Catheter-directed Thrombolysis for Lower Extremity Deep Venous Thrombosis: Report of a National Multicenter Registry

Mewissen, Mark W.; Seabrook, Gary R.; Meissner, Mark H.; Cynamon, Jacob; Labropoulos, Nicos; Haughton, Signe H.

doi:10.1148/radiology.211.1.r99ap4739

Cited by 861 publications

(693 citation statements)

References 11 publications

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“…While evidence from observational studies [62][63][64][65] and one RCT 66 supports catheter-directed thrombolysis for isolated lower extremity DVT [66][67][68][69] and combined upper and lower extremity DVT, 62 evidence in support of catheter-directed thrombolysis for PE is limited. One case report 67 and a case series 68 of 13 postoperative patients, treated with reduced dose urokinase and heparin titrated to fibrinogen, describe successful catheter-directed thrombolysis for PE.…”

Section: Catheter-directed Thrombolysismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications. Source:We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE. Principle findings:The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial. Conclusion:Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.

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Section: Catheter-directed Thrombolysismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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“…Compared with iliofemoral DVT, femoropopliteal DVT is associated with less deranged hemodynamics and a lower risk of recurrent VTE, and many femoropopliteal DVT patients experience symptom resolution or no PTS when treated with anticoagulation and compression stockings alone [139,140]. Multicenter registries have suggested a less favorable outcome for femoropopliteal than iliofemoral DVT treated with thrombolytic therapy [152]. Therefore, endovascular therapy can be performed in selected patients with progression of acute femoropopliteal DVT despite of using anticoagulant therapy or those with severe symptoms [146].…”

Section: ) Compression Therapymentioning

confidence: 99%

“…In contrast, the overall survival rate was not significantly different between the two groups [173]. Therefore, routine placement of permanent IVC filters in patients undergoing CDT for DVT is not recommended in terms of short-term efficacy and long-term complications [2,147,152,[173][174][175].…”

Section: Recommendationmentioning

confidence: 99%

“…Unfortunately, adequate ultrasonography for iliac veins is often limited by body habitus, depth, overlying bowel gas, and incompressibility of the retroperitoneal veins. Hence, venography is preferred for monitoring the degree of venous restoration during or after endovascular treatment for DVT, and venographic results can be adopted as an indicator for technical success of endovascular treatment for DVT rather than color Doppler ultrasonography findings [152,153,191,193]. 7) Surgical treatment of acute lower extremity DVT Anticoagulation therapy is the main treatment option for acute femoropopliteal DVT, but anticoagulation only in extensive iliofemoral DVT is not sufficient to prevent later development of chronic venous insufficiency and postphlebitic syndrome [125,148,194].…”

Section: Recommendationmentioning

confidence: 99%

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Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

Kim

Min

Kang

et al. 2016

J Korean Soc Radiol

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“…CDT has been used successfully for nearly 30 years in this context. Results of an American multicenter registry were published in 1998 [17] and although somewhat disparate (multiple centers, different treatment algorithms) they were helpful in terms of identification of potential risks and complications. Essentially, the risk of significant intracranial bleed is considerably less than 1%; the risk of a GI bleed requiring transfusion is at the order of 5%.…”

Section: Cdtmentioning

confidence: 99%

Thrombolysis versus thrombectomy in acute deep vein thrombosis

O’Sullivan

2011

Interventional Cardiology

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Thrombolysis versus thrombectomy in acute deep vein thrombosis reviewDeep vein thrombosis (DVT) is a significant health problem leading to the admission of over 250,000 Americans each year. Its most serious acute complication, namely pulmonary embolus kills approximately 100,000 each year, and is the third most common cardiovascular related mortality after myocardial infarction and stroke. Chronic leg problems following DVT include leg heaviness, tiredness, cramping and ulceration. These are termed the post-thrombotic syndrome. The current standard therapy of anticoagulation has changed little over 50 years. It does not remove or destroy thrombus, relying instead on the bodies own fibrinolytic mechanisms to do so. DVT needs to be more accurately categorized on an anatomical basis, and for a variety of reasons, the area of most importance is the iliofemoral region. The rationale for active, rather than passive, thrombus removal relies on multiple observations that, by doing so improves luminal patency, restores valvular function and has the potential to reduce the severity of post-thrombotic syndrome. Techniques of thrombus removal include catheter-directed thrombolysis, mechanical thrombectomy, and various combinations of both (pharmacomechanical catheter-directed thrombolysis). Although there no few direct trials comparing these directly, there is a reasonable body of evidence demonstrating their efficacy.

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Catheter-directed Thrombolysis for Lower Extremity Deep Venous Thrombosis: Report of a National Multicenter Registry

Abstract: Catheter-directed thrombolysis is safe and effective. These data can guide patient selection for this therapeutic technique.

Cited by 861 publications

References 11 publications

A critical review of thromboembolic complications associated with central venous catheters

A critical review of thromboembolic complications associated with central venous catheters

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

Thrombolysis versus thrombectomy in acute deep vein thrombosis

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