Hybrid treatment of deep venous thrombosis : Local fibrinolytic therapy, mechanical fragmentation, and clot aspiration.

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Deep venous thrombosis is a common sourse of morbidity and mortality even in Japan. Complications include pulmonary thromboembolism and chronic post thrombotic syndrome. The standard treatment consists of medical management with anticoagulation, but anticoagulation alone does not always restore venous patency and many patients are left with venous outflow obstruction and valvular inconpetence. Aggressive endovascular techniques for managing deep venous thrombosis have evolved as a result. Catheter directed thrombolysis was the first such procedure with demonstrated efficacy, but its acceptance has been limited by perceived risks, time to lysis, and cost. As a result, alternative measures have evolved including percutaneous interventional procedure.After the experimental research, I started the clinical study of these interventional procedures.Objective : To evaluate the efficacy and safety of a hybrid treatment for severe deep venous thrombosis by combining local thrombolysis, mechanic … More al fragmentation, and clot aspiration.Subjects and methods : 45 patients with deep venous thrombosis were treated with hybrid interventional procedures. After insertion of a temporary vena cava filter, thrombo-aspiration with a PTCA guiding catheter and/or mechanical thrombectomy with OASIS or modified rotating pigtail catheter system were performed. Additional balloon PTA/stenting and continuous local urokinase therapy was performed, if needed. The primary endpoint was venographic findings of thrombus extraction. Systemic thrombolysis and anticoagration therapy followed.Results : Trans-femoral interventional radiological therapy was achieved in 42 patients. Approach was ipsilateral : 22, contralateral : 20. Interventional techniques were as followed : manual clot aspiration 37, OASIS thrombectomy 13, mechanical thrombus fragmentation using a modified pigtail catheter 3, balloon PTA 3, stenting 4, and continuous local thrombolysis 16. Successful recanalization was achieved in 37 out of 42 patients. A temporary vena caval filter was easily removed 9.2 days after the insersion in 37 patients. Complications : haemothorax 1, retroperitoneal hematoma 1.Conclusion : Hybrid treatments are a therapeutic option in patients presenting deep venous thrombosis. Less