular surgery: Venous and lymphatic disorders. 2014;2,(1):8–14.

10. Choi Y. J., Kim D. H., Kim D. I., Kim H. Y., Lee S. S., Jung H. J. Comparison of Treatment Result Between Anticoagulation Alone and Catheter-DirectedThrombolysis Plus Anticoagulation in Acute Lower Extremity Deep Vein Thrombosis. Vasc Specialist Int. 2019;35(1):28–33. Doi: 10.5758/vsi.2019.35.1.28.

11. Bendix S. D., Nolan R., Banipal S., Oppat W. F. Posterior tibial vein approach to catheter-directed thrombolysis for iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2019 Sep;7(5):629–634. Doi: 10.1016/j.jvsv.2019.01.064.

12. Sukovatyh B. S., Sukovatyh M. B., Muradyan V. F., Seredickij A. V., Azarov A. M., Rodionov O. A., Gerasimova O. F., Lapinas A. A. Effektivnost’ lecheniya trombozov glubokih ven nizhnih konechnostej razlichnoj protyazhennosti sovremennymi oral’nymi antikoagulyantami. Vestnik khirurgii im. I. I. Grekova. 2018;177(3):31–35. Doi: 10.24884/0042-4625-2018-177-3-31-35 (In Russ.).