Ultrasound-guided popliteal venous catheter-directed thrombolysis for deep venous
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Abstract:
Objective To assess the clinical value of ultrasound-guided popliteal venous cath- eter-directed thrombolysis for lower extremity deep venous thrombosis （ DVT ）. Methods The data on 79 patients with iliofemoral venous thrombosis who had been hospitalized from April 2007 to October 2009 were retrospectively analyzed. Ultrasound-guided insertion of thrombolysis catheter into popliteal vein was performed. Tthrombolytic drugs were administered continuously by a micro-pump and anticoagulant therapy was conducted simultaneously. Results Thrombolysis catheter was successfully inserted in all the patients. Of all the patients, 33 were cured, 38 had obvious effect, and 8 had postive effect, with a total effectiveness rate of 100%. Conclusions Ultrasound-guided popliteal venous catheter-directed thrombolysis has a high curative rate and effectiveness rate. It shortens the course of therapy, reduces urokinase use, has fewer complications, and is worth popularizing.
Key words:
Ultrasound guided; Catheter-directed thrombolysis; Popliteal vein; Deep vein thrombosisKeywords:
Popliteal vein
Objective To evaluate the clinical efficacy of inferior vena cava filter placement combined with the catheter directed thrombolysis for acute lower extremity deep vein thrombosis(DVT).Methods A retrospective analysis was made which was about 15 patients with acute DVT from February 2008 to October 2009 who were under the treatment of vena cava filter placement contact the United catheter thrombolysis(CDT) in our hospital treated patient information.All inferior vena cava filters were placed under surveillance DSA,and then contact catheter directed thrombolysis was taken,in which the thrombolysis catheter tip was inserted into the internal venous thrombosis,and then the urokinase was continuously infused with a micro-pump.Before treatment and final follow-up,the circumference of both the diseased leg and the uninvolved leg were measured and the difference was calculated.The paired t-test was used for statistical analysis.Follow-up was continued after discharge to understand the patient's condition changes.Results After treatment,the lower limb swelling symptom in all patients was significantly released,the circumference difference between the diseased and the uninvolved leg was significantly different(P0.05).No serious complications were observed in the followup course after treatment.Conclusion Combined inferior vena cava filter placement and catheter directed thrombolysis for acute lower limb is a safe and effective treatment.
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Objective
To compare the efficacy of transjugular intrahepatic portosystemic shunt(TIPS) and percutaneous transhepatic catheter directed thrombolysis(CDT) on acute portal vein thrombosis(PVT).
Methods
The clinical data of 34 patients with acute portal vein thrombosis were analyzed retrospectively. Among them, 14 cases were treated with TIPS and catheter contact thrombolysis, 17 cases received percutaneous transhepatic catheter thrombolysis, and 3 cases failed to be operated successfully. The thrombolytic therapeutic time, effect, complications and recurrence of PVT during the follow-up were compared.
Results
TIPS combined with CDT were successfully created in 14 patients. The mean thrombolytic therapeutic time was 7.2 days, and portal veins were recanalized more than 75.0% by imaging finding in 11 patients (78.6%). Four patients(28.6%) had complications. During follow-up, 1 patient (7.1%) had recurrence of thrombus. In the 17 cases treated by percu-taneous transhepatic catheter thrombolysis, the mean postoperative time of thrombolysis was 10.1 days, portal vein recanalization (>75.0%) examed by X-ray occurred in 6 cases(35.3%), 8 cases experienced complications (47.1%), during the follow-up 7 cases (41.2%) suffered recurrent thrombosis. After TIPS and catheter directed thrombolysis, the thrombolysis time was shortened (P=0.033), the recanalization rate of portal vein (>75%) was higher (P=0.029), and the recurrence rate of thrombus was low (P=0.045).
Conclusions
Both the two methods are effecive in the treatment of acute PVT, and TIPS combined with CDT may be better.
Key words:
Portosystemics hunt; Transjugular intrahepatic; Portal vein thrombosis; Catheter directed thrombolysis
Portal vein thrombosis
Portography
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Central venous catheter
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Objective To assess the clinical value of ultrasound-guided percutaneous catheter-directed thrombolysis in treating lower extremity deep venous thrombosis(DVT).Methods A total of 34 patients with DVT,admitted to our department during the period from September 2009 to September 2010,were enrolled in this study.After the inferior vena cave filter was implanted,ultrasound-guided percutaneous catheter-directed thrombolysis was carried out in all patients.Urokinase 500 000 U/d and heparin 5 000 U/d were administered continuously by using a micro-pump.Transjugular inferior vena cava filter placement was employed in 2 patients because of inferior vena cava thrombosis.Other 2 patients were treated with catheterdirected thrombolysis via the great saphenous vein.In the remaining patients ultrasound-guided insertion of thrombolysis catheter into popliteal vein was performed.The clinical results were analyzed.Results The thrombolysis catheter was successfully inserted in all patients,and the indwelling catheter remained in the vein for 5 to 7 days.After the treatment,the swelling basically disappeared and the daily activity was significantly improved in 27 patients.However,5 patients still felt lacking in strength and leg heaviness after activity.One patient who relapsed 3 months after the surgery was treated by catheter-directed thrombolysis once more and got better.Another patient who relapsed 6 months after the surgery had deep venous thrombosis,which occurred in the contralateral lower extremity.Then the anticoagulation and thrombolysis through peripheral vein was applied.Angiography of the diseased lower extremity was performed in all the patients.Iliofemoral veins were unobstructed in 26 patients after the treatment,while in the other 8 patients the iliofemoral veins were unobstructed in segment.Conclusion Ultrasound-guided percutaneous catheterdirected thrombolysis has many advantages,such as minimal invasion,accurately positioning, individualization of drug dosage,high success rate of thrombolysis,etc.Therefore,this technique is an effective treatment for lower extremity DVT.
Popliteal vein
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Objective:To discuss the feasibility of catheter directed thrombolysis deep venous thrombosis of lower limbs.Methods:67 cases of deep venous thrombosis of lower limbs from 12/2002 to 2/2005 were treated with catheter directed thrombolysis,the popliteal puncture under ultrasound guidance for the venous access, course of therapy continued for 10~14 day with anticoagulation.Results:The procedures of the popliteal puncture and catheter and guidewire exchanges were successful in all 67 cases,and were not permitted passing through iliac veins in 3 cases.Clinical manifestations were alleviated in all 67 cases.Implied by imaging examination before discharged from hospital,11 cases were completely cured,8 cases with the couse of diseases no more than 10 days,significantly improved in 42 cases,and improved in 16 cases.There were 5 cases accepted balloon dilatation in iliac venous,3 cases accepted iliac venous stent,1 case accepted by-pass surgery.Conclusion:The catheter directed thrombolysis deep venous thrombosis of lower limbs can prolong the time of thrombolysis,decrease the dosage of urokinase and complication of hemorrhage,and it can take the chance of subsequent therapy.
Popliteal vein
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[Objective]To explore the nursing of Vena cava filter combined with catheter - directed thrombolysis for deep venous thrombosis(DVT) of lower limb.[Method]51 patients with DVT received vena cava filter placement combined with catheter- directed thrombolysis.By strengthening the perioperative intervention,the nursing and observing of the thrombolytic therapy,the related complications were checked and treated in time.[Result]11 cases were cured,34 cases were with excellent effect,and 6 cases were improved.The total effective rate was 100%.There were no pulmonary embolisms or important organism bleeding in all the cases.[Conclusion]Vena cava filter placement combined with catheter - directed thrombolysis for DVT has advantage of fewer complications,injury,and quick recovery and so on.By close observation and meticulous nursing,patients will receive a satisfactory therapeutic effect.
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Bolus (digestion)
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Catheter directed venous thrombolysis is gaining acceptance but little is known about efficacy in children. We describe our experience with catheter based thrombolysis in the pediatric population. We retrospectively reviewed all pediatric peripheral and caval catheter-directed venous lysis cases at our institution from 1997 to 2007. Complete thrombolysis was defined as > 95% reduction in clot burden whereas partial thrombolysis was defined as 50-95% reduction in clot burden. Ten (n=10) patients were included in the study. Average age at presentation was 15.6 years (12.4-17.9 yrs); M= 3, F= 7. All patients presented with acute lower extremity or pelvic pain and/or lower extremity swelling. 3 patients had associated PEs. 9/10 cases demonstrated congenital variants in anatomy. IVC variants were seen in 3 patients (segmental atresia, n =2; hypoplastic, n=1). 7/10 cases had May-Thurner anatomy. Persistent left sciatic vein and Klippel-Trenaunay syndrome was identified in one. Significant risk factors (smoking (n=2), oral contraceptives (n=3), trauma (n=1), post-partum (n=1), Crohn's (n=2)) and/or positive coagulopathy was seen in 10/10. The majority of patients (n=6) were hypercoagulable. tPA infusion time was 2.8 ± 1.5 days and hospitalization 9.4 ± 3.5 days. Stents were placed in 3 left iliac veins. Removable IVC filters were placed in 8/10 patients as prophylaxis. All attempted filter removals (6/8) were successful; duration in place was 15 ± 18 days. Complete thrombolysis was achieved in 6/10; partial thrombolysis in 3/10; failed thrombolysis in 1/10. Pediatric patients presenting for thrombolysis frequently have congenital venous anomalies and often are hypercoaguable. Presentation in adolescence may be related to the combined effect of modifiable risk factors. Catheter based thrombolysis can be an effective treatment option in pediatric patients with symptomatic DVT.
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Objective
To evaluate catheter thrombectomy, mechanical thromboaspiration and catheter-directed thrombolysis for the treatment of deep venous thrombosis.
Methods
From January 2015 to February 2016, 60 patients with acute deep vein thrombosis were placed the inferior vena cava filter from contralateral femoral vein or right internal jugular vein. A 5 F pigtail catheter was led to the ipsilateral deep vein, bolus urokinase was given and catheter thrombectomy was undertaken and thromboaspiration was carried out using 10-12 F catheter, then through catheter continuous infusion of urokinase.
Results
45 cases were cured, 8 cases were significantly improved, 5 cases were improved, 2 cases were judged as ineffective, the effective rate was 96.6%. Before thrombolysis the thigh circumference difference between affected limb and the contralateral limb was (3.6±1.9)cm (P 0.05), calf circumference difference was (0.5±1.0)cm (P>0.05).
Conclusions
Catheter thrombectomy, thromboaspiration and catheter-directed thrombolysis for deep venous thrombosis is safe and effective.
Key words:
Venous thrombosis; Thrombolytic therapy; Urokinase; Catheter thrombectomy
Bolus (digestion)
Femoral vein
Popliteal vein
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Objective
To evaluate the clinical efficacy of portal venous thrombolysis by way of TIPS.
Methods
The clinical data of 40 patients with portal venous system thrombosis treated by TIPS at our department from May 2012 to May 2018 were retrospectively analyzed.There were 34 cases of via catheter-directed thrombolysis(7 cases by catheter-directed thrombolysis alone and 27 cases by way of TIPS before catheter-directed thrombolysis ), and 6 cases via pharmaco mechanical thrombectomy(AngioJet); the postoperative complications of the two methods were followed up.
Results
The portal vein was opened in all 40 patients, and there were no major complications during the operation. One patient in the catheter-directed thrombolysis group developed acute liver failure after surgery.In the mechanical thrombolysis group, 1 patient was discharged after small intestinal necrosis resection and intestinal fistula reconstruction.After 6-24 months of postoperative follow-up, 6 patients in the group of thrombolysis suffered from shunt canal stricture.
Conclusions
It is a safe and minimally invasive method to treat portal venous system thrombosis through TIPS. Mechanical thrombolysis is more direct and rapid than catheter thrombolysis.
Key words:
Portal vein; Venous thrombosis; Liver cirrhosis
Portal vein thrombosis
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