Sequestrated thrombolysis: Comparative evaluation in vivo

Purpose: Lysis of a thrombus is a function of the local concentration of thrombolytic enzymes. This study was designed to determine in a porcine model of acute deep vein thrombosis (DVT) whether perithrombic sequestration of small volumes of a concentrated enzyme solution can accelerate the process of thrombolysis. Methods: DVT was induced in both hind limbs using a previously described technique (n = 32). Thirty minutes later the animal was heparinized and unilateral thrombolysis was attempted using 8 mg recombinant tissue plasminogen activator (rt-PA); saline was administered in the opposite leg. For conventional high-volume infusion (CI) (n = 5) rt-PA (0.067 mg/ml) was infused at 1 ml/min. For sequestrated thrombolysis the external iliac vein was endoluminally occluded, and rt-PA (0.25 mg/ml) administered either for proximal injection (ST-P) (n = 5), as a bolus every 3 min through a microcatheter placed via the balloon catheter, or for transthrombic injection (ST-T) (n = 5), as a bolus every 3 min through a Katzen wire in the balloon catheter. At autopsy, the thrombus mass in the iliofemoral veins was measured, and the extent of residual thrombosis in the venous tributaries graded at four sites. From these data a thrombolysis score was calculated. Results: One pig died before thrombolysis could be performed. Only with ST-T was residual thrombus mass in the test limb normalized to control, residual thrombus index (RTI), consistently less than unity. The median RTI of this group was 0.50 (range 0.39–0.97) compared with 1.22 (0.64–1.38) for ST-P and 0.88 (0.37–1.13) for CI. Compared with contralateral controls, a lower grade of residual thrombosis in tributaries was observed in test limbs at more venous sites with ST-T (8/20; 95% confidence interval 5–13) and ST-P (9/20; confidence interval 5–13) than with CI (2/20; confidence interval 0–5) (p= 0.04). A trend toward lower thrombolysis scores was observed with ST-T (p = 0.08). Systemic fibrinogenolysis was not observed in any of the groups. Changes in coagulation parameters during thrombolysis were similar irrespective of treatment protocol. Conclusions:“Transthrombic” sequestrated thrombolysis may offer some advantages over conventional selective infusion for the treatment of acute DVT. However further refinements will be necessary before it can be considered an alternative to the latter.     

Ultrasound thrombolysis in hemodialysis access: In vitro investigation

Purpose: To evaluate the effectiveness of ultrasound thrombolysis in occluded hemodialysis access shunts using an in vitro model. Methods: Thrombosed hemodialysis accesses were simulated by clotted bovine blood in a flow model (silicone tubing; inner diameters 4, 6, and 9 mm). After retrograde and antegrade sheath placement (7 Fr), mechanical thrombolysis was performed using an ultrasound probe (Acolysis, Angiosonics, Morrisville, NC, USA). The tip of the device measured 2.2 mm in diameter. During sonication, the catheter was moved slowly back and forth using an over-the-wire system. Thirty complete occlusions [tubing diameters 4 mm (n = 12), 6 mm (n = 12), 9 mm (n = 6)] were treated. Initial thrombus weights were 3.5 (± 0.76) g, 7.7 (± 1.74) g, and 19.4 (± 2.27) g for the three diameters. Maximum sonication time was 15 min for each probe. Results: With this device, we were able to restore a continuous lumen in all 12 occluded 4∼mm silicone tubes. No wall-adherent thrombi remained after sonication for 3.5–9.6 min. In hemodialysis access models with diameters of 6 mm, thrombus fragments persisted in 25% (3/12 accesses). These were located in the medial portion of the access loop and near to the puncture sites. However, flow was re-established after 5.0–13.0 min of treatment in all settings. Mechanical dissolution of thrombus material failed in five of six access models with diameters of 9 mm, even though ultrasound energy was applied for the maximum of 15 min. Conclusion: In a clotted hemodialysis shunt model, successful ultrasound thrombolysis was limited to small access diameters and small amounts of thrombus.     

Animal Model of Acute Deep Vein Thrombosis

Purpose: To develop an animal model of acute deep vein thrombosis (DVT). Methods: In part I of the study nine juvenile domestic pigs were used. Each external iliac vein was transluminally occluded with a balloon catheter. Thrombin was infused through a microcatheter in one leg according to one of the following protocols: (1) intraarterial (IA): 1250 U at 25 U/min in the common femoral artery (n= 3); (2) intravenous (IV): 5000 U in the popliteal vein at 500 U/min (n= 3), or at 100 U/min (n= 3). Saline was administered in the opposite leg. After the animals were killed, the mass of thrombus in the iliofemoral veins was measured. The pudendoepiploic (PEV), profunda femoris (PF), and popliteal veins (PV) were examined. Thrombosis in the tributaries of the superficial femoral vein (SFVt) was graded according to a three-point scale (0, +, ++). In part II of the study IV administration was further investigated in nine pigs using the following three regimens with 1000 U at 25 U/min serving as the control: (1) 1000 U at 100 U/min, (2) 250 U at 25 U/min, (3) 250 U at 6.25 U/min. Results: All animals survived. In part I median thrombus mass in the test limbs was 1.40 g as compared with 0.25 g in the controls (p= 0.01). PEV, PFV and PV were thrombosed in all limbs infused with thrombin. IV infusion was more effective in inducing thrombosis in both the parent veins (mass 1.32–1.78 g) and SVFt (++ in 4 of 6 legs), as compared with IA infusion (mass 0.0–1.16 g; SFVt ++ in 1 of 3 legs). In part II thrombus mass in axial veins ranged from 1.23 to 2.86 g, and showed no relationship with the dose of thrombin or the rate of infusion. Tributary thrombosis was less extensive with 250 U at 25 U/min than with the other regimens. Conclusion: Slow distal intravenous thrombin infusion in the hind legs of pigs combined with proximal venous occlusion induces thrombosis in the leg veins that closely resembles clinical DVT in distribution.     

Venous recanalization by metallic stents after failure of balloon angioplasty or surgery: Four-year experience

Purpose: This retrospective study describes our updated experience in treating venous stenoses and occlusions with metallic endovascular stents. Methods: Gianturco, Palmaz, and Wallstent stents were placed in 55 patients over a 4-year period. Stent sites included the subclavian veins (9), innominate veins (3), superior vena cava (4), inferior vena cava (3), iliac veins (29), femoral veins (5), and portal veins (6). The most common indications for stent placement were malignant stenoses and chronic pelvic venous occlusions. Venoplasty and/or urokinase were used as ancillary therapy. Patients were anticoagulated for 3–6 months. Follow-up included clinical assessment and duplex ultrasound. Results: Lifetable analysis shows 59%, 63%, and 72% primary, primary assisted, and secondary 1-year patency rates, respectively. The 4-year primary patency rates were the same. Duration of patency depended on the venous site. Death was a complication of stent placement in 2 patients and 12 patients died within 6 months after stent placement from primary disease progression. Although early failures were more common in stents placed across occlusions than stenoses, 1-year secondary patency rates were comparable. Primary patency rates were only slightly lower in patients with malignant obstruction than in patients with benign disease. Conclusion: Endovascular stent placement provides a nonsurgical alternative for reestablishment of venous flow and symptomatic relief in patients with benign as well as malignant venous obstruction. Received: 0/00/00/Accepted: 0/00/00     

Low-dose streptokinase thrombolysis of axillary-subclavian vein thrombosis

Nine patients with 10 episodes of acute axillary-subclavian vein thrombosis were treated with local low-dose streptokinase infusion. All patients except one were heparinized during the procedure with conversion to oral anticoagulation upon completion of the infusion. Recanalization was achieved in 7 patients (70%). Thrombosis recurred in 1, and in 2 patients the procedure was unsuccessful. No major complications were encountered. We concluded that local low-dose streptokinase infusion is a safe, simple, and effective method for treating acute axillary-subclavian vein thrombosis.     

Effort thrombosis: Role of interventional therapy

Effort thrombosis, a form of axillary-subclavian vein occlusion in young people, was identified in patients referred over a 5-year period. Eleven of 120 patients (9%) with venous occlusion from many causes had effort thrombosis. They were treated acutely with heparin and then by thrombolysis, angioplasty, surgical bypass, or a combination. Five of the 10 patients with thrombolysis or surgery had patent veins on follow-up venography, but 9 of these later developed axillary-subclavian reocclusion. By later follow-up, however, all patients were asymptomatic at the time of collateral vein formation. We conclude that effort thrombosis leads to recurrent occlusion of the axillary-subclavian vein, short-term (12-month) recurrence of symptoms with exercise, and progressive compensatory collateral vein development. Radiographic documentation of reestablished venous flow is important, and can be used to guide the completion of treatment.     

Catheter direct thrombolysis: Role of actilyse in treatment of acute deep venous thrombosis

Purpose

To evaluate the short and long term efficiency of catheter directed thrombolysis using recombinant tissue type plasminogin activator (r-TPA; Actilyse), in treating acute deep venous thrombosis of the lower limb.

Material and methods

Twenty-eight patients with acute lower limb deep venous thrombosis underwent treatment by direct intra clot injection of thrombolytic therapy; Actilyse.

Result

Thrombus lysis was completed in 23 (82.2%) of 28 patients, partial in 4 (14.3%) patients and not achieved in one (3.5%) patient. There was no major complication. There was no rethrombosis or post thrombotic syndrome in any of the treated 23 patients over the follow up period of one year.

Conclusion

The treatment of acute lower limb deep venous thrombosis using recombinant tissue type plasminogin activator (r-TPA; Actilyse), is safe, effective and achieves significantly better short and long term clinical outcome for patients.     

Optimal management strategy for use of compression US for deep venous thrombosis in symptomatic patients: a cost-effectiveness analysis

RATIONALE AND OBJECTIVES: The authors' purpose was to identify the optimal strategy for using compression ultrasonography (US) in patients suspected of having deep venous thrombosis (DVT). MATERIALS AND METHODS: The authors developed a decision-analytic model representing the natural history of DVT and the benefits and risks of anticoagulation therapy. They evaluated six initial imaging strategies: (a) unilateral examination of the common femoral and popliteal veins; (b) unilateral examination of the common femoral, popliteal, and femoral veins; (c) bilateral examination of the common femoral and popliteal veins; (d) bilateral examination of the common femoral, popliteal, and femoral veins; (e) complete unilateral examination of the symptomatic leg (including calf veins); and (f) complete bilateral examination of both legs. RESULTS: For 65-year-old men with unilateral symptoms of DVT, the most effective strategy was bilateral examination of the common femoral and popliteal veins with anticoagulation therapy in patients with proximal DVT and follow-up bilateral examination of the common femoral and popliteal veins in patients without an initial diagnosis of DVT with an incremental cost-effectiveness ratio of $39,000 per quality-adjusted life year gained. CONCLUSION: These results suggest that bilateral examination limited to the common femoral and popliteal veins, with follow-up bilateral examination limited to the common femoral and popliteal veins, was as cost-effective as other well-accepted medical interventions. The results were sensitive to the distribution of clot, diagnostic accuracy of compression US, and probability of bleeding with long-term morbidity.     

球囊扩张辅助经导管直接溶栓治疗急性下肢深静脉血栓

目的 研究球囊扩张辅助经导管直接溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)的疗效及安全性.方法 回顾性分析连续收治的94例急性下肢DVT患者的临床资料.A组为2008年9月至2009年8月收治的病例,共50例,行单纯CDT;B组为2009年9月至2011年5月收治的病例,共44例,行球囊扩张辅助CDT.以治疗前后健侧和患侧下肢周径差、静脉通畅度评分、静脉通畅率评价治疗效果.比较2组尿激酶用量及溶栓导管留置时间.以肺栓塞、出血并发症的发生率评价治疗的安全性.用超声和(或)血管造影随访静脉通畅率.正态分布的计量资料用(x)±s表示,采用成组设计t检验和配对t检验进行统计分析;非正态分布的计量资料用四分位数法表示[中位数(25％位数,75％位数)],采用配对样本比较的Wilcoxon符号秩检验和两个独立样本比较的Wilcoxon 秩和检验;计数资料用率表示,采用x2检验进行统计分析.结果 治疗前2组膝上20 cm处健侧和患侧周径差分别为(5.37±1.97)cm和(5.41±2.22) cm,差异无统计学意义(t=-0.113,P=0.910);治疗后分别为(2.96±1.10)cm和(1.78±1.40)cm,差异有统计学意义(t=4.66,P＜0.01).治疗前2组膝下15 cm处健侧和患侧周径差分别为(4.14±1.57)cm和(4.05±1.61)cm,差异无统计学意义(t =0.288,P =0.774);治疗后分别为(1.93±0.84) cm和(1.41±1.17)cm,差异有统计学意义(t=2.548,P=0.012).治疗前2组静脉通畅度评分分别为9.0(8.0,10.0)分和8.3(7.0,10.0)分,差异无统计学意义(Z=-1.5172,P=0.1292);治疗后分别为3.5(2.0,5.0)分和0(0,1.0)分,差异有统计学意义(Z=- 5.7702,P＜0.01).治疗结束时2组平均静脉通畅率分别为55.0％ (42.3％,72.4％)和100％ (88.5％,100％),差异有统计学意义(Z=4.9148,P＜0.01).2组尿激酶用量分别为5.950(5.525,7.225)×106 U和4.100(3.600,5.050) ×106U,差异有统计学意义(Z=-6.0133,P＜0.01).2组溶栓导管留置时间分别为10(9,12)d和6(5,7)d,差异有统计学意义(Z=-8.0358,P＜0.01).2组皆无症状性肺栓塞发生.2组出血并发症发生率分别为38.0％ (19/50)和22.3％( 10/44),差异无统计学意义(x2=2.5590,P=0.1097).2组临时滤器取出率分别为88.37％(38/43)和100％ (39/39),差异有统计学意义(x2 =4.829,P =0.028).末次随访时平均静脉通畅率分别为50.0％(44.4％,59.2％)和95.4％ (83.6％,100％),差异有统计学意义(Z=- 3.2721,P=0.0011).结论 在下腔静脉滤器保护下,球囊扩张辅助的CDT治疗急性下肢DVT较单纯CDT,溶栓效果好、尿激酶用量少、肺栓塞并发症发生率并无增加.     

下肢深静脉血栓的经动脉溶栓治疗

目的：探讨经动脉保留导管溶栓治疗下肢深静脉血栓的应用价值。方法：40例下肢深静脉血栓患者经健侧股动脉穿刺插管至患侧髂股动脉内，并保留导管3－7d，经导管注入肝素3000－5000IU及尿激酶25万－100万IU稀释液50－200ml，每日1次。另40例经足背静脉注入同样的药物。共植入下腔静脉滤器31例，髂股静脉支架植入术10例。结果：80例患肢肿胀、疼痛均于溶栓治疗后1－3d内开始消退、减轻。31例滤器均未发生移位变形，下腔静脉通畅，10例支架无阻塞。结论：经动脉保留导管溶栓治疗下肢深静脉血栓形成，安全有效。     

Simulated flow pattern in massive pulmonary embolism: Significance for selective intrapulmonary thrombolysis

Purpose: The flow pattern in the central pulmonary arteries proximal to large pulmonary emboli was studied experimentally. The currents to which thrombolytic agents are exposed when administered via an intrapulmonary catheter were visualized in order to explain the lack of benefit of local versus systemic administration. Methods: By illumination of suspended microspheres, the flow pattern proximal to an obstructing embolus was visualized in an in vitro pulmonary arterial flow model. In six dogs massive pulmonary embolism was created. A pigtail catheter was positioned in the pulmonary artery immediately proximal to the central edge of the occluding embolus. To allow visualization of the local flow pattern, a small amount of contrast material (4 ml) was injected through the catheter at a high flow rate (25 ml/sec). The course of the radiopaque spot that emerged from the catheter tip within 160 msec was monitored with digital subtraction angiography at a frame rate of 12.5 frames/sec. In two dogs, the study was repeated after embolus fragmentation with the same catheter position. Results: The flow model study revealed formation of a vortex proximal to the occluding embolus. In vivo experiments showed that the radiopaque spot was whirled by the vortex proximal to the embolus and made only evanescent contact with the edge of the embolus. Regardless of the embolus location, the contrast spot was washed into the non-occluded ipsilateral and contralateral pulmonary arteries within 0.40–0.64 sec. After embolus fragmentation, the contrast spot was carried completely into the formerly occluded artery. Conclusion: Flow studies explain why thrombolytic agents administered via a catheter positioned adjacent to the embolus may have no more effect than systemically administered agents. An enhanced local effect is precluded by the rapid washout into the non-occluded pulmonary arteries and subsequent systemic dilution. These results support the practice of direct intrathrombic injection of thrombolytics or local thrombolysis as an adjunct to embolus fragmentation.     

Colour Doppler flow imaging ultrasonography versus venography as screening method for asymptomatic postoperative deep venous thrombosis

Objective: To evaluate colour Doppler flow imaging ultrasonography (CDFI), compared with venography, as a screening method for postoperative deep venous thrombosis (DVT) in a clinical trial on thromboprophylaxis. Methods: Patients undergoing major abdominal or thoracic surgery were prospectively screened for DVT by CDFI. Patients were examined preoperatively, and on postoperative days 1, 3, 7, 14, 21, and 28. When the CDFI was positive venography was performed. Bilateral venography was performed on day 28 in all patients. The study group comprised 82 patients who underwent CDFI and venography on the same day: four because of suspected DVT (positive CDFI), and 78 on day 28 according to protocol. Results: DVT was detected by venography in seven patients, in three of whom CDFI was positive. CDFI was falsely positive in one case. There were two popliteal and five calf DVTs, of which CDFI detected one and two, respectively. The sensitivity of CDFI was 43%, the specificity 99%. The PVpos for CDFI was 75%, and the PVneg 96%. Conclusion: Due to low sensitivity, CDFI cannot stand alone as a screening method for asymptomatic postoperative DVT.     

Diagnosis and management of deep vein thrombosis of the upper extremity: a review

Deep vein thrombosis of the upper extremity is an increasing clinical problem due to the use of long-term indwelling catheters for chemotherapy or long-term feeding. The clinical diagnosis is difficult to make, and various imaging modalities have been used for this purpose. The use of (interventional) radiological procedures has been advancing in recent years. This review describes the clinical background, the imaging modalities that may be employed, treatment options and outcome of patients with upper extremity thrombosis.     

Retrievable IVC square stent filter: Experimental study

Purpose: In vitro and in vivo evaluation of a new retrievable, home-made, inferior vena cava (IVC) Square stent filter (SSF) with two trapping levels. Methods: In vitro, the SSF was compared in a flow model with the stainless steel Greenfield filter (SGF) for emboli- trapping efficiency by serially passing 300 emboli of 3 and 6 mm in diameter and 15–30 mm in length in each type of filter. Nine swine were used for the in vivo testing of the SSF for deployment and retrievability, emboli-trapping efficiency, stability, and self-centering ability and two were used (total of 11 swine) for testing repositioning and retrievability of the SSF at 2 weeks and for gross and histologic IVC changes at 2 months. Results: In vitro, the SSF and SGF had similar efficiency in trapping large emboli but the SSF had significantly better efficiency than the SGF for trapping all sizes of emboli (91.7% vs 81%), medium size emboli (93% vs 80%), and small emboli (86% vs 69%). Efficiency decreased in both filters from the first to the fifth embolus in each series but was still significantly better for the SSF. With the SSF, 89% of emboli were caught at the primary and 11% at the secondary filtration level. In the nine animals used for acute studies, the SSF was easily placed in all 27 attempts, assumed a central position 26 times, and was easily retrieved in 21 of 22 attempts. One tilted filter needed additional manipulation for retrieval. During emboli injection in five swine, the SSF had 97.2% emboli-trapping efficiency and demonstrated good stability. In the two animals used for longer-term evaluation, the filters were easily retrieved 2 weeks after implantation. Histologic evaluation at 2 months showed neointimal proliferation around the SSF wires in contact with the IVC wall, which was otherwise normal. Conclusion: The SSF is a promising filter. It is easy to place and retrieve, is stable after placement, and has high efficiency for trapping emboli. Promising results justify further experimental and eventual clinical studies with a commercially manufactured SSF.     

In Vivo Evaluation of a Retrievable Vena Cava Filter—The Dibie-Musset Filter: Experimental Results

Purpose: To evaluate, in an animal model, the efficacy and safety of a 7 Fr percutaneous vena cava filter for temporary or permanent use. Methods: The Dibie-Musset (DM) filter is a wire preformed into a double-spiral shape with a spring effect. The experiment was performed in 15 adult sheep and consisted of the insertion of 45 filters, clot trapping tests, and filter retrieval. Follow-up in all sheep consisted of radiologic (abdominal radiograph, inferior vena cavogram, abdominal computed tomography), macroscopic, and microscopic examinations between days 8 and 386 after filter placement. Results: Of the 45 filters implanted in 15 sheep, 29 were retrieved between day 0 and day 15. Filtration efficiency was 100% for clots 4 × 4 × 20 mm. No long-term (1 year) side-effects were detectable. Microscopic examination of the vein wall showed only a dense intimal fibrosis without signs of acute inflammation at 1 year. Conclusion: These results support the efficiency and safety of the DM filter in an animal model.     

The Diagnosis and Treatment of Intratesticular Varicocele

A case of varicocele is reported. The dilated veins were situated in the left testis. The diagnosis required color Doppler sonography. Successful treatment was performed by transcatheter embolization of the left spermatic vein. The control sonogram revealed complete regression. A literature search yielded only three previous cases of intratesticular varicocele. No data were found on the treatment of this entity. Received: 0/00/00/Accepted: 0/00/00     

PTA arid stenting of benign venous stenoses in the pelvis: Long-term results

Purpose: To provide follow-up data on endovascular intervention for venous stenoses in the pelvis. Methods: Between 1985 and 1995, 35 patients presented with 42 stenoses of the pelvic veins after operative thrombectomy and creation of an arteriovenous fistula, combined with intraoperative venous angioscopy. All patients underwent angioplasty and, if unsuccessful, percutaneous insertion of an endovascular stent (n = 7). Results: Angioplasty with and without endovascular stenting was technically successful in 34 of 35 patients (97%). Average length of the stenoses was 20.6 mm (range 10–90 mm), average diameter before dilation 4.1 mm (range 2–6 mm), and average diameter after dilation 10.1 mm (range 5–18 mm). Intraoperative angioscopy showed pathologic findings (intimal laceration or residual thrombotic material) in 14 patients. After an average follow-up period of 4.13 years, 24 (69%) patients had patent veins. The difference in the primary patency rate between patients with angioscopically abnormal veins (6 of 14 patients, corresponding to a patency rate of 43%) and patients with angioscopically normal veins after thrombectomy (18 of 21 patients, corresponding to a patency rate of 86%) was statistically significant (p < 0.01, log rank test). Conclusions: Percutaneous transluminal angioplasty and/or stenting are good treatment modalities for pelvic vein stenosis following surgical thrombectomy. Angioscopically abnormal veins have a poorer long-term patency, regardless of the type of intervention.     

Evaluation of deep vein thrombosis with multidetector row CT after orthopedic arthroplasty: a prospective study for comparison with Doppler sonography

OBJECTIVE: This prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement. MATERIALS AND METHODS: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference. RESULTS: The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively. CONCLUSION: The ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating post-arthroplasty patients.     

Mechanical thrombectomy in patients with deep venous thrombosis

Purpose: To report our experience with mechanical thrombectomy in proximal deep vein thrombosis (DVT). Methods: Eighteen patients with a mean (± SD) age of 37.6 ± 16.1 years who presented with DVT in the iliac and femoral vein (n = 3), inferior vena cava (n = 5), or inferior vena cava and iliac vein (n = 10), were treated with the Amplatz Thrombectomy Device after insertion of a temporary caval filter. Results: Successful recanalization was achieved in 15 of 18 patients (83%). Overall, the percentage of thrombus removed was 66 ± 29%: 73 ± 30% at caval level and 55 ± 36% at iliofemoral level. Complementary interventions (seven patients) were balloon angioplasty (n = 2), angioplasty and stenting (n = 2), thrombo-aspiration alone (n = 1), thrombo-aspiration, balloon angioplasty, and permanent filter (n = 1), and permanent filter alone (n = 1). There was one in-hospital death. Follow-up was obtained at a mean of 29.6 months; three patients had died (two cancers, one myocardial infarction); 10 had no or minimal sequelae; one had post-phlebitic limb. Conclusion: Mechanical thrombectomy is a potential therapeutic option in patients presenting with proximal DVT.     

Limitations of percutaneous techniques in the treatment of portal vein thrombosis

New therapeutic alternatives to portal vein thrombosis (PVT) include the percutaneous, transhepatic infusion of fibrinolytic agents, balloon dilatation, and stenting. These maneuvers have proven to be effective in some cases with acute, recent PVT. We have treated two patients with acute PVT via transhepatic or transjugular approaches and by using pharmacologic and mechanical thrombolysis and thrombectomy. Although both patients clinically improved, morphologic results were only fair and partial rethrombosis was observed. The limitations of percutaneous procedures in the recanalization of acute PVT in noncirrhotic patients are discussed.