Background: Traditional treatment of deep venous thrombosis (DVT) with therapeutic anticoagulation has been increasingly challenged by aggressive percutaneous treatment using ultrasound-accelerated catheter directed thrombolysis (US-CDT) or percutaneous pharmacomechanical thrombectomy (PMT). These techniques have been promoted to improve thrombus removal, prolong venous patency, prevent venous insufficiency, and reduce postthrombotic syndrome. This study reviews midterm results using these endovascular techniques for both acute and chronic DVT.Methods: A retrospective chart review was performed on patients treated for acute or chronic DVT with US-CDT and/or PMT. Charts were reviewed for patient demographics, symptoms and time course of venous thrombosis, anticoagulation regimen, underlying prothrombotic disorders, operative details, and postoperative outcomes. Intraoperative venography and intravascular ultrasound (IVUS) quantified clot response to therapy. Duplex ultrasound defined the pre-and postoperative extent of venous thrombosis, venous patency, and valvular function.Results: Between October 1, 2002 and September 30, 2010, eightyseven patients were treated for iliofemoral (n ϭ 48), iliofemoropopliteal (n ϭ 15), femoropopliteal (n ϭ 17), or subclavian (n ϭ 7) venous thrombosis. Mean age was 45.8 years (range, 15-78 years) and 27 patients (31%) had a documented history of hypercoaguable state. IVUS confirmed May-Thurner syndrome in 34 patients (39%). Fifty-nine patients (68%) were treated for acute symptoms; the mean time to intervention from symptom onset was 7.0 days (range, 1-14 days). The remaining 28 patients (32%) had severe chronic symptoms and were treated at a mean of 8.6 months (range, 1.5-36 months) after DVT diagnosis was made. Patients were treated with PMT (n ϭ 52, 58%), US-CDT (n ϭ 14, 16%), or both (n ϭ 22, 25%). Adjunctive procedures, including percutaneous transluminal angioplasty alone or with stent placement, were required in 59% (n ϭ 35) of acute patients and in 96% (n ϭ 27) of chronic patients (P ϭ.09). A significant decrease in clot burden (Ͼ50%) or complete clot lysis was achieved in 79 of 87 patients (91%). Three patients (3.4%) had postoperative bleeding events requiring blood transfusion; there were no occurrences of intracranial hemorrhage or clinically significant pulmonary embolism. At a mean follow-up of 3.8 years (range, 1-8.9 years), venous patency was present in 55 of 59 acute patients (93%) and in 23 of 28 chronic patients (82%)( P ϭ .14). However, of the 80 lower extremities treated, valve function was preserved in 41 of 52 (79%) acute patients versus only 11 of 28 (39%) chronic patients (P Ͻ .001).Conclusions: Ultrasound-accelerated thrombolysis or percutaneous mechanical thrombectomy used alone or in tandem for treatment of acute and chronic deep venous thrombosis improves symptoms in the involved limb and maintains venous patency at midterm follow-up. Valvular function in the lower extremity is better preserved when sufficient treatment is provided acutely after the ons...

Objectives:We retrospectively reviewed our experience with catheter directed treatment (CDT) of acute deep venous thrombosis (DVT) in an ambulatory setting at a community hospital.Methods: All patients treated with CDT for DVT (iliofemoral, inferior vena cava, innominate or subclavian) in an ambulatory setting at a single community hospital were retrospectively reviewed from June 1, 2009 to October 1, 2011. The diagnosis of DVT was made by duplex ultrasound or CTA scan. All were started on fractionated heparin and scheduled for ambulatory venous thrombectomy (AVT). The protocol included CDT infusion of 10 mg of alteplase (tPA) utilizing power pulse with subsequent tPA infusion at 1 mg/hr for a mean time of 2.2 hours with a range of 1.5 to 4 hours. Adjunctive procedures were performed for incomplete thrombus resolution. Outcome measured was primary venous patency.Results: 66 patients (41 female) were treated in an ambulatory setting utilizing AVT. The mean age was 48.7 years (range 16-82 years). Complete primary resolution of thrombus was achieved in 12% of patients. Percutaneous mechanical thrombectomy was required in 58 patients (88%), angioplasty in 60 patients (90%), and stenting in 50 patients (76%). Technical success was achieved in all patients. All patients were discharged on the same day of treatment. There were no bleeding complications and no episodes of renal failure. All patients were placed on at least 6 months of anticoagulation. Primary patency was present in 61 patients (92%) at mean follow up of 14 months (range 3-24 months). There were 5 (7.6%) re-thrombosed veins, all 5 underwent repeat AVT and 3 are still patent.Conclusions: Ambulatory venous thrombectomy is a safe, effective treatment and financially viable modality for acute deep vein thrombosis. Further studies with longer follow up are required to assess AVT in a prospective manner.

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